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Semenza DC, Daruwala S, Brooks Stephens JR, Anestis MD. Gun Violence Exposure and Suicide Among Black Adults. JAMA Netw Open 2024; 7:e2354953. [PMID: 38319659 PMCID: PMC10848043 DOI: 10.1001/jamanetworkopen.2023.54953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
Importance Black individuals are disproportionately exposed to gun violence in the US. Suicide rates among Black US individuals have increased in recent years. Objective To evaluate whether gun violence exposures (GVEs) are associated with suicidal ideation and behaviors among Black adults. Design, Setting, and Participants This cross-sectional study used survey data collected from a nationally representative sample of self-identified Black or African American (hereafter, Black) adults in the US from April 12, 2023, through May 4, 2023. Exposures Ever being shot, being threatened with a gun, knowing someone who has been shot, and witnessing or hearing about a shooting. Main Outcomes and Measures Outcome variables were derived from the Self-Injurious Thoughts and Behaviors Interview, including suicidal ideation, suicide attempt preparation, and suicide attempt. A subsample of those exhibiting suicidal ideation was used to assess for suicidal behaviors. Results The study sample included 3015 Black adults (1646 [55%] female; mean [SD] age, 46.34 [0.44] years [range, 18-94 years]). Most respondents were exposed to at least 1 type of gun violence (1693 [56%]), and 300 (12%) were exposed to at least 3 types of gun violence. Being threatened with a gun (odds ratio [OR], 1.44; 95% CI, 1.01-2.05) or knowing someone who has been shot (OR, 1.44; 95% CI, 1.05-1.97) was associated with reporting lifetime suicidal ideation. Being shot was associated with reporting ever planning a suicide (OR, 3.73; 95% CI, 1.10-12.64). Being threatened (OR, 2.41; 95% CI, 2.41-5.09) or knowing someone who has been shot (OR, 2.86; 95% CI, 1.42-5.74) was associated with reporting lifetime suicide attempts. Cumulative GVE was associated with reporting lifetime suicidal ideation (1 type: OR, 1.69 [95% CI, 1.19-2.39]; 2 types: OR, 1.69 [95% CI, 1.17-2.44]; ≥3 types: OR, 2.27 [95% CI, 1.48-3.48]), suicide attempt preparation (≥3 types; OR, 2.37; 95% CI, 2.37-5.63), and attempting suicide (2 types: OR, 4.78 [95% CI, 1.80-12.71]; ≥3 types: OR, 4.01 [95% CI, 1.41-11.44]). Conclusions and Relevance In this cross-sectional study, GVE among Black adults in the US was significantly associated with lifetime suicidal ideation and behavior. Public health efforts to substantially reduce interpersonal gun violence may yield additional benefits by decreasing suicide among Black individuals in the US.
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Affiliation(s)
- Daniel C. Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey
- Department of Urban-Global Public Health, Rutgers University, Piscataway, New Jersey
- New Jersey Gun Violence Research Center, Rutgers University, Piscataway
| | - Samantha Daruwala
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | | | - Michael D. Anestis
- Department of Urban-Global Public Health, Rutgers University, Piscataway, New Jersey
- New Jersey Gun Violence Research Center, Rutgers University, Piscataway
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McIntosh A, Anguelovski I, Cole H. "The trauma machine expands faster than our services": Health risks for unhoused people in an early-stage gentrifying area. Health Place 2023; 83:103035. [PMID: 37331113 DOI: 10.1016/j.healthplace.2023.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 06/20/2023]
Abstract
While homelessness continues to be a prevalent problem throughout the United States, many urban neighborhoods are also concurrently experiencing an influx of affluent neighbors through gentrification, exposing the stark inequalities in housing access nationwide. Gentrification-induced changes in neighborhood dynamics have also been shown to affect the health of low-income and non-white groups, with high risks of trauma from displacement and exposure to violent crime and criminalization. This study addresses risk factors for health among the most vulnerable, unhoused individuals, and provides a detailed case study on the potential exposures to emotional and physical traumas for unhoused people in early-stage gentrifying areas. By conducting 17 semi-structured interviews with people who work with the unhoused community - health providers, nonprofit employees, neighborhood representatives, and developers - in Kensington, Philadelphia, we analyze how early-stage gentrification impacts the risks for negative health consequences among unhoused groups. Results show that gentrification impacts the health of unhoused people in four main areas that, all together, create what we identify as a "trauma machine" - that is compounding traumas for unhoused residents by 1) reducing and compromising spaces of safety from violent crime, 2) decreasing public services, 3) threatening the quality of healthcare, and 4) increasing the likelihood of displacement and associated trauma.
