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Jain V, Hemenway D. Cross-State Relationship of Firearm Violence Between Police and Civilians: Gun Ownership as a Common Denominator. J Urban Health 2024:10.1007/s11524-024-00904-5. [PMID: 39196466 DOI: 10.1007/s11524-024-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/29/2024]
Affiliation(s)
- Vageesh Jain
- Harvard T.H Chan School of Public Health, Boston, MA, USA.
| | - David Hemenway
- Harvard T.H Chan School of Public Health, Boston, MA, USA
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Bleyer A, Siegel SE, Estrada J, Thomas CR. Fallacy of attributing the U.S. firearm mortality epidemic to mental health. PLoS One 2024; 19:e0290138. [PMID: 39102407 PMCID: PMC11299823 DOI: 10.1371/journal.pone.0290138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/18/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Annual global data on mental disorders prevalence and firearm death rates for 2000-2019, enables the U.S. to be compared with comparable counties for these metrics. METHODS The Institute for Health Metrics and Evaluation (IHME) Global Health Burden data were used to compare the prevalence of mental disorders with overall, homicide and suicide firearm death rates including homicides and suicides, in high sociodemographic (SDI) countries. RESULTS Overall and in none of the nine major categories of mental disorders did the U.S. have a statistically-significant higher rate than any of 40 other high SDI countries during 2019, the last year of available data. During the same year, the U.S. had a statistically-significant higher rate of all deaths, homicides, and suicides by firearm (all p<<0.001) than all other 40 high SDI countries. Suicides accounted for most of the firearm death rate differences between the U.S. and other high SDI countries, and yet the prevalence of mental health disorders associated with suicide were not significantly difference between the U.S. and other high SDI countries. CONCLUSION Mental disorder prevalence in the U.S. is similar in all major categories to its 40 comparable sociodemographic countries, including mental health disorders primarily associated with suicide. It cannot therefore explain the country's strikingly higher firearm death rate, including suicide. Reducing firearm prevalence, which is correlated with the country's firearm death rate, is a logical solution that has been applied by other countries.
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Affiliation(s)
- Archie Bleyer
- Knight Cancer Institute and Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- McGovern Medical School, University of Texas, Houston, Texas, United States of America
| | - Stuart E. Siegel
- AYA Cancer Coalition and CureSearch, Los Angeles, California, United States of America
| | - Jaime Estrada
- Texas Doctors for Social Responsibility, San Antonio, Texas, United States of America
| | - Charles R. Thomas
- Radiation Oncology, Geisel School of Medicine @ Dartmouth, Hanover, New Hampshire, United States of America
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Rempel AML, Persons JE, Bengtson K, Nashelsky MB. Causes of Death in the Presence of Law Enforcement in Johnson County, Iowa, 2011-2020. Am J Public Health 2024; 114:642-650. [PMID: 38574318 PMCID: PMC11079845 DOI: 10.2105/ajph.2024.307616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Objectives. To examine sudden and unexpected or trauma-related deaths that occurred in the presence of law enforcement in Johnson County, Iowa, between 2011 and 2020. Methods. We identified deaths in the presence of law enforcement using definitions from the National Association of Medical Examiners. We obtained data, including demographics, cause and manner of death, toxicology results, and circumstances and location of event leading to death, from comprehensive medical examiner investigative reports. Results. There were 165 deaths that occurred in the presence of law enforcement: 114 were from a known disease, and 51 were either trauma related or the sudden, unexpected initial presentation of a previously unrecognized disease. Three deaths occurred in the context of physical restraint by law enforcement. Suicide was the leading manner of death among trauma-related deaths; the means of suicide was predictable based on in-custody (hanging) or precustody (firearm) circumstances. Conclusions. Our findings highlight the potential role of medical examiners and coroners in improving completeness of data on reporting death in the presence of law enforcement to public health agencies. (Am J Public Health. 2024;114(6):642-650. https://doi.org/10.2105/AJPH.2024.307616).
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Affiliation(s)
- Anne M L Rempel
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
| | - Jane E Persons
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
| | - Kate Bengtson
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
| | - Marcus B Nashelsky
- Anne M. L. Rempel, Jane E. Persons, and Marcus B. Nashelsky are with the Department of Pathology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City. Anne M. L. Rempel is also with the University of California, San Francisco, Department of Emergency Medicine, Fresno, CA. Kate Bengtson and Marcus B. Nashelsky are also with the Johnson County, Iowa Medical Examiner Department, Iowa City
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Abasilim C, Friedman LS, Shannon B, Holloway-Beth A. Relationship between Civilian Injuries Caused during Contact with Law Enforcement and Community-Level Sociodemographic Characteristics. J Urban Health 2024; 101:508-521. [PMID: 38806992 PMCID: PMC11189844 DOI: 10.1007/s11524-024-00865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/30/2024]
Abstract
Civilian injuries caused during contact with law enforcement personnel erode community trust in policing, impact individual well-being, and exacerbate existing health inequities. We assessed the relationship between ZIP code-level rates of civilian injuries caused during legal interventions and community-level sociodemographic characteristics using Illinois hospital data from 2016 to 2022. We developed multivariable Poisson regression models to examine whether legal intervention injury rates differed by race-ethnicity and community economic disadvantage across three geographic regions of Illinois representing different levels of urbanization. Over the study period, 4976 civilian injuries were treated in Illinois hospitals (rate of 5.6 per 100,000 residents). Compared to non-Hispanic white residents, non-Hispanic Black residents demonstrated 5.5-10.5 times higher injury rates across the three geographic regions, and Hispanic-Latino residents demonstrated higher rates in Chicago and suburban Cook County, but lower rates in the rest of the state. In most regions, models showed that as the percent of minority residents in a ZIP code increased, injury rates among non-Hispanic Black and Hispanic-Latino residents decreased. As community economic disadvantage increased at the ZIP code level, civilian injury rates increased. Communities with the highest injury rates involving non-Hispanic white residents were significantly more economically unequal and disadvantaged. While the injury rates were consistently and substantially higher among non-Hispanic Black residents throughout the state, the findings illustrate that the association between overall civilian injuries caused during contact with law enforcement and community sociodemographic characteristics varied across regions. Data on local law enforcement agency policies and procedures are needed to better identify appropriate interventions.
