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Uzzi M, Whittaker S, Esposito MH, Dean LT, Buggs SA, Pollack Porter KM. Racial capitalism and firearm violence: Developing a theoretical framework for firearm violence research examining structural racism. Soc Sci Med 2024; 358:117255. [PMID: 39197276 DOI: 10.1016/j.socscimed.2024.117255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 08/05/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024]
Abstract
Despite the early promise of centering structural racism in explanatory models of firearm violence, there are noticeable gaps in what's been produced thus far; in particular, a deeper and more serious engagement with long-standing theories of racism is needed to further enrich our understanding of how structural inequalities produce unequal burdens of firearm-related harms. Thus, building on theories and concepts from a range of academic fields and Black philosophical perspectives, we developed a theoretical framework to help explain the role of place-based structural racism on firearm violence disparities. A central component of our framework is the concept racial capitalism, which contends that racial exploitation and the accumulation of assets depend on and reinforce one another. In this article, we present our framework and highlight how two processes related to racial capitalism-racialized dispossession and racialized spatial stigma-are connected with geographic disparities in firearm violence. We also present the results of an ecological cross-sectional study that reveals a potential key association between racial capitalism and firearm violence disparities on the neighborhood-level. We used a structural intersectionality approach and descriptive epidemiological methods to highlight and quantitatively describe spatial firearm violence disparities that could potentially be linked to the varying exposure of two dimensions of racial capitalism-historical redlining and contemporary racialized subprime mortgage lending. We found that sustained disadvantaged census tracts (tracts that were historically redlined and experienced higher contemporary subprime lending) experienced the highest burden of firearm violence in Baltimore City between 2015 and 2019. Our research suggests that racial capitalism could potentially be a root cause of firearm violence disparities. A theoretical framework based on racial capitalism can inform the development and usage of indicators and analytic methods for racism-related firearm violence research. Moreover, this framework can identify factors to prioritize in equity-based violence prevention policies and programs.
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Affiliation(s)
- Mudia Uzzi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 750 East Pratt Street, 15th floor, Baltimore, MD, 21202, USA.
| | - Shannon Whittaker
- Department of Social and Behavioral Sciences, Yale School of Public Health, USA
| | | | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Shani A Buggs
- Department of Emergency Medicine, University of California, Davis, USA
| | - Keshia M Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 750 East Pratt Street, 15th floor, Baltimore, MD, 21202, USA
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L'Huillier JC, Boccardo JD, Stewart M, Wang S, Myneni AA, Bari AA, Nitsche LJ, Taylor HL, Lukan J, Noyes K. Gun violence revictimization in New York State: What increases the risk of being shot again? J Trauma Acute Care Surg 2024; 97:604-613. [PMID: 38689385 DOI: 10.1097/ta.0000000000004370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND While gun injuries are more likely to occur in urban settings and affect people of color, factors associated with gun violence revictimization-suffering multiple incidents of gun violence-are unknown. We examined victim demographics and environmental factors associated with gun violence revictimization in New York State (NYS). METHODS The 2005 to 2020 NYS hospital discharge database was queried for patients aged 12 years to 65 years with firearm-related hospital encounters. Patient and environmental variables were extracted. Patient home zip code was used to determine the Social Deprivation Index (SDI) for each patient's area of residence. We conducted bivariate and multivariate analyses among patients who suffered a single incident of gun violence or gun violence revictimization. RESULTS We identified 38,974 gun violence victims among whom 2,243 (5.8%) suffered revictimization. The proportion of revictimization rose from 4% in 2008 to 8% in 2020 ( p < 0.01). The median [interquartile range] time from first to second incident among those who suffered revictimization was 359 days [81-1,167 days]. Revictimization was more common among Blacks (75.0% vs. 65.1%, p < 0.01), patients with Medicaid (54.9% vs. 43.2%, p < 0.01), and in areas of higher deprivation (84.8 percentile vs. 82.1 percentile, p < 0.01). CONCLUSION Gun violence revictimization is on the rise. People of color and those residing in areas with high social deprivation are more likely to be re-injured. Our findings emphasize the importance of community-level over individual-level interventions for prevention of gun violence revictimization. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Joseph C L'Huillier
