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Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Using a Latent Variable Method to Develop a Composite, Multidimensional Measure of Structural Racism at the City Level. J Racial Ethn Health Disparities 2024; 11:2271-2283. [PMID: 37382871 PMCID: PMC11236873 DOI: 10.1007/s40615-023-01695-2] [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] [Received: 03/01/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Although structural racism is strongly related to racial health disparities, we are not aware of any composite, multidimensional measure of structural racism at the city level in the United States. However, many of the policies, programs, and institutions that create and maintain structural racism are located at the city level. To expand upon previous research, this paper uses a novel measure to measure structural racism at the city level for the non-Hispanic Black population. METHODS We used confirmatory factor analysis to model the latent construct of structural racism for 776 U.S. cities. The model included six indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status. We generated factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each city. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS There were profound differences in the magnitude of structural racism across cities. There were also striking differences in the magnitude of the racial disparity in firearm homicide across cities. Structural racism was a significant predictor of the magnitude of these racial disparities in firearm homicide. Each one standard deviation increase in the structural racism factor score increased the firearm homicide rate ratio by a factor of approximately 1.2 (95% confidence interval, 1.1-1.3). CONCLUSIONS These new measures can be utilized by researchers to relate structural racism to racial health disparities at the city level.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
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Herrera-Escobar JP, Lamarre T, Rosen J, Ilkhani S, Haynes AN, Hau K, Jenkins K, Ruske J, Wang JY, Serventi-Gleeson J, Sanchez SE, Kaafarani HM, Velmahos G, Salim A, Levy-Carrick NC, Anderson GA. Determinants of long-term physical and mental health outcomes after intensive care admission for trauma survivors. Am J Surg 2024; 233:72-77. [PMID: 38413351 DOI: 10.1016/j.amjsurg.2024.02.013] [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] [Received: 12/11/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Collectively, studies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. We sought to identify determinants of post-intensive care physical and mental health outcomes 6-12 months after injury. METHODS Adult trauma patients [ISS ≥9] admitted to one of three Level-1 trauma centers were interviewed 6-12 months post-injury to evaluate patient-reported outcomes. Patients requiring ICU admission ≥ 3 days ("ICU patients") were compared with those who did not require ICU admission ("non-ICU patients"). Multivariable regression models were built to identify factors associated with poor outcomes among ICU survivors. RESULTS 2407 patients were followed [598 (25%) ICU and 1809 (75%) non-ICU patients]. Among ICU patients, 506 (85%) reported physical or mental health symptoms. Of them, 265 (52%) had physical symptoms only, 15 (3%) had mental symptoms only, and 226 (45%) had both physical and mental symptoms. In adjusted analyses, compared to non-ICU patients, ICU patients were more likely to have new limitations for ADLs (OR = 1.57; 95% CI = 1.21, 2.03), and worse SF-12 mental (mean Δ = -1.43; 95% CI = -2.79, -0.09) and physical scores (mean Δ = -2.61; 95% CI = -3.93, -1.28). Age, female sex, Black race, lower education level, polytrauma, ventilator use, history of psychiatric illness, and delirium during ICU stay were associated with poor outcomes in the ICU-admitted group. CONCLUSIONS Physical impairment and mental health symptoms following ICU stay are highly prevalent among injury survivors. Modifiable ICU-specific factors such as early liberation from ventilator support and prevention of delirium are potential targets for intervention.
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Affiliation(s)
- Juan P Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Taylor Lamarre
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jordan Rosen
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Saba Ilkhani
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ashley N Haynes
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Kaman Hau
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Kendall Jenkins
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Jack Ruske
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Joyce Y Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jessica Serventi-Gleeson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sabrina E Sanchez
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Haytham Ma Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ali Salim
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Nomi C Levy-Carrick
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Geoffrey A Anderson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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3
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Poulson M, Riley K, Haqqani M, Green KA, Kenzik K, Scantling D. The Carceral State, Social Disorganization, and Firearm Homicides in Chicago. JAMA Surg 2024:2819796. [PMID: 38837148 PMCID: PMC11154366 DOI: 10.1001/jamasurg.2024.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/08/2024] [Indexed: 06/06/2024]
Abstract
Importance Black and other racially minoritized groups are overrepresented among those who experience firearm homicide. There has been a stark increase in incarcerated populations in the US since the 1980s, largely due to differential drug sentencing, of which racially minoritized individuals are also overrepresented; social disorganization theory postulates that community and family instability resulting from incarceration can further worsen crime. Objective To understand the association of race-specific incarceration with race-specific firearm violence rates in Chicago, Illinois, through the lens of social vulnerability and family instability. Design, Setting, and Participants This cross-sectional study with a retrospective cohort design utilized homicide data for the city of Chicago from January 1, 2001, to August 31, 2019. Demographic data at the census block level was obtained from the 2010 decennial census. Incarceration rates were obtained by race and ethnicity at the census tract level from the Opportunity Atlas. Data analysis occurred from January to June 2023. Exposure Race-specific incarceration rates were the primary exposures of interest. The Social Vulnerability Index and single-parent households were studied as mediators. Main Outcomes and Measures Race-specific firearm homicide rates were the outcomes of interest. Structural equation modeling was used to understand the mediating effect of social vulnerability and single-parent households on the association of incarceration with firearm homicides. Results A total of 46 312 census blocks were evaluated. Black-specific incarceration rates were found to be associated with Black-specific firearm homicides (incidence rate ratio [IRR], 1.70; 95% CI, 1.50-1.94), but there was no association for Hispanic incarceration rates (IRR, 0.98; 95% CI, 0.75-1.28) or White incarceration rates (IRR, 1.13; 95% CI, 0.39-1.16). In the association of Black incarceration rates with Black firearm homicide rates, social vulnerability did not mediate the interaction, but the percentage of single-parent households mediated 23% of the interaction. Conclusions and Relevance This study found that higher rates of incarceration were associated with increased rates of firearm homicides among Black communities alone; this association was found to be mediated partially through the density of single-parent households in these areas, suggesting that social disorganization resulting from mass incarceration may perpetuate firearm homicides. Targeted policies addressing mass incarceration and the disparities therein may be a means of reducing urban firearm homicides.