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Affiliation(s)
- Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA
| | - Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA.
| | - Brett Shannon
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA
| | - Alfreda Holloway-Beth
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA
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5
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Ward JA, Cepeda J, Jackson DB, Johnson O, Webster DW, Crifasi CK. National Burden of Injury and Deaths From Shootings by Police in the United States, 2015‒2020. Am J Public Health 2024; 114:387-397. [PMID: 38478866 PMCID: PMC10937603 DOI: 10.2105/ajph.2023.307560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 03/17/2024]
Abstract
Objectives. To describe all-outcome injurious shootings by police and compare characteristics of fatal versus nonfatal injurious shootings nationally. Methods. From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by US police, identified from Gun Violence Archive. We estimated injury frequency, case fatality rates, and relative odds of death by incident and victim characteristics. Results. A total of 1769 people were injured annually in shootings by police, 55% fatally. When a shooting injury occurred, odds of fatality were 46% higher following dispatched responses than police-initiated responses. Injuries associated with physically threatening or threat-making behaviors, behavioral health needs, and well-being checks were most frequently fatal. Relative to White victims, Black victims were overrepresented but had 35% lower odds of fatal injury when shot. Conclusions. This first multiyear, nationwide analysis of injurious shootings by US police suggests that injury disparities are underestimated by fatal shootings alone. Nonpolicing responses to social needs may prevent future injuries. Public Health Implications. We call for enhanced reporting systems, comprehensive evaluation of emerging reforms, and targeted investment in social services for equitable injury prevention. (Am J Public Health. 2024;114(4):387-397. https://doi.org/10.2105/AJPH.2023.307560).
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Affiliation(s)
- Julie A Ward
- Julie A. Ward is with the Department of Medicine, Health, and Society, the Program in Public Policy Studies, and the Center for Research on Inequality and Health at Vanderbilt University, Nashville, TN. Javier Cepeda is with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Dylan B. Jackson is with the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions. Odis Johnson Jr is with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins School of Education, and the Johns Hopkins Center for Gun Violence Solutions. Daniel W. Webster and Cassandra K. Crifasi are with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions
| | - Javier Cepeda
- Julie A. Ward is with the Department of Medicine, Health, and Society, the Program in Public Policy Studies, and the Center for Research on Inequality and Health at Vanderbilt University, Nashville, TN. Javier Cepeda is with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Dylan B. Jackson is with the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions. Odis Johnson Jr is with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins School of Education, and the Johns Hopkins Center for Gun Violence Solutions. Daniel W. Webster and Cassandra K. Crifasi are with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions
| | - Dylan B Jackson
- Julie A. Ward is with the Department of Medicine, Health, and Society, the Program in Public Policy Studies, and the Center for Research on Inequality and Health at Vanderbilt University, Nashville, TN. Javier Cepeda is with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Dylan B. Jackson is with the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions. Odis Johnson Jr is with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins School of Education, and the Johns Hopkins Center for Gun Violence Solutions. Daniel W. Webster and Cassandra K. Crifasi are with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions
| | - Odis Johnson
- Julie A. Ward is with the Department of Medicine, Health, and Society, the Program in Public Policy Studies, and the Center for Research on Inequality and Health at Vanderbilt University, Nashville, TN. Javier Cepeda is with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Dylan B. Jackson is with the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions. Odis Johnson Jr is with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins School of Education, and the Johns Hopkins Center for Gun Violence Solutions. Daniel W. Webster and Cassandra K. Crifasi are with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions
| | - Daniel W Webster
- Julie A. Ward is with the Department of Medicine, Health, and Society, the Program in Public Policy Studies, and the Center for Research on Inequality and Health at Vanderbilt University, Nashville, TN. Javier Cepeda is with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Dylan B. Jackson is with the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions. Odis Johnson Jr is with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins School of Education, and the Johns Hopkins Center for Gun Violence Solutions. Daniel W. Webster and Cassandra K. Crifasi are with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions
| | - Cassandra K Crifasi
- Julie A. Ward is with the Department of Medicine, Health, and Society, the Program in Public Policy Studies, and the Center for Research on Inequality and Health at Vanderbilt University, Nashville, TN. Javier Cepeda is with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Dylan B. Jackson is with the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions. Odis Johnson Jr is with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins School of Education, and the Johns Hopkins Center for Gun Violence Solutions. Daniel W. Webster and Cassandra K. Crifasi are with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Gun Violence Solutions
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Maksuta KD, Zhao Y, Yang TC. Race, disadvantage, and violence: A spatial exploration of macrolevel covariates of police-involved homicides within and between US counties. SOCIAL SCIENCE RESEARCH 2024; 119:102985. [PMID: 38609312 DOI: 10.1016/j.ssresearch.2024.102985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/30/2023] [Accepted: 01/27/2024] [Indexed: 04/14/2024]
Abstract
Efforts to explore the macrolevel determinants of police-involved homicides have expanded in recent years due in part to increased scrutiny and media attention to such events, and increased data availability of these events through crowdsourced databases. However, little empirical research has examined the spatial determinants of such events. The present study extends the extant macrolevel research on police-involved homicides by employing an underutilized spatial econometric model, the spatial Durbin model (SDM), to assess the direct and indirect county effects of racial threat, economic threat, social disorganization, and community violence on police killings within and between US counties from 2013 through 2020. Results indicate a direct inverse relationship between racial threat and police-involved homicides, no support for economic threat, and a direct positive association with two measures of social disorganization. Additionally, we find firearm availability exhibits significant direct and indirect spatial dependence on focal county police-involved homicides, reflecting spatial spillover processes. In essence, as firearm availability in neighboring counties increases, police-involved homicides within a focal county increase. The implications of these findings for racial threat, economic threat, social disorganization, and community violence are discussed.
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Affiliation(s)
- Kyle D Maksuta
- Department of Sociology and Criminology, Western Kentucky University, Bowling Green, KY, 42103, USA.
| | - Yunhan Zhao
- Department of Sociology, Criminology & Anthropology, Colorado State University Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany, 1400 Washington Ave., Albany, NY, 12222, USA
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Price JH, Foh EP. Descriptive Epidemiology of Fatal Law Enforcement Interactions with Teenagers, 2010-2020. J Community Health 2023; 48:1026-1030. [PMID: 37306842 DOI: 10.1007/s10900-023-01243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/13/2023]
Abstract
There is a dearth of population studies regarding law enforcement officers (LEOs) use of fatal force against teenagers. The purpose of this cross-sectional study was to characterize the teens most likely to be killed, the methods used to fatally injure teenagers, the geographic distribution of the killings, and the years of potential life lost before the age of 80 years (YPLL80) due to LEO interactions. Data from the Web-based Injury Statistics Query and Reporting System (WISQARS) from the Center for Disease Control and Prevention (CDC) were analyzed for the years 2010-2020. LEOs killed 330 teenagers; most were males (94.2%) and 6 of 7 teens (84.5%) were shot. The teens killed were disproportionately older teens ages 18-19 years (64.2%) and non-Hispanic Blacks (45.8%) who were usually killed in metropolitan areas (90.0%). The rate of teenage killings by LEOs significantly increased (267%) over the time frame studied. A total of 20,575 YPLL80 were lost and they significantly increased over time (263%). Mitigation of teenagers killed by LEOs will require transforming policing through policy changes (e.g. hiring and training) over an extended period of time. Also, the public needs education, (e.g. funding, interactions) regarding policing.
