Legislative Advocacy

Charles W. Pruitt, MD
Sofia Chaudhary, MD, FAAP

Injury Prevention Considerations for Youth Resettling in the United States

Sofia Chaudhary, MD, FAAP
Brittany Lee Murray, MD, MPhil
David Greenky, MD
Esther Kim, MD
Amy Zeidan, MD
Lin Snowe, CPST-I

Unintentional injuries are a leading cause of morbidity and mortality for children and teens in the United States. The risk of injury is even higher for youth that have resettled in the United States as these youth face unique structural vulnerabilities and may experience pre-migration, migration, and post-migration trauma. Prior research has found a 20% higher rate of unintentional injuries among refugees compared with non-refugees. Further, most injury prevention resources do not account for cultural and linguistic difference or preferences, which may lead to increased injuries among this population. There are a variety of reasons why families resettle in the United States whether it be a natural disaster, famine, war, or seeking asylum and as the number of displaced populations continues to rise, pediatric clinicians and injury prevention experts will continue to treat increasing numbers of immigrant families. In caring for resettled children, it is important that we explore cultural and linguistic preferences when developing injury prevention strategies, as traditional methods of injury prevention may be inaccessible or not as effective.

This interactive, case-based workshop will include speakers that have worked directly with pediatric immigrant populations and have content expertise in injury prevention strategies. These experts will share their recommendations for engaging in trauma-informed and culturally appropriate injury prevention education for families and their communities. In this session, attendees will learn about 1) the different types of pathways or statuses (e.g. asylum seekers, refugees, undocumented immigrants) and how this impacts access to medical care 2) some of the most common and unique injury risks for immigrant youth populations (e.g. pedestrian, carbon monoxide, transportation, burns, falls, occupational injury/child labor) 3) best practices for tailored injury prevention strategies that incorporate trauma informed practices and avoid re-traumatization (accounting for pre-migration, migration and/or post-migration trauma that can lead to anxiety, depression, or post-traumatic stress disorder) and 4) strategies for fostering community engaged partnerships to develop and provide population-based, culturally informed injury prevention anticipatory guidance and interventions. It is critical that we engage newly resettled families by partnering with pre-existing resettlement, post-resettlement agencies, and community-based injury prevention organizations. This early engagement can help build trusting partnerships and allow existing injury prevention organizations to serve as a resource while families navigate a high-risk period for injury.

1. Define pediatric communities at high risk for injuries that have settled in the United States including asylum seeker, refugee, undocumented.
2. Identify increased injury risks that these resettlement pediatric populations may have compared to local pediatric populations.
3. Explore the role of medical evaluation in healthcare setting with trauma informed approaches for this population.
4. Provide recommendations for conducting injury prevention education, initiatives, and research while being mindful of cultural values and linguistic needs.
5. Understand how to collaborate with existing agencies and community organizations as a platform for providing injury prevention education.

From birth to death: the intersection of social vulnerability and pediatric injury fatalities

Sarah Gard Lazarus, DO
Timothy Moran
Sofia Chaudhary, MD
Kiesha Fraser Doh, MD
Terri Miller
Carlos Delgado
Chris Rees

Unintentional injuries are the leading cause of childhood death in the United States. Children living in neighborhoods with lower social vulnerability indices (SVI), originally used to evaluate communities at higher risk of complications following natural disasters, have greater overall injury risk. However, the overlap in injury-related mortality risk by SVI looking at multiple mechanisms has been less explored. Our objective is to evaluate the association of SVI with the incidence of the five most common causes of injury-related death among children and young adults (0-24y) in the state of Georgia.

We conducted a cross-sectional study utilizing Georgia Department of Vital Records death certificates from 2011-2021. We evaluated the association between incident deaths from drownings, firearms, motor vehicle collisions (MVCs), poisonings, and sleep-related death (SUID) with census-level SVI defined by the CDC (a composite SVI divided into quartiles). We evaluated incident deaths for each cause stratified by the four subcategories comprising the SVI (socioeconomic, household composition/disability, minority, housing type/transportation). To determine factors associated with incident injury-related causes of death, we modeled outcomes using negative binomial regression controlling for the cause of death and SVI.

10,643 deaths were included: 531 from drownings, 3,798 from firearms, 3,414 from MVCs, 1,163 from poisonings, and 1,737 from SUID. Most of the deaths were in males (7,845, 74%). Lower socioeconomic SVI and greater minority SVI had the strongest correlation with incident deaths overall. Firearm deaths were most disparate between the lowest and highest overall SVI quartiles (2.1 deaths per 100,000 in the wealthiest SVI vs. 5.8 deaths per 100,000 in the poorest SVI). Conversely, the incidence of deaths from poisonings was highest in the wealthiest SVI in all subcategories (socioeconomic, household composition/disability, minority, housing type/transportation). Incident deaths from drownings varied the least by SVI (0.42 deaths per 100,000 in the wealthiest SVI vs. 0.64 deaths per 100,000 in the poorest SVI).

More socially vulnerable children had a higher incidence of injury-related deaths for all causes except for poisonings. Disparities in incident deaths were greatest in those affected by firearm injury, indicating a pressing need to address this cause of death in socially vulnerable populations. Determining which SVIs were associated with each injury-related mechanism can inform targeted interventions to prevent these untimely deaths.

1. Evaluate the incidence of the 5 most common causes of pediatric injury death in Georgia
2. Compare the incidence of pediatric injuries throughout SVI quartiles

The Struggle is Real: Starting and Maintaining a Firearm Safe Storage Program at Your Institution

Isabell Sakamoto, MS, CHES
Lindsay Clukies, MD, FAAP
Sofia Chaudhary, MD
Sandy McKay, MD
Kirsten Bechtel, MD

Best practices from the literature suggest that providing locking and storage devices to parents who are firearm owners is helpful in promoting safe firearm storage, especially during a behavioral health crisis in their child. This may reduce the likelihood of future injury or death from a firearm. However, many children’s hospitals do not have such programs in place. This workshop aims to help participants learn from program managers who have successfully started such programs at their institutions so that barriers and facilitators to program success can be disseminated amongst workshop participants. Additionally, workshop leaders will assist participants in drawing up a preliminary plan to initiate a firearm safety program at their respective institutions.

1. Understand the rationale for programs that provide locking and storage devices to parents who are firearm owners.
2. Develop program goals, values, and mission and identify key messaging to meet the needs of the community/institution.
3. Become familiar with barriers and facilitators to a program initiation within a hospital system (e.g., political, administrative, financial).
4. Determine who your key stakeholders are to initiate and sustain a program.
5. Learn how to engage with legal leadership at your institution.
6. Learn what various distribution mechanisms are available (e.g., community events, patient bedside, outpatient and inpatient settings, Emergency Department, universal hospital screening, at-risk screening).