- From the Department of Surgery, Jacobs School of Medicine and Biomedical Sciences (J.C.L., A.A.M., L.J.N., J.L., K.N.), University at Buffalo, Buffalo, NY; Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, School of Public Health and Health Professions (J.C.L., K.N.), University at Buffalo, Buffalo, NY; Department of Biostatistics (J.D.B.), University at Buffalo, Buffalo, NY; School of Architecture and Planning (M.S., A.A.B., H.L.T.), University at Buffalo, Buffalo, NY; and Department of Geography (S.W.), University at Buffalo, Buffalo, NY
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Testa A, Jackson DB, DeAngelis R, Heard-Garris N, Semenza DC, Johnson O. Historical Redlining and Contemporary Violent Victimization Over the Life Course. Am J Prev Med 2024; 67:477-484. [PMID: 38906426 PMCID: PMC11416311 DOI: 10.1016/j.amepre.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION This study assesses the relationship between living in historically redlined communities and the incidence of violent victimization and examines differences in this relationship across race and ethnicity. METHODS Data are from the U.S. National Longitudinal Study of Adolescent to Adult Health (Add Health) from Waves I (1994-1995; ages 12-17), III (2001; ages 18-26), IV (2008-2009; ages 24-32), and V (2016-2018; ages 34-44). Multi-level, within-between regression models were used to assess the relationship between residence in historically redlined areas and violent victimization from adolescence to adulthood. The study includes 8,266 participants, and data analysis was conducted in 2024. RESULTS Respondents who lived in redlined areas throughout adolescence and adulthood reported a 4.8% higher average probability of violent victimization relative to those who never lived in redlined areas. Respondents who moved from a non-redlined to a redlined area across waves also reported a 2.2% higher probability of victimization, on average. Although Black and Hispanic respondents were significantly more likely than their White peers to live in a redlined area and report violent victimization at each stage of the life course, the probability of experiencing victimization while living in a redlined area was similar between racial and ethnic groups. CONCLUSIONS These findings underscore the profound and enduring consequences of New Deal-era redlining policies for present-day safety, emphasizing the urgent need to confront and rectify historical injustices to enhance contemporary safety and well-being.
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Affiliation(s)
- Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Reed DeAngelis
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Outreach, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute for Policy Research, Northwestern University, Chicago, Illinois
| | - Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey; Department of Urban-Global Public Health, School of Public Health, Rutgers University, Piscataway, New Jersey; New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey
| | - Odis Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Edwards JR, Ong C, Barber S, Headen I, Tabb LP, De Roos AJ, Schinasi LH. Methodologic Strategies for Quantifying Associations of Historical and Contemporary Mortgage Discrimination on Population Health Equity: A Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02137-3. [PMID: 39289334 DOI: 10.1007/s40615-024-02137-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Mortgage discrimination refers to the systematic withholding of home mortgages from minoritized groups. In recent years, there has been an increase in empirical research investigating associations of historical and contemporary mortgage discrimination on contemporary outcomes. Investigators have used a variety of measurement methods and approaches, which may have implications for results and interpretation. PURPOSE We conducted a systematic review of peer-reviewed literature that has quantified links between both historical and current mortgage discrimination with contemporary adverse environmental, social, and health outcomes. Our goals were to document the methodology used to measure and assign mortgage discrimination, to assess implications for results and interpretation, and to make recommendations for future work. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, literature searches were conducted in September 2022 using terms that combined concepts of mortgage discrimination, health, and neighborhood environment. RESULTS In total, 45 papers fit the eligibility criteria. In these, researchers investigated associations between mortgage discrimination and: (1) health outcomes (N = 28); (2) environmental and social exposures including heat, air pollution, greenspace, soil lead levels, and crime (N = 12); and (3) built environment features, including presence of retail alcohol, fast food, and tobacco stores (N = 5). Eleven included studies used Home Mortgage Discrimination Act (HMDA) data to identify racialized bias in mortgage discrimination or redlining, and 34 used Homeowner Loan Corporation (HOLC) maps. The construction and parametrization of mortgage discrimination or redlining and the spatial assignment of HOLC grades to contemporary addresses or neighborhoods varied substantially across studies. CONCLUSIONS Results from our review suggest the need for careful consideration of optimal methods to analyze mortgage discrimination such as HOLC spatial assignment or HMDA index parametrization, contemplation of covariates, and place-based knowledge of the study location.
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Affiliation(s)
- Janelle R Edwards
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA.