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Shjarback JA, Semenza DC, Stansfield R. Firearm availability and police shootings of citizens: a city level analysis of fatal and injurious shootings in California and Florida. Inj Epidemiol 2023; 10:50. [PMID: 37864228 PMCID: PMC10588120 DOI: 10.1186/s40621-023-00466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND A growing body of research has found a link between firearm availability and police shootings of citizens across place. The problem, however, is that the previous studies on the topic tend to suffer from several limitations: a near exclusive focus on citizen fatalities, units of analysis at the state or county levels, and a variety of proxy measures tapping into community-level firearm access. The current study set out to address these issues by examining the relationship between different forms of firearm availability and both fatal and nonfatal injurious police shootings of citizens at the city level. METHODS More specifically, it merged The Trace's "Missing Pieces" measures of guns reported lost and stolen to police as well as licensed firearms dealers across jurisdictions from the Bureau of Alcohol, Tobacco, Firearms, and Explosives as proxies for firearm availability with data on police shootings of citizens in California and Florida from California's URSUS system and the Tampa Bay Times' "Why Cops Shoot" database, respectively. Negative binomial regression analyses were performed on a sample of 253 cities across the two states and a sub-sample of cities with licensed firearms dealers. RESULTS Findings uncovered a small positive association between rates of federally licensed guns stores and the number citizens shot by police as well as police shooting incidents while controlling for several community-level measures (e.g., concentrated disadvantage, gun homicide rates). Rates of guns lost or reported stolen were generally not significantly associated with the outcome measures in the multivariate models. CONCLUSIONS Firearm availability is a significant correlate of police shootings. Pooled counts of both citizens shot by police and police shooting incidents are heightened in jurisdictions with higher rates of licensed gun dealers, which may be due to the fact that all firearms sold in the USA first make their way to the public through these mechanisms. Such licensed gun dealers must be appropriately monitored and audited to reduce illicit behavior and prevent firearms from making their way into secondary markets. Addressing access to firearms can be meaningful for a host of gun-related morbidity and mortality outcomes, including police shootings of citizens.
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Affiliation(s)
- John A Shjarback
- Department of Law and Justice Studies, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University-Camden, Camden, NJ, USA
- Department of Urban-Global Public Health, Rutgers University, Piscataway, NJ, USA
- New Jersey Gun Violence Research Center, Piscataway, NJ, USA
| | - Richard Stansfield
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University-Camden, Camden, NJ, USA
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Crifasi CK, Ward J, McCourt AD, Webster D, Doucette ML. The association between permit-to-purchase laws and shootings by police. Inj Epidemiol 2023; 10:28. [PMID: 37386600 PMCID: PMC10311703 DOI: 10.1186/s40621-023-00439-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Fatal and nonfatal shootings by police are a public health issue that warrants additional research. Prior research has documented associations between fatal shootings by police and gun ownership, legislative strength scores, and lax concealed carry weapons laws. Despite research on other firearm-related outcomes, little is known about the impact of permit-to-purchase (PTP) laws on shootings by police. We generated counts of fatal and nonfatal OIS from the Gun Violence Archive from 2015 to 2020. We conducted cross-sectional regression modeling with a Poisson distribution and robust standard errors. In addition to PTP, we included several state-level policies that may be associated with shootings by police: comprehensive background check only (CBC-only) laws, concealed carry licensing laws, stand your ground laws, violent misdemeanor prohibitions, and extreme risk protection orders (ERPO). We controlled for state-level demographic characteristics and included a population offset to generate incidence rate ratios (IRR). FINDINGS PTP laws were associated with a 28% lower rate in shootings by police [IRR = 0.72, 95% confidence interval (CI) 0.64-0.81]. Shall Issue (IRR = 1.34, 95% CI 1.17-1.53) and Permitless (IRR = 1.61, 95% CI 1.35-1.91) concealed carry laws and CBC-only laws (IRR = 1.12, 95% CI 1.01-1.25) were associated with higher rates of shootings by police. Stand your ground, violent misdemeanor prohibitions, and ERPO laws were not associated with shootings by police. CONCLUSIONS Our study found that PTP laws were associated with significantly lower rates of shootings by police. Removing restrictions on civilian concealed carry was associated with significantly higher rates. State-level firearm policies may be a lever to address shootings by police.
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Affiliation(s)
- Cassandra K Crifasi
- Department of Health Policy and Management, Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 593, Baltimore, MD, 21202, USA.
| | - Julie Ward
- Department of Health Policy and Management, Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 593, Baltimore, MD, 21202, USA
| | - Alex D McCourt
- Department of Health Policy and Management, Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 593, Baltimore, MD, 21202, USA
| | - Daniel Webster
- Department of Health Policy and Management, Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 593, Baltimore, MD, 21202, USA
| | - Mitchell L Doucette
- Department of Health Policy and Management, Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 593, Baltimore, MD, 21202, USA
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Simckes M, Willits D, Rowhani-Rahbar A, Hajat A. Lethal use of force surveillance: practical considerations for open-source database linkage. J Epidemiol Community Health 2023:jech-2022-219022. [PMID: 37208155 DOI: 10.1136/jech-2022-219022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/06/2023] [Indexed: 05/21/2023]
Abstract
Currently, there remains no reliable and timely government tracking in the USA of deaths caused by law enforcement. Federal efforts to track these events are insufficient, generally missing as many as half of community deaths that occur annually because of law enforcement's lethal use of force. The dearth of accurate data on these events limits the ability to accurately quantify their burden and effectively identify opportunities for intervention and policy change. The most reliable data sources on law enforcement related deaths among community members in the USA are publicly run (such as those run by the Washington Post and The Guardian newspapers) or crowdsourced systems, such as Fatal Encounters and Mapping Police Violence, which draw on both traditional and non-traditional sources of reporting and provide open-source access to users. We used successive deterministic and probabilistic linkage to merge these four databases. After exclusions, we found a total of 6333 deaths identified from 2013 to 2017. While most cases were identified by multiple databases, each database also found unique cases during their years of operation. The methodology described here emphasises the importance of these non-traditional data sources and can serve as a helpful resource to improve data accessibility and timeliness for public health agencies and others seeking to expand their study, understanding and response to this growing public health crisis.