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Affiliation(s)
- Michael Poulson
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Kian Riley
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Maha Haqqani
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Kaye-Alese Green
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Dane Scantling
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Higginbotham GD. The Dark Side of Safety: A Call for a More Thorough Consideration of Racism and Collective Power Motivations in the Social Psychology of Firearms. Psychol Rep 2024:332941241252773. [PMID: 38830782 DOI: 10.1177/00332941241252773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
This paper situates current social psychological research on the symbolic use of firearms (e.g., as a source of personal safety) in broader historical context to motivate a more thorough consideration of collective power motives. Historically, firearms have been used to dominate racial outgroup members (e.g., White Americans use of firearms and firearm laws to dispossess indigenous people of land or control free and enslaved Black people) or, at times, attempt to resist group-based oppression (e.g., Black Americans use of firearms to struggle against White Jim Crow terrorism). Given most gun owners report self-protection as their primary reason for firearm ownership and yet anti-Black attitudes are still a consistently important predictor of firearm ownership among dominant group members (e.g., White Americans), this paper examines how guns may function as a perceived source of personal safety and collective power. I center the persistent role of White supremacy and anti-Blackness in original U.S. firearm psychology and policy to illuminate the interrelatedness of personal safety and collective power perceptions, and how perceived threats to in-group power may motivate the use of guns and policies that selectively regulate gun access to mitigate associated safety concerns. Seeking to nudge social psychology to more thoroughly examine firearms' potential function as a symbolic source of collective power, I end by discussing how considering collective power can help us better understand how historically dominant and historically marginalized groups view firearms today while also illuminating some barriers to the pursuit of gun safety for all.
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Affiliation(s)
- Gerald D Higginbotham
- Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, VA, USA
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Gause EL, McLone SG, Cunningham M, Jay J. Community-Academic Partnership to Assess the Role of Physical Disinvestment on Firearm Violence in Toledo, OH. J Urban Health 2024; 101:584-594. [PMID: 38771432 PMCID: PMC11189884 DOI: 10.1007/s11524-024-00870-y] [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: 04/05/2024] [Indexed: 05/22/2024]
Abstract
Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case-control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95% CI: 1.36, 2.07) higher odds of shooting incidence. Across all other measures, greater disinvestment was associated with higher odds of shooting incidence. Our finding of a strong association between physical disinvestment and firearm violence in Toledo can inform local action. Community-academic partnership could help increase adoption of violence prevention strategies focused on reversing physical disinvestment.
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Affiliation(s)
- Emma L Gause
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, USA.
- Firearm Injury and Policy Research Program, University of Washington, Seattle, WA, USA.
| | - Suzanne G McLone
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Malcolm Cunningham
- Mayor's Office of Neighborhood Safety and Engagement, City of Toledo, OH, USA
- Bloomberg American Health Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Carter PM, Seewald L, Zimmerman M. Injury Prevention Science and Firearm Injury in Pediatric Health. JAMA 2024; 331:1712-1713. [PMID: 38703402 DOI: 10.1001/jama.2024.4208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
MESH Headings
- Adolescent
- Child
- Humans
- Firearms/legislation & jurisprudence
- Firearms/statistics & numerical data
- United States/epidemiology
- Wounds, Gunshot/epidemiology
- Wounds, Gunshot/ethnology
- Wounds, Gunshot/prevention & control
- Infant
- Child, Preschool
- Young Adult
- Child Health
- Wounds and Injuries/epidemiology
- Wounds and Injuries/prevention & control
- Black or African American/statistics & numerical data
- American Indian or Alaska Native/statistics & numerical data
- Homicide/ethnology
- Homicide/statistics & numerical data
- Homicide/trends
- Suicide/ethnology
- Suicide/statistics & numerical data
- Suicide/trends
- Accidents, Traffic/history
- Accidents, Traffic/prevention & control
- Accidents, Traffic/statistics & numerical data
- Accidents, Traffic/trends
- History, 20th Century
- History, 21st Century
- Health Inequities
- Public Health Practice
- Accident Prevention/legislation & jurisprudence
- Accident Prevention/methods
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Affiliation(s)
- Patrick M Carter
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Laura Seewald
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Marc Zimmerman
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor
