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1.  Improving National Data Systems for Surveillance of Suicide-related Events 
American journal of preventive medicine  2014;47(3 Suppl 2):S122-S129.
Background
Describing the characteristics and patterns of suicidal behavior is an essential component in developing successful prevention efforts. The Data and Surveillance Task Force (DSTF) of the National Action Alliance for Suicide Prevention was charged with making recommendations for improving national data systems for public health surveillance of suicide-related problems, including suicidal thoughts, suicide attempts and deaths due to suicide. Data from the national systems can be used to draw attention to the magnitude of the problem and are useful for establishing national health priorities. National data can also be used to examine differences in rates across groups (e.g., sex, racial/ethnic, and age groups) and geographic regions, and are useful in identifying patterns in the mechanism of suicide, including those that rarely occur.
Methods
Using evaluation criteria from the Centers for Disease Control and Prevention, the World Health Organization, and the U.S.-based Safe States Alliance, the DSTF reviewed 28 national data systems for feasibility of use in the surveillance of suicidal behavior, including deaths, non-fatal attempts and suicidal thoughts. The review criteria included such attributes as the aspects of the suicide-related spectrum (e.g., thoughts, attempts, deaths) covered by the system, how the data are collected (e.g., census, sample, survey, administrative data files, self-report, reporting by care providers), and the strengths and limitations of the survey or data system.
Results
The DSTF identified common strengths and challenges among the data systems based on the underlying data source (e.g., death records, health care provider records, population-based surveys, health insurance claims). From these findings, the DSTF proposed several recommendations for improving existing data systems, such as using standard language and definitions, adding new variables to existing surveys, expanding the geographic scope of surveys to include areas where data are not currently collected, oversampling of underrepresented groups, and improving the completeness and quality of information on death certificates.
Conclusions
Some of the DSTF recommendations are potentially achievable in the short term (<1–3 years) within existing data systems, while others involve more extensive changes and will require longer term efforts (4–10 years). Implementing these recommendations would assist in the development of a national coordinated program of fatal and nonfatal suicide surveillance to facilitate evidence-based action to reduce the incidence of suicide and suicidal behavior in all populations.
doi:10.1016/j.amepre.2014.05.026
PMCID: PMC4959537  PMID: 25145729
2.  Leading Causes of Unintentional and Intentional Injury Mortality: United States, 2000–2009 
American journal of public health  2012;102(11):e84-e92.
Objectives
We have described national trends for the 5 leading external causes of injury mortality.
Methods
We used negative binomial regression and annual underlying cause-of-death data for US residents for 2000 through 2009.
Results
Mortality rates for unintentional poisoning, unintentional falls, and suicide increased by 128%, 71%, and 15%, respectively. The unintentional motor vehicle traffic crash mortality rate declined 25%. Suicide ranked first as a cause of injury mortality, followed by motor vehicle traffic crashes, poisoning, falls, and homicide. Females had a lower injury mortality rate than did males. The adjusted fall mortality rate displayed a positive age gradient. Blacks and Hispanics had lower adjusted motor vehicle traffic crash and suicide mortality rates and higher adjusted homicide rates than did Whites, and a lower unadjusted total injury mortality rate.
Conclusions
Mortality rates for suicide, poisoning, and falls rose substantially over the past decade. Suicide has surpassed motor vehicle traffic crashes as the leading cause of injury mortality. Comprehensive traffic safety measures have successfully reduced the national motor vehicle traffic crash mortality rate. Similar efforts will be required to diminish the burden of other injury.
doi:10.2105/AJPH.2012.300960
PMCID: PMC3477930  PMID: 22994256
3.  Differential association of socioeconomic status in ethnic and age defined suicides 
Psychiatry research  2009;167(3):258-265.
Suicide rates vary among racial- and age-defined groups, yet little is known about how suicide risk factors differentially impact individual groups. This study assessed differential associations of socioeconomic status among age- and race-defined groups of suicide victims. A database containing demographic information on declared suicides in Fulton County, GA from 01/01/1988 through 12/31/2003 was combined with annual per capita income by zip code in Atlanta, GA. Analyses were performed to evaluate differential associations of socioeconomic status among age- and race-defined groups of suicide victims. Compared to the respective ethnic populations of Fulton County, white suicide victims lived in areas with lower per capita income ($51,232 v. $35,893); African American suicide victims did not ($17,384 v. $18,179). Elderly suicide victims (≥65 years) were more likely to live in the lowest per capita income areas compared to other age groups (OR 1.80, 95% C.I. 1.14, 2.84). Cox proportional hazards models showed increasing income increased the instantaneous risk of suicide among adolescents (HR 2.76; 95% C.I. 2.15, 3.53), particularly African American adolescents (HR 4.22; 95% C.I. 2.19, 8.11), and decreased risk among the elderly (HR 0.58; 95% C.I. 0.50, 0.68). Socioeconomic status has differential associations among age- and race-defined groups of suicide victims.
doi:10.1016/j.psychres.2008.02.003
PMCID: PMC2736599  PMID: 19395050
suicide; socioeconomic status; ethnicity; age; adolescent; elderly
4.  Internet-Based Morbidity and Mortality Surveillance Among Hurricane Katrina Evacuees in Georgia 
Preventing Chronic Disease  2008;5(4):A133.
Introduction
The Internet has revolutionized the way public health surveillance is conducted. Georgia has used it for notifiable disease reporting, electronic outbreak management, and early event detection. We used it in our public health response to the 125,000 Hurricane Katrina evacuees who came to Georgia.
Methods
We developed Internet-based surveillance forms for evacuation shelters and an Internet-based death registry. District epidemiologists, hospital-based physicians, and medical examiners/coroners electronically completed the forms. We analyzed these data and data from emergency departments used by the evacuees.
Results
Shelter residents and patients who visited emergency departments reported primarily chronic diseases. Among 33 evacuee deaths, only 2 were from infectious diseases, and 1 was indirectly related to the hurricane.
Conclusion
The Internet was essential to collect health data from multiple locations, by many different people, and for multiple types of health encounters during Georgia's Hurricane Katrina public health response.
PMCID: PMC2578770  PMID: 18793521

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