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Affiliation(s)
- Maayan Simckes
- Washington State Department of Health, Olympia, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Dale Willits
- Department of Criminal Justice and Criminology, Washington State University, Pullman, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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11
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Police killings and suicide among Black Americans. Soc Sci Med 2022; 305:114964. [PMID: 35660700 DOI: 10.1016/j.socscimed.2022.114964] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/02/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
Black Americans are killed at higher rates by police than whites. Previous studies have shown that discrimination can lead to suicidal ideation, and that mental health of Black Americans deteriorates after police killings. The objective of this study is to examine whether police killings are associated with an increase in suicide rates amongst Black Americans. Controlling for a number of factors, we found that on months with at least one killing of a Black person by police, there were, on average, 0.0472 additional suicides per 100,000 Black Americans in the U.S. Census Division where the killing occurred. We did not find any spillover effects on other divisions. This association persisted when controlling for gun ownership, and did not seem to be a result of variance in deaths by assault. There was no association between killings of Black Americans and white suicides; white killings and Black suicides; or white killings and white suicides. This study highlights another reason for urgent action on reducing police killings.
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Doucette ML, Ward JA, McCourt AD, Webster D, Crifasi CK. Officer-Involved Shootings and Concealed Carry Weapons Permitting Laws: Analysis of Gun Violence Archive Data, 2014-2020. J Urban Health 2022; 99:373-384. [PMID: 35536393 PMCID: PMC9187822 DOI: 10.1007/s11524-022-00627-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
About 1,000 civilians are killed every year by a law enforcement officer in the USA, more than 90% by firearms. Most civilians who are shot are armed with a firearms. Higher rates of officer-involved shootings (OIS) are positively associated with state-level firearm ownership. Laws relaxing restrictions on civilians carrying concealed firearms (CCW) have been associated with increased violent crime. This study examines associations between CCW laws and OIS. We accessed counts of fatal and nonfatal OIS from the Gun Violence Archive (GVA) from 2014-2020 and calculated rates using population estimates. We conducted legal research to identify passage years of CCW laws. We used an augmented synthetic control models with fixed effects to estimate the effect of Permitless CCW law adoption on OIS over fourteen biannual semesters. We calculated an inverse variance weighted average of the overall effect. On average, Permitless CCW adopting states saw a 12.9% increase in the OIS victimization rate or an additional 4 OIS victimizations per year, compared to what would have happened had law adoption not occurred. Lax laws regulating civilian carrying of concealed firearms were associated with higher incidence of OIS. The increase in concealed gun carrying frequency associated with these laws may influence the perceived threat of danger faced by law enforcement. This could contribute to higher rates of OIS.
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Affiliation(s)
- Mitchell L Doucette
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Julie A Ward
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alex D McCourt
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel Webster
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cassandra K Crifasi
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Leslie TF, Frankenfeld CL, Hattery AJ. Differentiating Black and Hispanic: outcome differences of segregated communities and police shootings in the USA, 2015-2020. Inj Epidemiol 2022; 9:8. [PMID: 35241164 PMCID: PMC8892749 DOI: 10.1186/s40621-022-00372-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Police shootings are unevenly spatially distributed, with substantive spikes throughout the USA. While minorities are disproportionately the victims of police force, social or structural factors associated with this distribution are not well understood. The objective of this work was to evaluate police shootings in relation to victim race or ethnicity and residential segregation and racial diversity. METHODS Validated crowdsourced data from the Washington Post's Fatal Force (2015-2020) were linked with census tract-level data from the American Community Survey. Residential minority dissimilarity, interaction, and a racial and ethnic diversity metric were calculated in order to assess the potentially variant importance of evenness in distribution, exposure likelihood, and general representation. Logistic and multinomial regression was used to model associations between segregation and diversity, adjusted for other ecological characteristics. Analyses were stratified by victim race or ethnicity (Black, Asian, or Hispanic). RESULTS Across all races combined, the odds of a police shooting in a particular census tract were associated with non-Hispanic Black dissimilarity (OR = 0.98, 95% CI 0.97, 0.99) and racial and ethnic diversity (1.046, 95% CI 1.044, 1.060). Areas with higher racial diversity had a higher likelihood of having a police shooting event with Black victims (OR = 1.092, 95% CI 1.064, 1.120) or Asian victims (OR = 1.188, 1.051, 1.343) than less diverse areas. Higher non-Hispanic Black interaction was associated with a lower likelihood of having a police shooting event with Black victims (OR = 0.914, 95% CI 0.833, 0.946) than lower interaction areas. Higher Hispanic dissimilarity was associated with a lower likelihood of having a police shooting event with a Hispanic victim (OR = 0.398, 95% CI 0.324, 0.489) than lower dissimilarity areas. CONCLUSIONS The variant effects of residential segregation are only seen when victims are analyzed separately by race. There appears to be a protective effect for Hispanic populations in Hispanic communities, while the reverse is true of Black individuals. We urge law enforcement responsible for locations with segregated communities to monitor individual interactions that police have with residents as well as the patterns of frequency and context of those interactions.
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Affiliation(s)
- Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, 4400 University Dr., MS 6C3, Fairfax, VA, 22030, USA.
| | - Cara L Frankenfeld
- Public Health Program, University of Puget Sound, 1500 N. Warner St., Tacoma, WA, 98416, USA
| | - Angela J Hattery
- Department of Women and Gender Studies, University of Delaware, 25 N. College Ave., Newark, DE, 19716, USA
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Finch BK, Thomas K, Beck AN, Burghart DB, Klinger D, Johnson RR. Assessing Data Completeness, Quality, and Representativeness of Justifiable Homicides in the FBI's Supplementary Homicide Reports: A Research Note. JOURNAL OF QUANTITATIVE CRIMINOLOGY 2022; 38:267-293. [PMID: 37860123 PMCID: PMC10586131 DOI: 10.1007/s10940-021-09493-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 10/21/2023]
Abstract
Introduction The most widely used data set for studying police homicides-the Supplementary Homicide Reports (SHR) kept by the Federal Bureau of Investigation-is collected from a voluntary sample. Materials and Methods Using a journalist-curated database of police-related deaths, we find the SHR police homicide data to be substantially incomplete. This is due to both non-reporting and substantial under-reporting by agencies. Further, our inquiry discloses a pattern of error in identifying "victims" and "offenders" in the data, and finds that investigating agencies are often incorrectly listed as the responsible agency, which seriously jeopardizes police department-level analyses. Finally, there is evidence of sample bias such that the SHR data system is not representative of all police departments, nor is it representative of large police departments. Conclusions We conclude that the SHR data is of dubious value for assessing correlates of police homicides in the United States, as all analyses using it will reflect these widespread biases and significant undercounts. Analysis of SHR data for these purposes should cease.