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Dholakia A, Burdick KJ, Kreatsoulas C, Monuteaux MC, Tsai J, Subramanian SV, Fleegler EW. Historical Redlining and Present-Day Nonsuicide Firearm Fatalities. Ann Intern Med 2024; 177:592-597. [PMID: 38648643 DOI: 10.7326/m23-2496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Redlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential health implications of this federally sanctioned segregation. OBJECTIVE To examine the relationship between historical redlining policies and present-day nonsuicide firearm fatalities. DESIGN Maps from the HOLC were overlaid with incidence of nonsuicide firearm fatalities from 2014 to 2022. A multilevel negative binomial regression model tested the association between modern-day firearm fatalities and HOLC historical grading (A ["best"] to D ["hazardous"]), controlling for year, HOLC area-level demographics, and state-level factors as fixed effects and a random intercept for city. Incidence rates (IRs) per 100 000 persons, incidence rate ratios (IRRs), and adjusted IRRs (aIRRs) for each HOLC grade were estimated using A-rated areas as the reference. SETTING 202 cities with areas graded by the HOLC in the 1930s. PARTICIPANTS Population of the 8597 areas assessed by the HOLC. MEASUREMENTS Nonsuicide firearm fatalities. RESULTS From 2014 to 2022, a total of 41 428 nonsuicide firearm fatalities occurred in HOLC-graded areas. The firearm fatality rate increased as the HOLC grade progressed from A to D. In A-graded areas, the IR was 3.78 (95% CI, 3.52 to 4.05) per 100 000 persons per year. In B-graded areas, the IR, IRR, and aIRR relative to A areas were 7.43 (CI, 7.24 to 7.62) per 100 000 persons per year, 2.12 (CI, 1.94 to 2.32), and 1.42 (CI, 1.30 to 1.54), respectively. In C-graded areas, these values were 11.24 (CI, 11.08 to 11.40) per 100 000 persons per year, 3.78 (CI, 3.47 to 4.12), and 1.90 (CI, 1.75 to 2.07), respectively. In D-graded areas, these values were 16.26 (CI, 16.01 to 16.52) per 100 000 persons per year, 5.51 (CI, 5.05 to 6.02), and 2.07 (CI, 1.90 to 2.25), respectively. LIMITATION The Gun Violence Archive relies on media coverage and police reports. CONCLUSION Discriminatory redlining policies from 80 years ago are associated with nonsuicide firearm fatalities today. PRIMARY FUNDING SOURCE Fred Lovejoy Housestaff Research and Education Fund.
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Affiliation(s)
- Ayesha Dholakia
- Department of Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts (A.D., K.J.B.)
| | - Kendall J Burdick
- Department of Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts (A.D., K.J.B.)
| | | | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts (M.C.M.)
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, and St. Joseph's Medical Center in Stockton, Stockton, California (J.T.)
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, and Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (S.V.S.)
| | - Eric W Fleegler
- Department of Emergency Medicine, Massachusetts General Hospital, and Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts (E.W.F.)
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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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Goyal A, Labellarte PZ, Hayes AA, Bicek J, Barrera L, Becker AB, Rowell B, Brewer AG. Screening for Youth Firearm Violence Exposure in Primary Care. AJPM FOCUS 2024; 3:100146. [PMID: 38089425 PMCID: PMC10711457 DOI: 10.1016/j.focus.2023.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction The aim of this study was to assess a modified gun violence exposure tool at a pediatric clinic on the West Side of Chicago to identify youth at high risk of future gun violence. Methods A modified version of the SaFETy gun violence exposure tool, studied in a community pediatric primary care setting, was implemented from June to August 2021. Patients and pediatric clinicians were surveyed after pilot. Results Of 508 eligible patients, 341 youth (67.1%) completed the SaFETy tool. None had a SaFETy score ≥6, the threshold for immediate referral. Over a quarter (26.4%) of youth had scores of 1-5, and of those, 7.8% were referred at the clinician's discretion. Youth (n=84) participants randomly selected to complete an anonymous survey provided feedback about the SaFETY tool, reporting that the questions were easy to understand (92%). All 6 pediatric clinicians surveyed agreed that the tool helped to identify youth exposed to gun violence. Conclusions Screening for gun violence exposure among youth is logistically feasible in the pediatric outpatient setting. A more sensitive validated tool to stratify low-/medium-risk patients in the primary care setting is needed.
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Affiliation(s)
- Ansh Goyal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Ashley A. Hayes
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - J.C. Bicek
- Lawndale Christian Health Center, Chicago, Illinois
| | - Leonardo Barrera
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Adam B. Becker
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bruce Rowell
- Lawndale Christian Health Center, Chicago, Illinois
| | - Audrey G. Brewer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Senior R, Pickett L, Stirling A, Dash S, Gorgone P, Durst G, Jones D, Shannon R, Bhavsar NA, Bedoya A. Development of an interactive dashboard for gun violence pattern analysis and intervention design at the local level. JAMIA Open 2023; 6:ooad105. [PMID: 38088956 PMCID: PMC10712903 DOI: 10.1093/jamiaopen/ooad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/09/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Gun violence remains a concerning and persistent issue in our country. Novel dashboards may integrate and summarize important clinical and non-clinical data that can inform targeted interventions to address the underlying causes of gun violence. Methods Data from various clinical and non-clinical sources were sourced, cleaned, and integrated into a customizable dashboard that summarizes and provides insight into the underlying factors that impact local gun violence episodes. Results The dashboards contained data from 7786 encounters and 1152 distinct patients from our Emergency Department's Trauma Registry with various patterns noted by the team. A multidisciplinary executive team, including subject matter experts in community-based interventions, epidemiology, and social sciences, was formed to design targeted interventions based on these observations. Conclusion Targeted interventions to reduce gun violence require a multimodal data sourcing and standardization approach, the inclusion of neighborhood-level data, and a dedicated multidisciplinary team to act on the generated insights.