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Affiliation(s)
- Andrea McIntosh
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain.
| | - Isabelle Anguelovski
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain; Institución Catalana de Investigación y Estudios Avanzados (ICREA), Passeig de Lluís Companys, 23, 08010, Barcelona, Spain.
| | - Helen Cole
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain.
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Logan TK, Cole J. Firearm-related threat exposure and associated factors among men and women entering a supportive housing substance use disorder recovery program. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:367-377. [PMID: 35157534 DOI: 10.1080/00952990.2021.2007259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Exposure to firearm victimization has often been overlooked as a sequela of substance use disorders (SUD).Objectives: The overall objective of this study was to explore firearm-related victimization and associated factors among men and women entering a supportive housing SUD recovery program.Methods: This study used program intake information from men (n = 1,758) and women (n = 1,066) clients entering a SUD recovery program.Results: Results found that almost half (49.3%) of the clients entering the program had ever been threatened with a firearm or held at gunpoint, and one-quarter of those clients had experienced firearm-related threats in the 6 months before entering the program. Economic vulnerability, mental health problems, polysubstance use, interpersonal victimization, and early use of drugs and alcohol were associated with firearm-related threat exposure. Many of the factors associated with firearm-related threat exposure were similar for men and women. Multivariate results found that polysubstance use (OR 1.16 men and 1.13 women), number of adverse childhood events (OR 1.13 men and 1.09 women), and interpersonal victimization (OR 3.41 men and 2.05 women) in the 6 months before program entry were significantly associated with ever being threatened with a firearm. Suicidality (OR 1.53 men and 1.80 women) and interpersonal victimization (OR 6.38 men and 6.08 women) were associated with being threatened with a firearm in the 6 months before program entry for both men and women.Conclusion: Results suggest there is a need for firearm-related risk reduction interventions for individuals in SUD recovery programs.
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Affiliation(s)
- T K Logan
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Jennifer Cole
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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Hink AB, Killings X, Bhatt A, Ridings LE, Andrews AL. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. CURRENT TRAUMA REPORTS 2022; 8:41-53. [PMID: 35399601 PMCID: PMC8976221 DOI: 10.1007/s40719-022-00223-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/21/2022]
Abstract
Purpose of Review This provides up-to-date epidemiology of adolescent suicide and risk factors for suicide and highlights the overlap of risks for suicide and injury. It reviews signs and symptoms, and the up-to-date evidence on screening for depression, post-traumatic stress disorder (PTSD), suicide, substance abuse, and lethal means, and offers strategies of implementation in trauma centers. Recent Findings The incidence of adolescent suicide has continued to rise in the USA to 6.5 per 100,000, with notable racial disparities. The risk factors are complex, but many pre-existing risk factors and sequela after injury such as exposures to violence, suicidal behaviors, substance abuse, depression and post-traumatic stress disorder, and specific injuries including traumatic brain injury and spinal cord injury have further emerged as risks. Studies show rates of suicidality as high as 30% in the acute care setting. There are short screening instruments that can be used to universally screen for depression and suicidality in adolescent trauma patients. Step-up models of care for PTSD are promising to increase screening and services after injury. Lethal means counseling, secure firearm storage practices, and firearm safety policies can reduce the risk of suicide. Summary Suicide is the second leading cause of death in US adolescents, and trauma patients have significant risk factors for mental illness and suicidality before and after injury. Trauma centers should strongly consider screening adolescents, establish strategies for mental health support and referrals, and provide lethal means counseling to help prevent suicide.