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Affiliation(s)
- Brian Karl Finch
- Center for Economic and Social Research, University of Southern California, Los Angeles, USA
| | - Kyla Thomas
- Center for Economic and Social Research, University of Southern California, Los Angeles, USA
| | | | - D. Brian Burghart
- Center for Economic and Social Research, University of Southern California, Los Angeles, USA
- Fatal Encounters, Reno, USA
| | - David Klinger
- University of Missouri-St. Louis, St. Louis County, USA
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Cheng T, Burjonrappa S. Pediatric firearm injury trends in the United States: A national trauma data bank (NTDB) analysis. J Pediatr Surg 2022; 57:278-283. [PMID: 34952693 DOI: 10.1016/j.jpedsurg.2021.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 10/24/2022]
Abstract
AIM OF STUDY Firearm injuries are the second leading cause of injury-related death in the USA in children less than 18. We compared overall and intent-specific firearm hospitalizations across age group and race to understand recent trends. METHODS A retrospective cohort of 20,083 children from the national trauma data bank involved in incidences of firearm discharges from 2013 to 2017 was divided by race, discharge intent, gun type, and four age groups: infants (ages 0-2), toddlers (3-6), children (7-12), and adolescents (13-18). Discharge intent and gun type were determined by ICD-9-CM and ICD-10-CM External Causes of Injury codes. Injury severity score (ISS), hospital discharge disposition, and length of stay (LOS) were used as predictors for morbidity and mortality. RESULTS From 2013 to 2017, there were on an average 4016 firearm injuries reported to the NTDB (n = 20,083). 71% (n = 14,313) of the incidents were assaults. Victims who identified as African American and Caucasian made up 60% (n = 11,890) and 26% (n = 5162) of the total victims, respectively, and were predominantly male (86%, n = 17,202). Victims who identified as Caucasian made up 70% of suicides (n = 819), while African Americans made up 70% of assaults (n = 9733). 87% (n = 17,525) of the patient population were adolescents. The number of accidental firearm discharges compared to firearm assaults was greater for toddlers, while the opposite was true for infants, children, and adolescents. Average LOS by age group varied each year, though children had the highest total average LOS. Average ISS was highest for infants and adolescents (11.5 and 10.4) and American Indians and Caucasians (10.1 and 11.1). Overall mortality rate was 6% (n = 1220) and had no significant differences between years. Mortality rate was highest for infants (7%, n = 25). CONCLUSIONS Adolescent males and African Americans were disproportionately affected by overall and assault-specific firearm discharges. Firearm injury prevention legislation is critical to prevent these injures.
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Affiliation(s)
- Tiffany Cheng
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Sathyaprasad Burjonrappa
- Department of Pediatric Surgery, Robert Wood Johnson Medical School, Rutgers State University of New Jersey, Suite 504, Medical Education Building, 1 RWJ Place, New Brunswick, NJ 08901, USA.
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Hoops K, Fahimi J, Khoeur L, Studenmund C, Barber C, Barnhorst A, Betz ME, Crifasi CK, Davis JA, Dewispelaere W, Fisher L, Howard PK, Ketterer A, Marcolini E, Nestadt PS, Rozel J, Simonetti JA, Spitzer S, Victoroff M, Williams BH, Howley L, Ranney ML. Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:93-104. [PMID: 34232149 DOI: 10.1097/acm.0000000000004226] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE Firearm injury is a leading cause of morbidity and mortality in the United States. However, many medical professionals currently receive minimal or no education on firearm injury or its prevention. The authors sought to convene a diverse group of national experts in firearm injury epidemiology, injury prevention, and medical education to develop consensus on priorities to inform the creation of learning objectives and curricula for firearm injury education for medical professionals. METHOD In 2019, the authors convened an advisory group that was geographically, demographically, and professionally diverse, composed of 33 clinicians, researchers, and educators from across the United States. They used the nominal group technique to achieve consensus on priorities for health professions education on firearm injury. The process involved an initial idea-generating phase, followed by a round-robin sharing of ideas and further idea generation, facilitated discussion and clarification, and the ranking of ideas to generate a prioritized list. RESULTS This report provides the first national consensus guidelines on firearm injury education for medical professionals. These priorities include a set of crosscutting, basic, and advanced learning objectives applicable to all contexts of firearm injury and all medical disciplines, specialties, and levels of training. They focus on 7 contextual categories that had previously been identified in the literature: 1 category of general priorities applicable to all contexts and 6 categories of specific contexts, including intimate partner violence, mass violence, officer-involved shootings, peer (nonpartner) violence, suicide, and unintentional injury. CONCLUSIONS Robust, data- and consensus-driven priorities for health professions education on firearm injury create a pathway to clinician competence and self-efficacy. With an improved foundation for curriculum development and educational program-building, clinicians will be better informed to engage in a host of firearm injury prevention initiatives both at the bedside and in their communities.
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Affiliation(s)
- Katherine Hoops
- K. Hoops is assistant professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jahan Fahimi
- J. Fahimi is associate professor, Department of Emergency Medicine, University of California, San Francisco School of Medicine and Institute for Health Policy Studies, San Francisco, California
| | - Lina Khoeur
- L. Khoeur is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Christine Studenmund
- C. Studenmund is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Catherine Barber
- C. Barber is senior researcher, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Barnhorst
- A. Barnhorst is associate professor, Department of Psychiatry and Behavioral Sciences and Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, California
| | - Marian E Betz
- M.E. Betz is associate professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Cassandra K Crifasi
- C.K. Crifasi is assistant professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John A Davis
- J.A. Davis is professor and associate dean for curriculum, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - William Dewispelaere
- W. Dewispelaere is a resident, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Lynn Fisher
- L. Fisher is assistant professor, Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Patricia K Howard
- P.K. Howard is adjunct assistant professor, University of Kentucky, Lexington, Kentucky
| | - Andrew Ketterer
- A. Ketterer is clinical instructor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Evie Marcolini
- E. Marcolini is assistant professor, Department of Emergency Medicine and Department of Neurology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Paul S Nestadt
- P.S. Nestadt is assistant professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John Rozel
- J. Rozel is associate professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph A Simonetti
- J.A. Simonetti is assistant professor, Department of Medicine, University of Colorado School of Medicine, and Veterans Health Administration, Aurora, Colorado
| | - Sarabeth Spitzer
- S. Spitzer is a resident, Department of Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Victoroff
- M. Victoroff is clinical professor, Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian H Williams
- B.H. Williams is associate professor, Department of Surgery, University of Chicago Pritzker School of Medicine and Biological Sciences, Chicago, Illinois
| | - Lisa Howley
- L. Howley is senior director of strategic initiatives and partnerships, Association of American Medical Colleges, Washington, DC
| | - Megan L Ranney
- M.L. Ranney is associate professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Nix J, Shjarback JA. Factors associated with police shooting mortality: A focus on race and a plea for more comprehensive data. PLoS One 2021; 16:e0259024. [PMID: 34758026 PMCID: PMC8580236 DOI: 10.1371/journal.pone.0259024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To quantify nonfatal injurious police shootings of people and examine the factors associated with victim mortality. METHODS We gathered victim-level data on fatal and nonfatal injurious police shootings from four states that have such information publicly available: Florida (2009-14), Colorado (2010-19), Texas (2015-19), and California (2016-19). For each state, we examined bivariate associations between mortality and race/ethnicity, gender, age, weapon, and access to trauma care. We also estimated logistic regression models predicting victim mortality in each state. RESULTS Forty-five percent of these police shooting victims (N = 1,322) did not die. Black-white disparities were more pronounced in nonfatal injurious police shootings than in fatal police shootings. Overall, Black victims were less likely than white victims to die from their wound(s). Younger victims were less likely to die from their wound(s), as well as those who were unarmed. CONCLUSIONS Racial and age disparities in police shootings are likely more pronounced than previous estimates suggest. POLICY IMPLICATIONS Other states should strongly consider compiling data like that which is currently being gathered in California. Absent data on nonfatal injurious police shootings-which account for a large share of deadly force incidents-researchers and analysts must be cautious about comparing and/or ranking jurisdictions in terms of their police-involved fatality rates.