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Affiliation(s)
- Rashaud Senior
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Lisa Pickett
- Duke University Health System, Durham, NC 27710, United States
| | - Andrew Stirling
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Shwetha Dash
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Patti Gorgone
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Georgina Durst
- Duke University Health System, Durham, NC 27710, United States
| | - Debra Jones
- Duke University Health System, Durham, NC 27710, United States
| | - Richard Shannon
- Duke University Health System, Durham, NC 27710, United States
| | - Nrupen A Bhavsar
- Department of Medicine, Duke University Hospital, Durham, NC, United States
| | - Armando Bedoya
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
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11
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Donnelly KA, Goyal MK. The Epidemiology of Violence Exposure in Children. Pediatr Clin North Am 2023; 70:1057-1068. [PMID: 37865430 DOI: 10.1016/j.pcl.2023.06.005] [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] [Indexed: 10/23/2023]
Abstract
Exposure to violence remains a significant issue for children in the United States. The COVID-19 pandemic exacerbated many of these exposures. Violence unequally impacts children of color and lesbian, gay, bisexual, transgender, and questioning youth. Pediatricians can and must continue to advocate and intervene to decrease pediatric violence exposure and its effects.
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Affiliation(s)
- Katie A Donnelly
- Children's National Hospital, The George Washington University, 111 Michigan Avenue NW, Washington, DC 20010, USA.
| | - Monika K Goyal
- Children's National Hospital, The George Washington University, 111 Michigan Avenue NW, Washington, DC 20010, USA
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12
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Ghio M, Simpson JT, Ali A, Fleckman JM, Theall KP, Constans JI, Tatum D, McGrew PR, Duchesne J, Taghavi S. Association Between Markers of Structural Racism and Mass Shooting Events in Major US Cities. JAMA Surg 2023; 158:1032-1039. [PMID: 37466952 PMCID: PMC10357360 DOI: 10.1001/jamasurg.2023.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/22/2023] [Indexed: 07/20/2023]
Abstract
Importance The root cause of mass shooting events (MSEs) and the populations most affected by them are poorly understood. Objective To examine the association between structural racism and mass shootings in major metropolitan cities in the United States. Design, Setting, and Participants This cross-sectional study of MSEs in the 51 largest metropolitan statistical areas (MSAs) in the United States analyzes population-based data from 2015 to 2019 and the Gun Violence Archive. The data analysis was performed from February 2021 to January 2022. Exposure Shooting event where 4 or more people not including the shooter were injured or killed. Main Outcome and Measures MSE incidence and markers of structural racism from demographic data, Gini income coefficient, Black-White segregation index, and violent crime rate. Results There were 865 MSEs across all 51 MSAs from 2015 to 2019 with a total of 3968 injuries and 828 fatalities. Higher segregation index (ρ = 0.46, P = .003) was associated with MSE incidence (adjusted per 100 000 population) using Spearman ρ analysis. Percentage of the MSA population comprising Black individuals (ρ = 0.76, P < .001), children in a single-parent household (ρ = 0.44, P < .001), and violent crime rate (ρ = 0.34, P = .03) were other variables associated with MSEs. On linear regression, structural racism, as measured by percentage of the MSA population comprising Black individuals, was associated with MSEs (β = 0.10; 95% CI, 0.05 to 0.14; P < .001). Segregation index (β = 0.02, 95% CI, -0.03 to 0.06; P = .53), children in a single-parent household (β = -0.04, 95% CI, -0.11 to 0.04; P = .28), and Gini income coefficient (β = -1.02; 95% CI, -11.97 to 9.93; P = .93) were not associated with MSEs on linear regression. Conclusions and Relevance This study found that major US cities with higher populations of Black individuals are more likely to be affected by MSEs, suggesting that structural racism may have a role in their incidence. Public health initiatives aiming to prevent MSEs should target factors associated with structural racism to address gun violence.
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Affiliation(s)
- Michael Ghio
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - John Tyler Simpson
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ayman Ali
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Julia M. Fleckman
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katherine P. Theall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Joseph I. Constans
- Tulane University School of Science & Engineering, New Orleans, Louisiana
| | - Danielle Tatum
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Patrick R. McGrew
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Juan Duchesne
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
- University Medical Center, New Orleans, Louisiana
| | - Sharven Taghavi
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
- University Medical Center, New Orleans, Louisiana
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13
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Quinn KG, Hunt BR, Jacobs J, Valencia J, Voisin D, Walsh JL. Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination. Behav Med 2023:1-10. [PMID: 37578320 PMCID: PMC10864675 DOI: 10.1080/08964289.2023.2244626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 08/15/2023]
Abstract
In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin
| | - Bijou R Hunt
- Sinai Health System, Sinai Infectious Disease Center
| | | | | | - Dexter Voisin
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin
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14
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Lawrence WR, Freedman ND, McGee-Avila JK, Berrington de González A, Chen Y, Emerson MA, Gee GC, Haozous EA, Haque AT, Inoue-Choi M, Jackson SS, Lord B, Nápoles AM, Pérez-Stable EJ, Vo JB, Williams F, Shiels MS. Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020. JAMA Intern Med 2023; 183:849-856. [PMID: 37399025 PMCID: PMC10318548 DOI: 10.1001/jamainternmed.2023.2509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/30/2023] [Indexed: 07/04/2023]
Abstract
Importance Although deaths due to external causes are a leading cause of mortality in the US, trends over time by intent and demographic characteristics remain poorly understood. Objective To examine national trends in mortality rates due to external causes from 1999 to 2020 by intent (homicide, suicide, unintentional, and undetermined) and demographic characteristics. External causes were defined as poisonings (eg, drug overdose), firearms, and all other injuries, including motor vehicle injuries and falls. Given the repercussions of the COVID-19 pandemic, US death rates for 2019 and 2020 were also compared. Design, Setting, and Participants Serial cross-sectional study using national death certificate data obtained from the National Center for Health Statistics and including all external causes of 3 813 894 deaths among individuals aged 20 years or older from January 1, 1999, to December 31, 2020. Data analysis was conducted from January 20, 2022, to February 5, 2023. Exposures Age, sex, and race and ethnicity. Main Outcomes and Measures Trends in age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined), age, sex, and race and ethnicity for each external cause. Results Between 1999 and 2020, there were 3 813 894 deaths due to external causes in the US. From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries. Conclusions and Relevance Results of this cross-sectional study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the US. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.
