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BACKGROUND

Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership.

METHODS

We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns).

RESULTS

A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition.

CONCLUSIONS

Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.)

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Publication Type
Journal Articles
Publication Date
Journal Publisher
New England Journal of Medicine
Authors
Yifan Zhang
Sonja A. Swanson
Erin E. Holsinger
Matthew J. Spittal
Garen G. Wintemute
Matthew Miller
Number
2020
Authors
Becky Bach
News Type
News
Date
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Eyeglasses boosted the standardized test scores of rural Chinese schoolchildren as much as 18 percent in just six months, according to a large-scale, ongoing study led by Stanford researchers.

"The evidence is overwhelming," said Scott Rozelle, co-director of the Rural Education Action Program (REAP), a coalition of Chinese universities and Stanford's Freeman Spogli Institute for International Studies that works to improve education and health in rural China.

The initial test scores for nearsighted students hovered around 68 percent. After receiving glasses, average scores soared to 86 percent. "You do these simple interventions and a child's whole life changes," Rozelle said. "It's fantastic."

REAP scholars partnered with Chinese ophthalmologists and scores of graduate students to orchestrate the massive project, the first to examine vision problems in rural China.

In 2012 and 2013, the team screened the vision of approximately 20,000 fourth and fifth graders in rural Shaanxi and Gansu provinces and doled out more than 4,000 pairs of eyeglasses. They discovered that 25 percent of the students were nearsighted, but only one in seven of those nearsighted students had the glasses they needed.

"There's a huge amount of unmet need," said Matthew Boswell, a REAP project manager based at Stanford.

The results may seem intuitive. Yet, helping the millions of nearsighted children in rural China is anything but easy, the REAP team discovered. Few of these rural children (and adults) know they are nearsighted – the world, to them, is naturally blurry. In addition, eye doctors are concentrated in the populous coastal corridors or regional "county towns," often dozens of miles by bus from the homes of rural Chinese families, Boswell said.

Basic eyeglasses cost between 200 and 500 yuan ($30 to $80), a price out of reach for many, he said.

The researchers also struggled to counter pervasive superstitions about eyeglasses.

For example, many rural Chinese residents believe that glasses make children's' vision deteriorate, relying on the observation that vision generally worsens with age, Boswell said. In addition, many Chinese do "eye exercises" by rubbing their eyes, cheeks and temples each morning, a practice they believe improves vision, he said.

They also face political struggles: China's rural health care program doesn't pay for vision care. "We could tell health or education officials until we were blue in the face there was a high level of need for vision care in rural communities," Boswell said. "But if your findings are not attached to something they care about, it's hard to make them listen."

Hence the connection to the test scores, a highly valued measurement by Chinese policymakers. The REAP team taps its large network of Chinese academic collaborators to translate its research results into policy reform, a process that is often successful, Rozelle said.

REAP is currently analyzing alternative ways to boost the delivery and acceptance of eye care, Boswell said. The original study assigned nearsighted students into six groups.  Researchers gave one-third of the students glasses; one-third received a voucher to purchase glasses; and another third remained untreated. Then, half of the students in each group received training about the causes and treatments for vision problems.

The training failed to significantly affect whether students wore the glasses, Boswell said.  The students who had to invest time to acquire glasses using a voucher demonstrated similar usage rates as students who received free glasses, he said.

Among a variety of other initiatives currently underway, the REAP team is training Chinese teachers to conduct simple vision tests, Boswell said.

"It's an extreme feel–good example," Rozelle said. "You put the first pair of glasses on a kid … and then a huge smile lights up their face."

Becky Bach is a writer for the Stanford News Service.

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More than two-thirds of the population in Africa must leave their home to fetch water for drinking and domestic use. It is estimated that some 40 billion hours of labor each year are spent hauling water, a responsibility often borne by women and children. Cutting the walking time to a water source by just 15 minutes can reduce under-five mortality of children by 11 percent, and slash the prevalence of nutrition-depleting diarrhea by 41 percent.

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