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Affiliation(s)
- Justin Nix
- School of Criminology and Criminal Justice, University of Nebraska Omaha, Omaha, NE, United States of America
| | - John A. Shjarback
- Department of Law and Justice Studies, Rowan University, Glassboro, NJ, United States of America
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Fatal police violence by race and state in the USA, 1980-2019: a network meta-regression. Lancet 2021; 398:1239-1255. [PMID: 34600625 PMCID: PMC8485022 DOI: 10.1016/s0140-6736(21)01609-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The burden of fatal police violence is an urgent public health crisis in the USA. Mounting evidence shows that deaths at the hands of the police disproportionately impact people of certain races and ethnicities, pointing to systemic racism in policing. Recent high-profile killings by police in the USA have prompted calls for more extensive and public data reporting on police violence. This study examines the presence and extent of under-reporting of police violence in US Government-run vital registration data, offers a method for correcting under-reporting in these datasets, and presents revised estimates of deaths due to police violence in the USA. METHODS We compared data from the USA National Vital Statistics System (NVSS) to three non-governmental, open-source databases on police violence: Fatal Encounters, Mapping Police Violence, and The Counted. We extracted and standardised the age, sex, US state of death registration, year of death, and race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic of other races, and Hispanic of any race) of each decedent for all data sources and used a network meta-regression to quantify the rate of under-reporting within the NVSS. Using these rates to inform correction factors, we provide adjusted estimates of deaths due to police violence for all states, ages, sexes, and racial and ethnic groups from 1980 to 2019 across the USA. FINDINGS Across all races and states in the USA, we estimate 30 800 deaths (95% uncertainty interval [UI] 30 300-31 300) from police violence between 1980 and 2018; this represents 17 100 more deaths (16 600-17 600) than reported by the NVSS. Over this time period, the age-standardised mortality rate due to police violence was highest in non-Hispanic Black people (0·69 [95% UI 0·67-0·71] per 100 000), followed by Hispanic people of any race (0·35 [0·34-0·36]), non-Hispanic White people (0·20 [0·19-0·20]), and non-Hispanic people of other races (0·15 [0·14- 0·16]). This variation is further affected by the decedent's sex and shows large discrepancies between states. Between 1980 and 2018, the NVSS did not report 55·5% (54·8-56·2) of all deaths attributable to police violence. When aggregating all races, the age-standardised mortality rate due to police violence was 0·25 (0·24-0·26) per 100 000 in the 1980s and 0·34 (0·34-0·35) per 100 000 in the 2010s, an increase of 38·4% (32·4-45·1) over the period of study. INTERPRETATION We found that more than half of all deaths due to police violence that we estimated in the USA from 1980 to 2018 were unreported in the NVSS. Compounding this, we found substantial differences in the age-standardised mortality rate due to police violence over time and by racial and ethnic groups within the USA. Proven public health intervention strategies are needed to address these systematic biases. State-level estimates allow for appropriate targeting of these strategies to address police violence and improve its reporting. FUNDING Bill & Melinda Gates Foundation, National Institute on Minority Health and Health Disparities, and National Heart, Lung, and Blood Institute.
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Impact of ShotSpotter Technology on Firearm Homicides and Arrests Among Large Metropolitan Counties: a Longitudinal Analysis, 1999-2016. J Urban Health 2021; 98:609-621. [PMID: 33929640 PMCID: PMC8566613 DOI: 10.1007/s11524-021-00515-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 10/21/2022]
Abstract
Over the past decade, large urban counties have implemented ShotSpotter, a gun fire detection technology, across the USA. It uses acoustic listening devices to identify discharged firearms' locations. We examined the effect of ShotSpotter with a pooled, cross-sectional time-series analysis within the 68 large metropolitan counties in the USA from 1999 to 2016. We identified ShotSpotter implementation years through publicly available media. We used a Poisson distribution to model the impact of ShotSpotter on firearm homicides, murder arrests, and weapons arrests. ShotSpotter did not display protective effects for all outcomes. Counties in states with permit-to-purchase firearm laws saw a 15% reduction in firearm homicide incidence rates; counties in states with right-to-carry laws saw a 21% increase in firearm homicide incidence rates. Results suggest that implementing ShotSpotter technology has no significant impact on firearm-related homicides or arrest outcomes. Policy solutions may represent a more cost-effective measure to reduce urban firearm violence.
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Loder RT, Young A, Atoa B. Firearm injuries associated with law enforcement activity. J Forensic Leg Med 2021; 83:102249. [PMID: 34461598 DOI: 10.1016/j.jflm.2021.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Law enforcement activity can involve firearms, and either a civilian or the law enforcement officer can be injured. It was the purpose of this study to characterize the injuries and demographics associated with law enforcement firearm activity across the entire US using a national data base. METHODS Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study data 1993-2015 was used. Law enforcement involvement and other demographic variables were ascertained. Statistical analyses were performed accounting for the weighted, stratified nature of the data. P < 0.05 was considered to be statistically significant. RESULTS There were an estimated 2,667,896 ED visits for injuries due to firearms; 1.7% (45,497) were associated with law enforcement. Those involved with law enforcement were older (33.2 vs 29.8 years), a handgun was more commonly involved (80.3 vs 71.5%), male (90.7 vs 86.8%), White (52.9 vs 37.2%), had more upper trunk injuries (25.2 vs 16.2%), fewer lower extremity (15.1% vs 25.9%) injuries, and more fatalities (10.0 vs. 6.2%). An argument, crime, fight and drug involvement were all greater in the law enforcement group. Within the law enforcement group, when the injured patient was the civilian and not the officer, the patient was more commonly Black, male, sustained more trunk injuries, fewer extremity injuries, and more frequently admitted to the hospital. The civilian group had fewer upper extremity (11.7% vs 29.7%), lower extremity (12.2% vs 23.7%) and lower trunk injuries (14.6% vs 8.0%), more upper trunk injuries (31.3% vs 7.8%, and similar proportion of head/neck injuries (31.5% vs 30.7%) compared to the officer group. More females were injured in the officer group (16.9% vs 7.5%). The fatality rate was 12.6% for the civilian group and 3.0% for the officer group. There were no differences by race in disposition from the ED (released, admitted, death) for those who sustained injuries by the officer. CONCLUSIONS Firearm injuries due to law enforcement activity occurred in 1.7% of all ED visits for injuries due to firearms. The law enforcement officer was the injured patient in 23% of the events. This study spanning nearly a quarter of a century of data for injuries due to firearm activity resulting in ED visits is baseline data for future studies, especially in the present setting of calls for police reform within the US. This will be important when analyzing the effect of new programs in law enforcement training and/or police reform.