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Affiliation(s)
- Wayne R. Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jennifer K. McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Marc A. Emerson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles
| | - Emily A. Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico
| | - Anika T. Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Sarah S. Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Brittany Lord
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Eliseo J. Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Jacqueline B. Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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15
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Aubel AJ, Bruns A, Zhang X, Buggs S, Kravitz-Wirtz N. Neighborhood collective efficacy and environmental exposure to firearm homicide among a national sample of adolescents. Inj Epidemiol 2023; 10:24. [PMID: 37296449 DOI: 10.1186/s40621-023-00435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Living near an incident of firearm violence can negatively impact youth, regardless of whether the violence is experienced firsthand. Inequities in household and neighborhood resources may affect the prevalence and consequences of exposure across racial/ethnic groups. FINDINGS Using data from the Future of Families and Child Wellbeing Study and the Gun Violence Archive, we estimate that approximately 1 in 4 adolescents in large US cities lived within 800 m (0.5 miles) of a past-year firearm homicide during 2014-17. Exposure risk decreased as household income and neighborhood collective efficacy increased, though stark racial/ethnic inequities remained. Across racial/ethnic groups, adolescents in poor households in moderate or high collective efficacy neighborhoods had a similar risk of past-year firearm homicide exposure as middle-to-high income adolescents in low collective efficacy neighborhoods. CONCLUSIONS Empowering communities to build and leverage social ties may be as impactful for reducing firearm violence exposure as income supports. Comprehensive violence prevention efforts should include systems-level strategies that jointly strengthen family and community resources.
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Affiliation(s)
- Amanda J Aubel
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Angela Bruns
- Department of Sociology and Criminology, Gonzaga University, 502 E Boone Ave, Spokane, WA, 99258, USA
| | - Xiaoya Zhang
- Department of Family, Youth and Community Sciences, Institute of Food and Agricultural Sciences, University of Florida, 1604 McCarty Drive, PO Box 110310, Gainesville, FL, 32611, USA
| | - Shani Buggs
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Nicole Kravitz-Wirtz
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, USA
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16
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Buggs SA, Lund JJ, Kravitz-Wirtz N. Voicing narratives of structural violence in interpersonal firearm violence research and prevention in the United States. Front Public Health 2023; 11:1143278. [PMID: 37333568 PMCID: PMC10272797 DOI: 10.3389/fpubh.2023.1143278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Violence is defined as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation." Encompassed in this definition are multiple, interrelated forms of violence, including interpersonal firearm death and injury, but also the systems, policies, and practices enacted by those with power to advantage some groups while depriving others of meaningful opportunities for meeting their basic needs-known as "structural violence". Yet dominant violence prevention narratives too often ignore or deemphasize the deeply intertwined threads of structural violence with other forms of violence, leading to policies and practices that are frequently insufficient, and often harmful, for reducing interpersonal firearm violence and building community safety, particularly in minoritized and structurally marginalized communities. We highlight ways in which limited scrutiny of structural violence, the omission of its defining characteristics-power and deprivation-from functional characterizations and frameworks of interpersonal firearm violence, and the inadequate distribution of power and resources to those most impacted by violence to self-determine narratives of and solutions to interpersonal firearm violence grossly impacts how interpersonal firearm violence is collectively conceived, discussed, and addressed. Expanding dominant narratives of interpersonal firearm violence, guided by the wisdom and determination of those most impacted, such that the goal of prevention and intervention efforts is not merely the absence of violence but rather the creation of a community safety and health ecosystem is essential to meet this critical moment in firearm violence research and prevention.
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17
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Gobaud AN, Mehranbod CA, Kaufman E, Jay J, Beard JH, Jacoby SF, Branas CC, Bushover B, Morrison CN. Assessing the Gun Violence Archive as an Epidemiologic Data Source for Community Firearm Violence in 4 US Cities. JAMA Netw Open 2023; 6:e2316545. [PMID: 37266937 PMCID: PMC10238941 DOI: 10.1001/jamanetworkopen.2023.16545] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023] Open
Abstract
Importance Firearm injury is a major public health burden in the US, and yet there is no single, validated national data source to study community firearm violence, including firearm homicide and nonfatal shootings that result from interpersonal violence. Objective To assess the validity of the Gun Violence Archive as a source of data on events of community firearm violence and to examine the characteristics of individuals injured in shootings. Design, Setting, and Participants This cross-sectional observational study compared data on community firearm violence from the Gun Violence Archive with publicly available police department data, which were assumed to be the reference standard, between January 1, 2015, and December 31, 2020. Cities included in the study (Philadelphia, Pennsylvania; New York, New York; Chicago, Illinois; and Cincinnati, Ohio) had a population of greater than 300 000 people according to the 2020 US Census and had publicly available shooting data from the city police department. A large city was defined as having a population greater than or equal to 500 000 (ie, Philadelphia, New York City, and Chicago). Data analysis was performed in December 2022. Main Outcomes and Measures Events of community firearm violence from the Gun Violence Archive were matched to police department shootings by date and location. The sensitivity and positive predictive value of the data were calculated (0.9-1.0, excellent; 0.8-0.9, good; 0.7-0.8, fair; 0.6-0.7, poor; and <0.6, failed). Results A total of 26 679 and 32 588 shooting events were documented in the Gun Violence Archive and the police department databases, respectively, during the study period. The overall sensitivity of the Gun Violence Archive over the 6-year period was 81.1%, and the positive predictive value was 99.0%. The sensitivity steadily improved over time. Shootings involving multiple individuals and those involving women and children were less likely to be missing from the Gun Violence Archive, suggesting a systematic missingness. Conclusions and Relevance These findings support the use of the Gun Violence Archive in large cities for research requiring its unique advantages (ie, spatial resolution, timeliness, and geographic coverage), albeit with caution regarding a more granular examination of epidemiology given its apparent bias toward shootings involving multiple persons and those involving women and children.