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Hsu HT, Fulginiti A, Petering R, Barman-Adhikari A, Bedell K, Ferguson KM, Narendorf SC, Shelton J, Santa Maria D, Bender K, Rice E. Understanding the Correlates of Firearm Violence Involvement Among Young Adults Experiencing Homelessness: A 7-City Study. Am J Prev Med 2021; 61:585-590. [PMID: 33952410 PMCID: PMC8455409 DOI: 10.1016/j.amepre.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Young adults experiencing homelessness are vulnerable to firearm violence. This study aims to explore the correlates of firearm violence involvement among this vulnerable population, which may inform firearm violence reduction intervention development. METHODS Between 2016 and 2017, young adults experiencing homelessness aged 18-26 years (N=1,426) were recruited in 7 U.S. cities. Respondents completed a self-administered computer-assisted anonymous survey regarding their homeless experiences and violence involvement. Separate multivariate logistic regression models were conducted in 2020 to explore the correlates of direct firearm violence victimization, witness of firearm violence, and firearm violence perpetration. RESULTS A high proportion of young adults experiencing homelessness were involved in firearm violence (witnessing firearm violence: 40%; direct firearm violence victimization: 28%; perpetration: 18%). Stressful experiences, such as childhood trauma and street victimization, were associated with greater odds of firearm violence involvement. Black (OR=2.4, p<0.001) and Latinx (OR=2.0, p<0.05) young adults had greater odds of experiencing direct firearm violence victimization than White young adults. Black (OR=2.0, p<0.01) and Latinx (OR=2.4, p<0.001) young adults were also at greater risk of witnessing firearm violence. Young adults with mental illness had greater odds of being directly victimized by firearm violence (OR=1.7, p<0.01). CONCLUSIONS Given the inter-related nature of firearm violence involvement and given that risk factors for violence are often embedded in social and structural contexts, multipronged community-based approaches to prevent firearm violence among young adults experiencing homelessness are necessary. Targeted efforts may be indicated to attenuate the risk and promote resilience among subgroups of young adults experiencing homelessness who are disproportionately affected by firearm violence.
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Affiliation(s)
- Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | | | | | - Kenneth Bedell
- School of Social Work, University of Missouri, Columbia, Missouri
| | | | - Sarah C Narendorf
- Graduate College of Social Work, University of Houston, Houston, Texas
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, New York, New York
| | - Diane Santa Maria
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | - Eric Rice
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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Kagawa RMC, Riley ED. Gun violence against unhoused and unstably housed women: A cross-sectional study that highlights links to childhood violence. Inj Epidemiol 2021; 8:52. [PMID: 34412710 PMCID: PMC8375069 DOI: 10.1186/s40621-021-00348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Unstably housed women experience high levels of violence. While previous studies have investigated psychological, physical, and sexual violence, weapon and gun violence are rarely delineated. We examined factors associated with experiencing violence as an adult among unhoused and unstably housed women, with a focus on gun violence. Methods We recruited women with a history of housing instability from San Francisco homeless shelters, street encampments, free meal programs, low-income hotels, and health clinics. Participants completed interviews including questions regarding both childhood and adult violence. We used multivariable logistic regression to examine associations of specific types of childhood violence (i.e., physical, sexual, gun, other weapon-involved violence), age, race, ethnicity, educational attainment, and sexual orientation, with risk of experiencing specific types of violence as an adult (i.e., gun, other weapon-involved, physical violence). Because the violence outcomes were not rare, odds ratios were transformed to approximate risk ratios. Results Nearly half of women (n = 110, 45%) had been attacked with a gun as an adult. Violent victimization in adulthood was common, with 33% having experienced all three forms of violence. The probability of being attacked with a gun as an adult was almost 70% higher among women who had been hit or kicked hard enough to cause injury as a child (RR = 1.68; 95% CI = 1.24, 2.11), and this association was present for all three violence outcomes. No other risk factors explored, including other types of violence experienced as a child, met the statistical threshold to be considered significant. Conclusions The high prevalence of gun violence reported here is consistent with prior studies of violence conducted in similar populations. Considered in combination with prior research, findings suggest multi-generational violence prevention interventions for low-income women and girls are needed. They also emphasize the need to more actively include people who experience unstable housing in statewide and national violence surveys to better understand the extent of the problem and address on a broader scale the high rates of violence experienced by unstably housed populations, which have been consistently documented in local research.
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Affiliation(s)
- Rose M C Kagawa
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California at Davis, 2315 Stockton Blvd., Sacramento, CA, 95817, USA.
| | - Elise D Riley
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
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