The Sandy Hook Elementary School shooting as tipping point: “This time is different.”
Context: School-based “rampage shooting” in Newtown, Connecticut, USA, December 2012. Distinguishing features of this event, psychological ramifications, and social media coverage are examined
Among rampage shooting massacres, the Sandy Hook Elementary School shooting on December 14, 2012 in Newtown, Connecticut galvanized public attention. This Commentary examines the features of this episode of gun violence that generated strong reactions and energized discourse. Authors describe six distinguishing features of the event that coalesced into a riveting story and a call for action: First, the shooting was random and extreme. Second, Americans identified closely with Newtown. Third, a sitting President made this rampage shooting his personal mission. Fourth, as described using the Population Exposure Model, powerful psychological reactions spread nationwide. Fifth, the mass media “framing” brought continuous and intense focus to this episode. Sixth, social media messaging reverberated throughout the “digital sphere,” keeping individuals engaged in multi-way conversation. Collectively, these elements created a “tipping point” moment with potential for prompting constructive solutions to diminish high rates of firearm deaths and injuries in the United States.
Trauma and PTSD rates in an Irish psychiatric population: A comparison of native and immigrant samples
Context: Examination of traumatic experiences, frequency of traumatic events, trauma symptomatology levels, rates of torture, and rates of PTSD in native Irish and migrant mental health service-users in Dublin, Ireland. Migrants to Ireland were frequently asylum-seekers who had been subjected to conflict-related traumatic experiences in their countries of origin
Researchers report on a study of 178 psychiatric outpatients using mental health services in Dublin, Ireland. The study examined and compared rates of traumatic experiences, frequency of traumatic events, trauma symptomatology levels, rates of torture, and rates of PTSD between Irish and migrant service-users. Analyses further distinguished forced migrant vs. voluntary migrant subgroups of service-users. Investigators found that a substantial number of service-users had experienced at least one lifetime trauma (71.3%), and a high percentage of both the Irish (47.4%) and migrant groups (70.3%) of service-users had experienced two or more traumatic events. Forced migrants displayed more traumatic life events, posttraumatic symptoms, and higher levels of PTSD than their voluntary migrant and Irish counterparts, with over 50% experiencing torture prior to arrival in Ireland. Investigators stated that although Western mental health services are increasingly involved in the treatment of traumatized individuals migrating from other countries, trauma and posttraumatic stress disorder (PTSD) are routinely under-detected and undiagnosed in psychiatric populations. The study authors concluded that the results of this study are informative about the nature and extent of the problem of trauma and PTSD among migrant mental health service users as well as highlighting the under-detected levels of trauma among native-born service users in Ireland.
Disparity in disaster preparedness between racial/ethnic groups
Context: Analysis of race/ethnic disparities in citizen disaster preparedness in the US based on data from the national Behavioral Risk Factor Surveillance Survey
This study examined the association between race/ethnicity (including language subgroups among Hispanics) and disaster preparedness for Behavioral Risk Factor Surveillance System (BRFSS) survey respondents in eight states that implemented the optional “general preparedness module” from 2006 through 2010. Researchers examined three dependent variables: 1) presence of four preparedness items (food, water, flashlight, and radio), 2) emergency evacuation plan, and 3) three-day supply of medication in relation to race/ethnicity. Respondents were classified into the following race/ethnicity categories: Black, English-speaking Hispanic, Spanish-speaking Hispanic, and non-Hispanic White. Racial/ethnic minority respondents (Black and Hispanic) were less likely to have medication supplies compared with non-Hispanic Whites. Spanish-speaking Hispanics respondents were less likely to have an emergency evacuation plan than non-Hispanic Whites. Public health officials can use these findings to support targeting racial/ethnic minorities to increase the presence of preparedness items important to mitigate the effects of disasters, with particular emphasis on medication supplies and Spanish-speaking Hispanics.
Epidemic activity after natural disasters without high mortality in developing settings
Context: Health surveillance following natural disasters in Peru in 2005/2006 – a flood, an earthquake, and volcanic activity – all characterized by low mortality
This study is noteworthy for focusing on disasters of moderate magnitude and low mortality that, nevertheless, produce significant morbidity and economic costs. Compared with catastrophic mega-disasters, such events represent the mainstay of disasters that prompt local, regional, and national emergency response worldwide. However, the scientific literature on such disasters of modest magnitude is limited. The authors bring an epidemiologic vantage to their description of health surveillance following a flood, an earthquake, and volcanic activity in Peru. Following post-disaster guidelines, healthcare facilities and evacuation centers surveyed 10–12 health conditions for ~45 d and compared disease frequencies. Collectively, these three disasters affected more than 20,000 persons. Among disaster survivors, almost 30 percent had a health condition detected through disease surveillance and 15 percent were displaced from their homes. Acute respiratory conditions accounted for more than half of the cases and psychological distress was also prominent, especially among disaster survivors who were displaced to “evacuation centers.” Given the observed prevalence rates of health conditions across a diversity of natural disasters, the authors concluded that low-mortality disasters are capable of producing significant increases in morbidity, suggesting that post-disaster surveillance for prominent health conditions is warranted and valuable.
Fatal school shootings and the epidemiological context of firearm mortality in the United States
Context: Epidemiological analysis of more than two decades of fatal school shooting events in the United States
The high-visibility mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, USA occurred within the epidemiological context of US firearm mortality that claims more than 88 lives daily. Each year, more than 32,000 Americans die by firearms and more than 70,000 are wounded, representing a volume of preventable deaths and injuries that the US government describes as a “public health crisis.” National epidemiologic data on firearm deaths over two decades were analyzed along with data registries on school shootings in order to place the tragedy at Sandy Hook in perspective. The US has the highest rates of firearm deaths, suicides, and homicides among the world’s 34 “advanced economies.” Seventy percent of US homicides and more than 50% of US suicides are committed using a firearm. “Shooting massacres” in school settings are extremely rare events accounting for only 1/800th of national firearm homicides. School shootings were classified as random or targeted. Most episodes were “targeted” shootings in which the perpetrator intentionally killed a specific individual in a school setting; only one-in-eight fatal school shootings were “random” or “rampage” events. School massacres, such as Sandy Hook, occur periodically, galvanizing public reaction and bringing forth a collective call for intervention. Epidemiological analyses position these infrequent, but uniquely compelling, incidents within the broader national patterns of gun violence.
Examining the relationship between infectious diseases and flooding in Europe: A systematic literature review and summary of possible public health interventions
Context: Systematic literature review of flooding in Europe in relation to infectious disease occurrence, with discussion of public health implications and the possible exacerbating role of climate change
Cognizant of the sensitivity of infectious disease occurrence to environmental variability, a systematic literature review was conducted, focusing on the evidence on infectious diseases following flooding throughout Europe. Using a range of scientific databases, the literature review was performed for the period 2004–2012, supplemented with key informant interviews. Thirty-eight studies met the inclusion criteria. Evidence suggested that water-borne, rodent-borne, and vector-borne diseases have been associated with flooding in Europe. The study authors asserted that it is important for health officials and the public to understand that exacerbation of disease risk factors contribute to infectious disease outbreaks following flooding. Moreover, they stated that if climate change causes more floods, the future health burden of infectious diseases from floods is likely to increase. The researchers postulated that disease surveillance and early warning systems, coupled with effective prevention and response capabilities, may reduce current and future vulnerability to infectious diseases following flooding. In their concluding discussion, the authors stated that, in order to mitigate infectious disease risk following flooding, those involved in flood planning, response, and recovery should be aware of the results of this systematic literature review.
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