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Affiliation(s)
- Ariana N. Gobaud
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Christina A. Mehranbod
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Jessica H. Beard
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Sara F. Jacoby
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Charles C. Branas
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Brady Bushover
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Christopher N. Morrison
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
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18
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Bond AE, Brooks JR, Rodriguez TR, Bandel SL, Anestis MD. Examining characteristics and experiences of Black firearm owners. J Clin Psychol 2023. [PMID: 37190950 DOI: 10.1002/jclp.23532] [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: 10/03/2022] [Revised: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The present study sought to better understand the characteristics of those who own firearms in the Black community; and to understand how Black firearm owners differ from nonfirearm owning Black individuals on a variety of variables related to safety, threat concerns, and suicide risk. METHODS Two samples were utilized in this study. The first was a subsample of those who identified as Black from a nationally representative sample (N = 502) seeking to understand firearm ownership within the United States. The second used a subsample of those who identified as Black (N = 1086) from a representative sample from New Jersey, Minnesota, and Mississippi. Variables related to safety and threat concerns were included in the second sample. RESULTS In both samples, multiple demographic variables, such as being a woman and having higher education, predicted firearm ownership. In the second sample, experiences of everyday discrimination and crime experiences were associated with firearm ownership. Additionally, Black firearm owners reported significantly more suicidal ideation than Black nonfirearm owners. CONCLUSION The findings demonstrate the unique characteristics and experiences of Black firearm owners and show that firearm ownership is associated with increased suicide risk factors for Black adults. Findings should be used to advocate for the creation of more culturally relevant suicide prevention and firearm means safety strategies.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Jasmin R Brooks
- Department of Psychology, The University of Houston, Houston, Texas, USA
| | - Taylor R Rodriguez
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
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19
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Nistler CM, James TL, Dugan E, Pino EC. Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2286-2312. [PMID: 35604722 DOI: 10.1177/08862605221101395] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3 years after surviving a penetrating injury.Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3 years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population.
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Affiliation(s)
- Conor M Nistler
- 27118Boston University School of Public Health, Boston, MA, USA
| | - Thea L James
- Department of Emergency Medicine, Boston Violence Intervention Advocacy Program (VIAP), 1836Boston Medical Center, Boston, MA, USA
| | - Elizabeth Dugan
- Department of Emergency Medicine, Boston Violence Intervention Advocacy Program (VIAP), 1836Boston Medical Center, Boston, MA, USA
| | - Elizabeth C Pino
- Department of Emergency Medicine, Boston Violence Intervention Advocacy Program (VIAP), 1836Boston Medical Center, Boston, MA, USA
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20
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Haddad DN, Kaufman EJ. Rising Rates of Homicide of Children and Adolescents: Preventable and Unacceptable. JAMA Pediatr 2023; 177:117-119. [PMID: 36534406 DOI: 10.1001/jamapediatrics.2022.4946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Diane N Haddad
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
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21
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Motairek I, Chen Z, Makhlouf MH, Rajagopalan S, Al-Kindi S. Historical Neighborhood Redlining and Contemporary Environmental Racism. LOCAL ENVIRONMENT 2022; 28:518-528. [PMID: 37588138 PMCID: PMC10427113 DOI: 10.1080/13549839.2022.2155942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/13/2022] [Indexed: 08/18/2023]
Abstract
To stabilize the housing market during the great depression, the government-sanctioned Home Owners' Loan Corporation (HOLC) created color coded maps of nearly 200 United States cities according to lending risk. These maps were largely driven by racial segregation, with the worst graded neighborhoods colored in red, later termed redlined neighborhoods. We sought to investigate the association between historical redlining, and trends in environmental disparities across the US over the past few decades. We characterized environmental exposures including air pollutants (e.g., NO2 and fine particulate matter), vegetation, noise, and light at night, proximity hazardous emission sources (e.g., hazardous water facilities, wastewater discharge indicator) and other environmental and social indicators harnessed from various sources across HOLC graded neighborhoods and extrapolated census tracts (A [lowest risk neighborhoods] to D [highest risk neighborhoods]). Lower graded areas (C and D) had consistently higher exposures to worse environmental factors. Additionally, there were consistent relative disparities in the exposures to PM2.5 (1981-2018) and NO2 (2005-2019), without significant improvement in the gap compared with HOLC grade A neighborhoods. Our findings illustrate that historical redlining, a form of residential segregation largely based on racial discrimination is associated with environmental injustice over the past 2-4 decades.
