There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world. The endemic period is a good time for the development of ongoing prevention approaches, including assessment and monitoring of local risk factors over time and application of proven measures to reduce these risk factors, development of means to address changing circumstances, and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday life.

The neighborhood social and physical environments are considered significant factors contributing to children's inactive lifestyles, poor eating habits, and high levels of childhood obesity. Understanding of neighborhood environmental profiles is needed to facilitate community-based research and the development and implementation of community prevention and intervention programs. We sought to identify contrastive and comparable districts for childhood obesity and physical activity research studies. We have applied GIS technology to manipulate multiple data sources to generate objective and quantitative measures of school neighborhood-level characteristics for school-based studies. GIS technology integrated data from multiple sources (land use, traffic, crime, and census tract) and available social and built environment indicators theorized to be associated with childhood obesity and physical activity. We used network analysis and geoprocessing tools within a GIS environment to integrate these data and to generate objective social and physical environment measures for school districts. We applied hierarchical cluster analysis to categorize school district groups according to their neighborhood characteristics. We tested the utility of the area characterizations by using them to select comparable and contrastive schools for two specific studies. Results We generated school neighborhood-level social and built environment indicators for all 412 Chicago public elementary school districts. The combination of GIS and cluster analysis allowed us to identify eight school neighborhoods that were contrastive and comparable on parameters of interest (land use and safety) for a childhood obesity and physical activity study. Conclusion The combination of GIS and cluster analysis makes it possible to objectively characterize urban neighborhoods and to select comparable and/or contrasting neighborhoods for community-based health studies.

The objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity. Using a proof of concept study design, we collected pre/post outcomes from a single intervention cohort of urban low-income in a single community area. A community-based participatory research approach was employed. Forty-six children and their caregivers were recruited. Children were 5–12 years old with physician-diagnosed asthma and body mass index (BMI) > 85%. Families were offered 12 home visits from CHWs that integrated asthma and obesity core curriculums. The primary asthma outcome was asthma control, measured via the Childhood Asthma Control Test (cACT). The primary obesity outcome was child body mass index (BMI). Families received a median of 10 out of the 12 home visits over 1 year. At 1 year, there was a significant improvement in the number of children with controlled asthma as measured via cACT (85.7% at 1 year compared to 61.9% at baseline, p = 0.01). Activity limitations and emergency utilization were reduced while inhaler technique improved (p < 0.01 for all). Child BMI z-score was reduced: mean = 1.97 (SD 0.79) at 1 year compared to mean = 2.13 (SD 0.40) at baseline, p < 0.01. No association was seen between change in child BMI and change in asthma control. Worse baseline child depression scores were associated with less improvement in asthma control (p = 0.003) and higher baseline caregiver post-traumatic stress disorder scores were associated with increased child BMI (p = 0.012). The CHW intervention has promise for improving asthma and weight outcomes in high-risk children with comorbid asthma and obesity; this model warrants further development and investigation.

This report summarizes a conference: “Early Origins of Child Obesity: Bridging Disciplines and Phases of Development”, held in Chicago on September 30–October 1, 2010. The conference was funded in part by the National Institutes of Health and the Williams Heart Foundation, to achieve the conference objective: forging a next-step research agenda related to the early origins of childhood obesity. This research agenda was to include working with an array of factors (from genetic determinants to societal ones) along a continuum from prenatal life to age 7, with an emphasis on how the developing child deals with the challenges presented by his/her environment (prenatal, parental, nutritional, etc.). The conference offered a unique opportunity to facilitate communication and planning of future work among a variety of researchers whose work separately addresses different periods in early life. Over the span of two days, speakers addressed existing, critical research topics within each of the most-studied age ranges. On the final day, workshops fostered the discussion needed to identify the highest priority research topics related to linking varied early factor domains. These are presented for use in planning future research and research funding.

Context:Following heightened gun violence in the 1990s, many medical societies in the United States adopted policies on the topic.Objective:Identify points of firearm violence policy agreement among large medical organizations.Design:Fourteen national medical societies—clinical focus, demonstrated interest in gun injury prevention, >2000 members—were selected for policy review in 2002. Policies were categorized on areas covered and items within these.Consensus areaswere addressed by ⩾7/14 societies.Consensus itemswere included by ⩾7/14 societies, shared itemsby 5–6.Results:There were fiveconsensus areas: access prevention, gun commerce, research, public education, and clinical counseling. There were fourconsensus items: restricting gun access by enforcing existing laws, restricting access to all guns at the point of sale, restricting access to handguns at the point of sale, and creating a national database on gun injury and death.Shared itemspromote violence prevention, clinical education on risks of guns in the home, treating guns as consumer products, restricting gun access to children, bans on automatic weapons, and promoting trigger locks.Conclusions:Large medical societies in the United States agree on key approaches for reducing gun injury mortality and morbidity. Future research will be needed to track the evolution of this emerging standard for physician action, which now includes the consensus areas and items. It promises to be, in effect, a medical standard of care for gun injury prevention. The United States experience may be useful to others working on gun injury prevention.