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Affiliation(s)
- Randall T Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Allison Young
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bradley Atoa
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Loder RT, Leiser A. Injury patterns and demographics due to legal intervention seen in US emergency departments. J Forensic Leg Med 2021; 79:102150. [PMID: 33714163 DOI: 10.1016/j.jflm.2021.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Injury and deaths inflicted by law enforcement are a topic of significant discussion in the US. The purpose of this study was to analyze injuries due to law enforcement activity that presented to emergency departments (ED) across the entire US and correlate the injury patterns with patient demographics. METHODS The National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) data was used for the years 2005 through 2015. Injuries due to legal/law enforcement activity were identified. Statistical analyses were performed with SUDAAN 11.0.01™. A p < 0.05 was considered statistically significant. RESULTS There were 939,405 ED visits for non-fatal injuries due to law enforcement. The average age was 31.9 years; 84.6% were male. The mechanism of injury was being struck in 69.7%; firearm gunshot wounds accounted for only 1.2%. The most common location of injury was the head and neck (44.0%) followed by the upper extremity (20.2%). The vast majority of the patients (94.9%) were treated and released from the ED. The seven major diagnoses were contusion/abrasion (37.8%), strain/sprain (22.7%), laceration (12.9%), fracture (7.6%), puncture (8.2%), and foreign body (2.5%). The injuries with the highest percentage of hospital admissions were foreign bodies and fractures (11.4% and 11.3% respectively. Although the number of events occurring at schools or sporting venues was 2.0%, those seen at children's hospitals demonstrated a higher percentage at 15.6%. CONCLUSIONS This data set provides another viewpoint of injuries inflicted by police. It can be used as baseline data for further studies, especially in the US recent sociopolitical environment calling for police reform and improvements in the education and training of police officers.
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Affiliation(s)
- Randall T Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Abraham Leiser
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Magee LA, Fortenberry JD, Tu W, Wiehe SE. Neighborhood variation in unsolved homicides: a retrospective cohort study in Indianapolis, Indiana, 2007-2017. Inj Epidemiol 2020; 7:61. [PMID: 33256823 PMCID: PMC7706017 DOI: 10.1186/s40621-020-00287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homicide is a widely acknowledged public health problem in the United States. The majority of homicides are committed with a firearm and have long-term health consequences for family members and entire communities. When left unsolved, violence may be perpetuated due to the retaliatory nature of homicides. Improving homicide clearance rates may help prevent future violence, however, we know little about the community-level social dynamics associated with unsolved homicides. METHODS This study examines the individual-and-community-level social processes associated with low homicide clearance rates in Indianapolis, Indiana between 2007 and 2017. Homicide clearance is the primary outcome, defined as if a perpetrator was arrested for that homicide case between 2007 and 2017. Individual-level variables include the victim's race/ethnicity, sex, and age. Community-level (i.e., census tracts) variables include the number of resident complaints against the police, resident complains of community disorder, income inequality, number of police interactions, and proportion of African American residents. RESULTS In Indianapolis over a 11-year period, the homicide clearance rate decreased to a low of 38% in 2017, compared to a national clearance rate of 60%. Homicide case clearance was less likely for minority (OR 0.566; 95% CI, 0.407-0.787; p < 0.01) and male (OR 0.576; 95% CI, 0.411-0.807; p < 0.01) victims. Resident complaints of community disorder were associated with a decreased odds of case clearance (OR 0.687; 95% CI, 0.485-0.973; p < .01)., African American victim's cases were less likely to be cleared in 2014-2017 (OR 0.640; 95% CI, 0.437-0.938; p < 0.05), compared to 2007. CONCLUSIONS Our study identified differences in neighborhood social processes associated with homicide clearance, indicating existing measures on these community factors are complex. Programs aimed at improving signs of community disorder and building community engagement may improve neighborhood clearance rates, lower violence, and improve the health of these communities.
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Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, 801 W. Michigan Street, Indianapolis, Indiana, 46202, USA.
| | - J Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, 410 W. 10th Street, Suite 1000, Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, 410 W. 10th Street, Suite 3000, Indianapolis, Indiana, USA
| | - Sarah E Wiehe
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Suite 2000, Indianapolis, USA
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Abdalla SM, Keyes KM, Galea S. A Public Health Approach to Tackling the Role of Culture in Shaping the Gun Violence Epidemic in the United States. Public Health Rep 2020; 136:6-9. [PMID: 33108975 DOI: 10.1177/0033354920965263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Salma M Abdalla
- 27118 Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | - Katherine M Keyes
- 33638 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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24
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Maani N, Abdalla SM, Galea S. The Firearm Industry as a Commercial Determinant of Health. Am J Public Health 2020; 110:1182-1183. [PMID: 32639903 DOI: 10.2105/ajph.2020.305788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nason Maani
- The authors are with the Boston University School of Public Health, Boston, MA. Nason Maani is also with the London School of Hygiene and Tropical Medicine, London, UK
| | - Salma M Abdalla
- The authors are with the Boston University School of Public Health, Boston, MA. Nason Maani is also with the London School of Hygiene and Tropical Medicine, London, UK
| | - Sandro Galea
- The authors are with the Boston University School of Public Health, Boston, MA. Nason Maani is also with the London School of Hygiene and Tropical Medicine, London, UK
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Schwartz GL, Jahn JL. Mapping fatal police violence across U.S. metropolitan areas: Overall rates and racial/ethnic inequities, 2013-2017. PLoS One 2020; 15:e0229686. [PMID: 32579553 PMCID: PMC7313728 DOI: 10.1371/journal.pone.0229686] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND & METHODS Recent social movements have highlighted fatal police violence as an enduring public health problem in the United States. To solve it, the public requires basic information, such as understanding where rates of fatal police violence are particularly high, and for which groups. Existing mapping efforts, though critically important, often use inappropriate statistical methods and can produce misleading, unstable rates when denominators are small. To fill this gap, we use inverse-variance-weighted multilevel models to estimate overall and race-stratified rates of fatal police violence for all Metropolitan Statistical Areas (MSAs) in the U.S. (2013-2017), as well as racial inequities in these rates. We analyzed the most recent, reliable data from Fatal Encounters, a citizen science initiative that aggregates and verifies media reports. RESULTS Rates of police-related fatalities varied dramatically, with the deadliest MSAs exhibiting rates nine times those of the least deadly. Overall rates in Southwestern MSAs were highest, with lower rates in the northern Midwest and Northeast. Yet this pattern was reversed for Black-White inequities, with Northeast and Midwest MSAs exhibiting the highest inequities nationwide. Our main results excluded deaths that could be considered accidents (e.g., vehicular collisions), but sensitivity analyses demonstrated that doing so may underestimate the rate of fatal police violence in some MSAs by 60%. Black-White and Latinx-White inequities were slightly underestimated nationally by excluding reportedly 'accidental' deaths, but MSA-specific inequities were sometimes severely under- or over-estimated. CONCLUSIONS Preventing fatal police violence in different areas of the country will likely require unique solutions. Estimates of the severity of these problems (overall rates, racial inequities, specific causes of death) in any given MSA are quite sensitive to which types of deaths are analyzed, and whether race and cause of death are attributed correctly. Monitoring and mapping these rates using appropriate methods is critical for government accountability and successful prevention.