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Affiliation(s)
- Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Mohamed H.E. Makhlouf
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
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22
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The Relationship of Historical Redlining with Present-Day Neighborhood Environmental and Health Outcomes: A Scoping Review and Conceptual Model. J Urban Health 2022; 99:959-983. [PMID: 35915192 PMCID: PMC9342590 DOI: 10.1007/s11524-022-00665-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/31/2022]
Abstract
Following the Great Depression and related home foreclosures, the federal government established new agencies to facilitate access to affordable home mortgages, including the Home Owners' Loan Corporation (HOLC) and Federal Housing Administration (FHA). HOLC and FHA directed widespread neighborhood appraisals to determine investment risk, referred to as "redlining," which took into account residents' race. Redlining thereby contributed to segregation, disinvestment, and racial inequities in opportunities for homeownership and wealth accumulation. Recent research examines associations between historical redlining and subsequent environmental determinants of health and health-related outcomes. In this scoping review, we assess the extent of the current body of evidence, the range of outcomes studied, and key study characteristics, examining the direction and strength of the relationship between redlining, neighborhood environments, and health as well as different methodological approaches. Overall, studies nearly universally report evidence of an association between redlining and health-relevant outcomes, although heterogeneity in study design precludes direct comparison of results. We critically consider evidence regarding HOLC's causality and offer a conceptual framework for the relationship between redlining and present-day health. Finally, we point to key directions for future research to improve and broaden understanding of redlining's enduring impact and translate findings into public health and planning practice.
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23
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Burgdorf CE, Maholmes V, O’Connor S, Blachman-Demner DR. Emerging research areas and contributions of NIH in violence research across the lifespan and throughout different settings. Transl Behav Med 2022; 12:956-964. [DOI: 10.1093/tbm/ibac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
This commentary provides background for NIH’s interest in research designed to better understand the causes and consequences of violence and the development, evaluation, and implementation of preventive and treatment interventions to address the resulting trauma, injuries, and mortality from violence. The manuscript describes the context that contributed to a range of initiatives from the NIH focused on violence research, with a particular emphasis on firearms violence prevention research, and opportunities and gaps for future research.
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Affiliation(s)
- Caitlin E Burgdorf
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD 20892 , USA
| | - Valerie Maholmes
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD 20892 , USA
| | - Stephen O’Connor
- National Institute of Mental Health, National Institutes of Health , Bethesda, MD 20892 , USA
| | - Dara R Blachman-Demner
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD 20892 , USA
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24
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Ou Z, Ren Y, Duan D, Tang S, Zhu S, Feng K, Zhang J, Liang J, Su Y, Zhang Y, Cui J, Chen Y, Zhou X, Mao C, Wang Z. Global burden and trends of firearm violence in 204 countries/territories from 1990 to 2019. Front Public Health 2022; 10:966507. [PMID: 36111185 PMCID: PMC9470124 DOI: 10.3389/fpubh.2022.966507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/02/2022] [Indexed: 01/24/2023] Open
Abstract
Background Gaps remained in the updated information of the firearm violence (FV) burden from a global landscape. Understanding the global burden of FV could contribute to decision-making. Methods Data on the FV burden, including physical violence by firearm (PVF), self-harm by firearm (SHF), and unintentional firearm injuries (UFI), were extracted from the Global Burden of Disease 2019. The temporal trends of age-standardized rate (ASR) were estimated using estimated annual percentage change (EAPC). Results In 2019, PVF, SHF, and UFI reported 710.64 × 103, 335.25 × 103, and 2,133.88 × 103, respectively, incident cases worldwide. Their ASR (/100,000 people-years) were 9.31, 4.05, and 28.07. During 1990-2019, the overall incident ASRs of PVF presented an increasing trend (EAPC = 0.61, 95% confidence interval [CI]: 0.48 to 0.75). Notably, pronounced increasing trends were observed in Tropical Latin America, and North Africa and Middle East. However, incident trends of SHF and UFI declined globally, with the respective EAPCs being -0.68 (95% CI: -0.83 to -0.54) and -0.98 (95% CI: -1.19 to -0.77). In 2019, the ASR of death due to PVF, SHF, and UFI were 2.23, 0.65, and 0.26, and that of DALYs were 127.56, 28.10, and 17.64, respectively. Decreasing trends in the ASRs of FV were observed in most regions and countries worldwide over the past three decades, particularly that of PVF in Estonia. Conclusion The FV burden was heterogeneous across regions and countries, which was deeply subjected to socioeconomic factors. The findings highlighted that specific prevention strategies and interventions were required, particularly in the high prevalent settings.
