(UroToday.com) Dr. Brian Stork, a community Urologist in Muskegon, Michigan, starts the session with sharing his experience with gun violence growing up in Iowa farming communities, where suicide amongst farmers was and continues to be high. With this background, we dive into addressing gun violence among our country’s youth.
In the past years, gun violence has surpassed motor vehicle accidents as the #1 killer of youth in this country. Adverse Childhood Experiences (ACEs) have been shown to have significant links to patient health, behaviors, and life expectancy, well after childhood. ACEs include personal childhood experiences of emotional, physical, and sexual abuse and household challenges including intimate partner violence, substance abuse, mental illness, parental separation or divorce, and incarcerated household member. It has been shown that individuals with >6 ACEs have a 20 year shorter life expectancy than peers without any ACEs.
Individuals living in Muskegon, Michigan have a higher rate of ACEs than the national average, most notably with 31.4% of the population with 4+ ACEs (compared to 14.3% nationally). With this, a high volume of gun violence is seen in the city.
Dr. Stork and his team performed a retrospective study looking at firearm-related injuries treated at Mercy Health Muskegon (MHM) between May 1, 2015-June 30, 2019, with 307 injuries included. 70& of injuries were in cases of attempted murder or attempt to cause bodily harm. Higher proportion of black men were injured due to gun violence in comparison to white men (P<0.001). The highest rate of mortality (50%) seen in self-inflicted injuries followed by attempted murder (7%) and accidental discharge (3.1%) (p<0.001). The median hospital charge was $8,008, with Medicaid the primary payer in 68% of cases. However, there was a net loss observed by the hospital by providing services for gun violence victims. The paper concludes that young, black men are primary victims of gun violence and that public Medicaid insurance is the primary payer for such injuries, showing that multiple stakeholders including communities, hospitals, and payers all stand to benefit from curtailing gun violence.
With this research, the Mercy Health Muskegon (MHM) system will be partnering with the University of Michigan Youth Violence Prevention Center in implementing the SafERTeens program through a CDC grant. SafERTeens is a one-on-one 30 minute intervention for youth seen in the Emergency Department for any reason. The evidence-based program was tested in randomized control trial in Flint, Michigan and then expanded to other locations with results showing decreased aggression with peers and in intimate partner situations, decreased risk for future substance use, among other findings. The program will begin in Muskegon, Michigan in partnership with both community emergency departments and also expand to include primary care facilities.
Dr. Stork’s work continues outside of SafERteens and his local community, with him continuing his efforts with a recent visit to Capital Hill to continue advocating to combat gun violence on the federal level.
Presented by: Brian Stork, MD, Community Urologist in Muskegon, Michigan, Assistant Clinical Professor, University of Michigan, Department of Urology, Chair, Urology Care Foundation, Public Education Council
Written by: Michelle Leach, MD, PGY3 Urology Resident Physician at UC San Diego, during the 2023 Urology for Social Responsibility Meeting January 14-15, 2023References:
- Brown DW, Anda RF, Tiemeier H, Felitti VJ, Edwards VJ, Croft JB, Giles WH. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med. 2009 Nov;37(5):389-96. doi: 10.1016/j.amepre.2009.06.021. PMID: 19840693.
- Mattson CM, Kaylor R, Koehler TJ, Ydenberg M, Grill J, Stork BR. Gun Violence and Firearm Injuries in West Michigan: Targeting Prevention. West J Emerg Med. 2021 May 19;22(3):488-497. doi: 10.5811/westjem.2021.3.49255. PMID: 34125018; PMCID: PMC8203015.
- Carter PM, Walton MA, Zimmerman MA, Chermack ST, Roche JS, Cunningham RM. Efficacy of a Universal Brief Intervention for Violence Among Urban Emergency Department Youth. Acad Emerg Med. 2016 Sep;23(9):1061-70. doi: 10.1111/acem.13021. Epub 2016 Sep 7. PMID: 27265097; PMCID: PMC5018914.