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA.
| | - Christian Ong
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
| | - Irene Headen
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
| | - Loni P Tabb
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
- Dornsife School of Public Health, Ubuntu Center On Racism, Global Movements, and Population Health Equity, Drexel University, Philadelphia, PA, USA
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Kaufman EJ, Song J, Xiong R, Seamon MJ, Delgado MK. Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020. Ann Intern Med 2024; 177:1157-1169. [PMID: 39074371 DOI: 10.7326/m23-2251] [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: 07/31/2024] Open
Abstract
BACKGROUND Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury. OBJECTIVE To combine health care data with death certificate data to estimate total firearm injuries in various racial and ethnic groups. DESIGN Retrospective, cross-sectional study. SETTING Fatal injury data were collected from the Centers for Disease Control and Prevention. Data on nonfatal injuries were collected from the Nationwide Emergency Department Sample (NEDS), a 20% stratified sample of U.S. emergency department visits, weighted to provide national estimates for the United States, 2019 to 2020. PARTICIPANTS All firearm injuries and deaths in the United States. INTERVENTION Race and ethnicity were classified into 5 mutually exclusive categories: Asian or Pacific Islander, Black, Hispanic, Native American, and White. International Classification of Diseases, 10th Revision codes were used to classify firearm injury intent. MEASUREMENTS Incidence of fatal and nonfatal injury in the U.S. population and case-fatality ratios (CFRs). RESULTS There were 252 376 total firearm injuries, including 84 908 deaths from firearm injures. Of all firearm injuries, 37.8% were unintentional, 37.3% were assault related, 21.0% were self-harm, and 1.3% were law enforcement associated. Self-harm had the highest CFRs (90.9% overall). Unintentional injuries accounted for just 1021 (1.2%) deaths but 94 433 (56.4%) of nonfatal injuries. Rates of self-harm were highest among White persons (11.0 per 100 000 population in 2020) followed by Native Americans (8.6 per 100 000). Rates of assault were highest among Black persons (70.1 per 100 000), as were unintentional injuries (56.1 per 100 000). LIMITATION Findings are limited by the accuracy of discharge coding in NEDS, particularly regarding injury intent and patient race and ethnicity. CONCLUSION From 2019 to 2020, the total burden of firearm injuries amounts to an average of 1 injury every 4 minutes and 1 death every 12 minutes in the United States. Racial disparities in firearm injury death are mirrored in nonfatal injury. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, and Penn Injury Science Center, Philadelphia, Pennsylvania (E.J.K.)
| | - Jamie Song
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (J.S., M.J.S.)
| | - Ruiying Xiong
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (R.X.)
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (J.S., M.J.S.)
| | - M Kit Delgado
- Department of Emergency Medicine and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, and Penn Injury Science Center, Philadelphia, Pennsylvania (M.K.D.)
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Davis DW, Jawad K, Feygin YB, Stevenson M, Wattles B, Jones VF, Porter J, Lohr WD, Le J. The Relationships Among Neighborhood Disadvantage, Mental Health and Developmental Disabilities Diagnoses, and Race/Ethnicity in a U.S. Urban Location. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01751-w. [PMID: 39192086 DOI: 10.1007/s10578-024-01751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2024] [Indexed: 08/29/2024]
Abstract
Childhood health disparities by race have been found. Neighborhood disadvantage, which may result from racism, may impact outcomes. The aim of the study is to describe the distribution of mental health (MH) and developmental disabilities (DD) diagnosis across Child Opportunity Index (COI) levels by race/ethnicity. A cross-sectional study using 2022 outpatient visit data for children < 18 years living in the Louisville Metropolitan Area (n = 115,738) was conducted. Multivariable logistic regression analyses examined the association between diagnoses and COI levels, controlling for sex and age. Almost 18,000 children (15.5%) had a MH or DD (7,905 [6.8%]) diagnosis. In each COI level, the prevalence of MH diagnosis was lower for non-Hispanic (N-H) Black than for N-H White children. In adjusted analyses, there were no significant associations between diagnoses and COI for non-White children for MH or DD diagnoses. The odds of receiving a MH [OR: 1.74 (95% CI: 1.62, 1.87)] and DD [OR: 1.69 (95% CI: 1.51, 1.88)] diagnosis were higher among N-H White children living in Very Low compared to Very High COI areas. Current findings suggest that COI does not explain disparities in diagnosis for non-White children. More research is needed to identify potential multi-level drivers such as other forms of racism. Identifying programs, policies, and interventions to reduce childhood poverty and link children and families to affordable, family-centered, quality community mental and physical health resources is needed to ensure that families can build trusting relationships with the providers while minimizing stigma.