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Affiliation(s)
- Zejin Ou
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yixian Ren
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Danping Duan
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Shihao Tang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Shaofang Zhu
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Kexin Feng
- Department of Hematology, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jinwei Zhang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jiabin Liang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yiwei Su
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yuxia Zhang
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Jiaxin Cui
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuquan Chen
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Xueqiong Zhou
- Department of Occupational Health and Medicine, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China,Chen Mao
| | - Zhi Wang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China,Chen Mao
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25
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Kravitz-Wirtz N, Bruns A, Aubel AJ, Zhang X, Buggs SA. Inequities in Community Exposure to Deadly Gun Violence by Race/Ethnicity, Poverty, and Neighborhood Disadvantage among Youth in Large US Cities. J Urban Health 2022; 99:610-625. [PMID: 35672546 PMCID: PMC9172977 DOI: 10.1007/s11524-022-00656-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 01/31/2023]
Abstract
Understanding the burden of gun violence among youth is a public health imperative. While most estimates are based on direct and witnessed victimization, living nearby gun violence incidents may be consequential too. Yet detailed information about these broader experiences of violence is lacking. We use data on a population-based cohort of youth merged with incident-level data on deadly gun violence to assess the prevalence and intensity of community exposure to gun homicides across cross-classified categories of exposure distance and recency, overall and by race/ethnicity, household poverty, and neighborhood disadvantage. In total, 2-18% of youth resided within 600 m of a gun homicide occurring in the past 14-365 days. These percentages were 3-25% for incidents within 800 m and 5-37% for those within a 1300-m radius. Black and Latinx youth were 3-7 times more likely, depending on the exposure radius, to experience a past-year gun homicide than white youth and on average experienced incidents more recently and closer to home. Household poverty contributed to exposure inequities, but disproportionate residence in disadvantaged neighborhoods was especially consequential: for all racial/ethnic groups, the difference in the probability of exposure between youth in low vs high poverty households was approximately 5-10 percentage points, while the difference between youth residing in low vs high disadvantage neighborhoods was approximately 50 percentage points. Given well-documented consequences of gun violence exposure on health, these more comprehensive estimates underscore the importance of supportive strategies not only for individual victims but entire communities in the aftermath of gun violence.
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Affiliation(s)
- Nicole Kravitz-Wirtz
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Boulevard, Sacramento, CA, 95817, USA.
| | - Angela Bruns
- Department of Sociology & Criminology, Gonzaga University, Spokane, WA, USA
| | - Amanda J Aubel
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Boulevard, Sacramento, CA, 95817, USA
| | - Xiaoya Zhang
- Department of Human Ecology, University of California Davis, Davis, CA, USA
| | - Shani A Buggs
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Boulevard, Sacramento, CA, 95817, USA
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26
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Fischer KR, Walton E, Jasani GN. United States' Infrastructure Bill Contains Hidden $15 Billion Investment in Violence Prevention: Lead Abatement. Front Public Health 2022; 10:885460. [PMID: 35874975 PMCID: PMC9301236 DOI: 10.3389/fpubh.2022.885460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kyle R. Fischer
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- *Correspondence: Kyle R. Fischer
| | - Erin Walton
- Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, United States
| | - Gregory N. Jasani
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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27
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Degli Esposti M, Gravel J, Kaufman EJ, Delgado MK, Richmond TS, Wiebe DJ. County-Level Variation in Changes in Firearm Mortality Rates Across the US, 1989 to 1993 vs 2015 to 2019. JAMA Netw Open 2022; 5:e2215557. [PMID: 35666501 PMCID: PMC9171565 DOI: 10.1001/jamanetworkopen.2022.15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Firearm violence remains a critical public health challenge, disproportionately impacting some US regions. County-level variation may hold key insights into how firearm mortality rates vary across the US. OBJECTIVE To model county-level changes in firearm mortality rates (total, homicide, and suicide) from 1989 to 1993 vs 2015 to 2019 and identify and characterize hot spots showing unexpected changes over time. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study with 2 time points using a novel small area estimation method to analyze restricted access mortality microdata by cause of death and US county. The analysis included 3111 US counties from 49 states and the District of Columbia from January 1, 1989, to December 31, 2019. Bayesian spatial models were fitted to map geographical variation in changes in age-standardized firearm mortality rates (per 100 000 person-years) from 1989 to 1993 vs 2015 to 2019. County outliers (or hot spots) were defined as having observed rates that fell outside the 95% credible intervals of their expected posterior predictive distribution. These counties were characterized using visualization and descriptive statistics of their characteristics. Data were analyzed from June to December 2021. EXPOSURES County of residence. MAIN OUTCOMES AND MEASURES Five-year age-standardized mortality rates by US county, age, and cause of death for 1989 to 1993 and 2015 to 2019. RESULTS Between 1989 and 2019, 1 036 518 firearm deaths were recorded in counties across the US. Suicide was the most common cause of firearm mortality (589 285 deaths) followed by homicide (412 231 deaths). Age-standardized rates (deaths per 100 000 individuals) for firearm deaths and suicides increased from 1989 to 1993 vs 2015 to 2019 (mean [SD] change, 0.16 [8.78] for firearm deaths and 1.21 [6.91] for suicides), while firearm homicides decreased (mean [SD] change, -0.39 [3.96]). However, these national trends were not homogeneous across counties and often varied by geographical region. The West and Midwest showed the most pronounced increases in firearm suicide rates, whereas the Southeast showed localized increases in firearm homicide rates, despite the national decreasing trend. Critical hot spots were identified in urban counties of Alabama, and firearm homicide rates (per 100 000) in Baltimore City, Maryland, almost doubled from 29.71 to 47.43, and by 2015 to 2019 it accounted for 66.7% of all firearm homicide in Maryland. By contrast, District of Columbia showed promising improvements over time, decreasing from 56.5 firearm homicides per 100 000 in 1989 to 1993 to 14.45 in 2015 to 2019. CONCLUSIONS AND RELEVANCE There was substantial variation in rates and changes in firearm deaths among US counties. Geographical hot spots may be useful to inform targeted prevention efforts and local policy responses.
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Affiliation(s)
- Michelle Degli Esposti
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jason Gravel
- Department of Criminal Justice, Temple University, Philadelphia, Pennsylvania
| | - Elinore J. Kaufman
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - M. Kit Delgado
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Therese S. Richmond
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia
| | - Douglas J. Wiebe
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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