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Affiliation(s)
- Gabriel L. Schwartz
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Jaquelyn L. Jahn
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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26
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Hemenway D, Berrigan J, Azrael D, Barber C, Miller M. Fatal police shootings of civilians, by rurality. Prev Med 2020; 134:106046. [PMID: 32145239 DOI: 10.1016/j.ypmed.2020.106046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/21/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
In the United States, firearm homicides disproportionately occur in urban areas. We examine whether the same is true for fatal police shootings. We use data on fatal police shootings from Washington Post's "Fatal Force Database" (2015-2017). Using Census population estimates, we examine rates of fatal police shootings, stratified by race/ethnicity (White, Black, Hispanic), across urban and rural areas using five different classification schemes. Two classification schemes-from the National Center for Health Statistics and the US Department of Agriculture-use counties as the basic unit. Three classification schemes-from the National Center for Education Statistics, the US Census Bureau, and the website "FiveThirtyEight" use zip codes. There were just under 1000 fatal police shootings per year from 2015 to 2017, a rate of 0.31 per 100,000 population. Black victimization rates were more than twice those for Whites, with Hispanic victimization rates in between. Across all classification schemes there was little difference in rates of fatal police shootings between urban and rural areas, with suburbs having somewhat lower rates. Among Whites, rates of fatal police shooting victimization were higher in rural areas compared to urban areas, while among Blacks the rates were higher in more urban areas. Our results suggest that efforts to reduce police shootings of civilians should include rural and suburban as well as urban areas.
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Affiliation(s)
- David Hemenway
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America.
| | - John Berrigan
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America; Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States of America
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Doucette ML, Crifasi CK, Frattaroli S. Right-to-Carry Laws and Firearm Workplace Homicides: A Longitudinal Analysis (1992-2017). Am J Public Health 2019; 109:1747-1753. [PMID: 31622144 DOI: 10.2105/ajph.2019.305307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives. To examine the impact of right-to-carry (RTC) firearm laws on firearm workplace homicides (WPHs) in the United States from 1992 to 2017.Methods. We employed 2 longitudinal methods to examine the average effect (pooled, cross-sectional, time-series analysis) and the state-specific effect (random effects meta-analysis) of RTC laws on WPHs committed by firearms from 1992 to 2017 in a 50-state panel. Both methods utilized a generalized linear mixed model with a negative binomial distribution.Results. From 1992 to 2017, the average effect of having an RTC law was significantly associated with 29% higher rates of firearm WPHs (95% confidence interval [CI] = 1.14, 1.45). No other state-level policies were associated with firearm WPHs. Sensitivity analyses suggest robust findings. State-specific estimates suggest that passing an RTC law during our study period was significantly associated with 24% increase in firearm WPH rates (95% CI = 1.09, 1.40).Conclusions. This is the first study to our knowledge to examine the link between RTC firearm laws and firearm WPHs. Findings indicate that RTC laws likely pose a threat to worker safety and contribute to the recent body of literature that finds RTC laws are associated with increased incidence of violence.
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Affiliation(s)
- Mitchell L Doucette
- Mitchell L. Doucette is with the Department of Health Science, Eastern Connecticut State University, Willimantic, and the Injury Prevention Center at Connecticut Children's Medical Center, Hartford. Cassandra K. Crifasi and Shannon Frattaroli are with the Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cassandra K Crifasi
- Mitchell L. Doucette is with the Department of Health Science, Eastern Connecticut State University, Willimantic, and the Injury Prevention Center at Connecticut Children's Medical Center, Hartford. Cassandra K. Crifasi and Shannon Frattaroli are with the Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shannon Frattaroli
- Mitchell L. Doucette is with the Department of Health Science, Eastern Connecticut State University, Willimantic, and the Injury Prevention Center at Connecticut Children's Medical Center, Hartford. Cassandra K. Crifasi and Shannon Frattaroli are with the Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Conner A, Azrael D, Lyons VH, Barber C, Miller M. Validating the National Violent Death Reporting System as a Source of Data on Fatal Shootings of Civilians by Law Enforcement Officers. Am J Public Health 2019; 109:578-584. [PMID: 30789773 DOI: 10.2105/ajph.2018.304904] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the National Violent Death Reporting System (NVDRS) as a surveillance system for fatal shootings of civilians by law enforcement in the United States. METHODS We cross-linked individual-level mortality data from the 2015 NVDRS and 5 open-source data sets ( FatalEncounters.org , Mapping Police Violence, the Guardian's "The Counted," Gun Violence Archive, and The Washington Post's "Fatal Force Database"). Using the comprehensive cross-linked data set, we assessed the proportion of study-identified fatal police shootings that were captured by NVDRS, overall and by state, and by each open-source data set. RESULTS There were 404 unique study-identified fatal shootings by law enforcement in the 27 states for which data were available from NVDRS, 393 (97%) of which were captured in NVDRS. The proportion of shootings captured by NVDRS varied only slightly by state. CONCLUSIONS The NVDRS provides a comprehensive count of fatal police shootings. Public Health Implications. Expanding NVDRS to all 50 states would provide comprehensive counts of fatal police shootings and detailed circumstantial information about these deaths at the national level. Open-source data can continue to provide real-time data collection as well as more complete information about nonfirearm officer-involved deaths.
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Affiliation(s)
- Andrew Conner
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Deborah Azrael
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Vivian H Lyons
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Catherine Barber
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Matthew Miller
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
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