Firearm Violence and the Path to Prevention: What We Know, What We Need

Comparing Firearm and Stabbing Injuries in the Pediatric Trauma Population Using Propensity Matching

OBJECTIVES

The objective of this study was to compare differences in mortality and nonhome discharge in pediatric patients with firearm and stab injuries, while minimizing bias. Our secondary objective was to assess the influence of insurance on these same outcomes.

METHODS

Patients aged 0 to 17 years included in the National Trauma Data Bank (2007-2015) with firearm and stabbing injury were matched by propensity score. Logistic regression was used to assess associations of injury type and insurance with long-term care discharge and death.

RESULTS

The average age was 14.8 years, 19.2% were female, 48% were African American, 58.4% had an injury severity score ≤8, and assaults accounted for 73.1% of cases. Firearm injuries were associated with a higher risk of discharge to long-term care (adjusted odds ratio [aOR], 2.07) compared with propensity-matched patients who were stabbed. Similarly, we found a higher risk of mortality in those with firearm injuries compared with stabbing injuries (aOR, 1.85). Regardless of mechanism, self-pay insurance status was associated with a higher risk of mortality (aOR, 2.41). When compared with stab wound patients with commercial insurance, self-pay firearm-injured patients were found to have an increased risk of mortality (aOR, 5.25).

CONCLUSIONS

Pediatric victims of firearm violence were more likely to die or need additional care outside the home than victims of other types of penetrating injury when accounting for confounding characteristics to minimize bias.

Association of Firearm Access, Use, and Victimization During Adolescence With Firearm Perpetration During Adulthood in a 16-Year Longitudinal Study of Youth Involved in the Juvenile Justice System

IMPORTANCE

Preventing firearm violence requires understanding its antecedents. Yet no comprehensive longitudinal study has examined how involvement with firearms during adolescence-use, access, and victimization (defined as threatened with a weapon or gunshot injury)-is associated with the perpetration of firearm violence in adulthood.

OBJECTIVE

To examine the association between firearm involvement during adolescence and subsequent firearm perpetration and ownership in adulthood among youth involved in the juvenile justice system.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed interview responses of 1829 randomly selected participants as part of the Northwestern Juvenile Project, a longitudinal study of health needs and outcomes of youth sampled from a temporary juvenile detention center in a large US city. Youth aged 10 to 18 years were interviewed in detention from November 1995 through June 1998. Participants were reinterviewed up to 13 times over 16 years through February 2015, for a total of 17 776 interviews. The sample was stratified by sex, race/ethnicity, age, and legal status (juvenile or adult court). Data were analyzed from April 2017, when data preparation began, through November 2020.

EXPOSURES

Firearm involvement during adolescence: use (ie, threaten, shoot), access (ownership, ease of access, firearm in household, membership in gang that carries firearms), and victimization (gunshot injury, threatened with a weapon).

MAIN OUTCOMES AND MEASURES

Firearm involvement during adulthood: perpetration of firearm violence (ie, threatening with or using a firearm) and firearm ownership.

RESULTS

Among the 1829 participants, 1388 had a 16-year follow-up interview: 860 males, 528 females; 809 were African American, 203 were non-Hispanic White; 374 were Hispanic; and 2 were other race/ethnicity; median (interquartile range) age of 32 (30-32) years. Eighty-five percent of males and 63.2% of females were involved with firearms as adolescents. Compared with females, males had significantly higher odds of every type of involvement except having a firearm in the home. In adulthood, 41.3% of males and 10.5% of females perpetrated firearm violence. Adolescents who had been threatened with a weapon or injured by firearms had 3.1 (95% CI, 2.0-4.9) and 2.4 (95% CI, 1.2-4.9) times the odds of perpetrating violence during adulthood. Similar associations were found for firearm ownership.

CONCLUSIONS AND RELEVANCE

Involvement with firearms during adolescence-including victimization-is a significant risk factor for firearm perpetration and ownership during adulthood.

A Pragmatic Epidemiological Approach to Confronting the Genocidal Death Effect of Homicide and Suicide among Young Black Males in the United States

Genocide is a dehumanizing crime that threatens the welfare of any civilized society. Yet, before the annihilation of any targeted human group, the collective outcomes of the genocidal process (e.g., systemic desecrations) and genocidal death effect (e.g., years of mass deaths and death disparities) have often gone undetected, underestimated, or ignored by public health and human rights advocates. From1950-2010, the mass homicide-suicide killings engendering the premature deaths of Black males, ages15-24 years, corroborate that aspects of the genocidal process and genocidal death effect are happening in America. The mass killings of young Black males from these preventable homicide and suicide deaths are ethically alarming, and the determinants of death impacting their premature deaths command immediate primordial prevention and reinforced prevention efforts. An epidemiological genocide prevention matrix is explored as an innovative approach to address, prevent, and research premature deaths resulting from homicide and suicide, and genocidal death effect of young Black males. Undergirded by the Theory of Epidemiologic Transition, this article also examines the mass killings of young Black males through the genocidal and pragmatic lens. Death disparities, determinants of death, and genocidal death effect definitions are operationalized, and the Genocidal Death Effect Conceptual Framework is debuted in this article.