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Affiliation(s)
- Deborah Winders Davis
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA.
- Norton Children's Research Institute Affiliated With the University of Louisville School of Medicine, Louisville, KY, USA.
| | - Kahir Jawad
- Norton Children's Research Institute Affiliated With the University of Louisville School of Medicine, Louisville, KY, USA
| | - Yana B Feygin
- Norton Children's Research Institute Affiliated With the University of Louisville School of Medicine, Louisville, KY, USA
| | - Michelle Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
| | - Bethany Wattles
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
| | - Veronnie Faye Jones
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- University of Louisville Health Science Center Office of Diversity and Inclusion, Louisville, KY, USA
| | - Jennifer Porter
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
| | - W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
- Kentucky Cabinet for Health and Family Services, Frankfort, KY, USA
| | - Jennifer Le
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
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Doucette ML, Meyerson NS, Crifasi CK, Wagner E, Webster DW. Firearm injury hospitalizations and handgun purchaser licensing laws: longitudinal evaluation of state-level purchaser licensure requirements on firearm violence, 2000-2016. Inj Epidemiol 2024; 11:39. [PMID: 39180063 PMCID: PMC11342609 DOI: 10.1186/s40621-024-00522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Handgun purchaser licensing (HPL) laws mandate individuals to obtain a license from law enforcement before buying a firearm. Research indicates these laws effectively reduce various forms of fatal firearm violence, including homicides, suicides, and mass shootings. Our study sought to assess the impact of HPL laws on non-fatal firearm violence. METHODS Utilizing the augmented synthetic control method (ASCM), we estimated the average treatment effect on the treated (ATT) resulting from a full repeal of an HPL law in Missouri (2007), a partial repeal in Michigan (2012), and an adoption on HPL law in Maryland (2013) on firearm injury hospitalizations. We utilized RAND's healthcare cost and utilization project-based dataset from 2000 to 2016 for our outcome variable. We conducted in-time placebo testing and leave-one-out donor pool testing as sensitivity analyses. RESULTS Maryland's adoption was associated with a statistically significant 32.3% reduction in firearm-related injury hospitalization (FIH) rates (ATT = - 0.497, standard error (SE) = 0.123); Missouri's repeal was associated with a statistically significant 35.7% increase in FIH rates (ASCM = 0.456, SE = 0.155); and Michigan's partial repeal showed no statistically significant associations with FIH rates (ATT = - 0.074, SE = 0.129). Sensitivity analyses confirm the robustness of the estimated HPL effects. DISCUSSION HPL laws appear to be protective against hospitalizations for nonfatal firearm injuries. These findings align with prior research indicating that HPL laws are effective in reducing fatal firearm violence. States without such licensing systems ought to consider these robust policies as a means to address firearm violence.
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Affiliation(s)
- Mitchell L Doucette
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Nicholas S Meyerson
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Cassandra K Crifasi
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Elizabeth Wagner
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Daniel W Webster
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
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Kauffman J, Nance M, Cannon JW, Sakran JV, Haut ER, Scantling DR, Rozycki G, Byrne JP. Association of pediatric firearm injury with neighborhood social deprivation in Philadelphia. Trauma Surg Acute Care Open 2024; 9:e001458. [PMID: 39171083 PMCID: PMC11337676 DOI: 10.1136/tsaco-2024-001458] [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: 03/26/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024] Open
Abstract
Background Firearm-related injury is the leading cause of death among children and adolescents. There is a need to clarify the association of neighborhood environment with gun violence affecting children. We evaluated the relative contribution of specific social determinants to observed rates of firearm-related injury in children of different ages. Methods This was a population-based study of firearm injury in children (age <18 years) that occurred in Philadelphia census tracts (2015-2021). The exposure was neighborhood Social Deprivation Index (SDI) quintile. The outcome was the rate of pediatric firearm injury due to interpersonal violence stratified by age, sex, race, and year. Hierarchical negative binomial regression measured the risk-adjusted association between SDI quintile and pediatric firearm injury rate. The relative contribution of specific components of the SDI to neighborhood risk of pediatric firearm injury was estimated. Effect modification and the role of specific social determinants were evaluated in younger (<15 years old) versus older children. Results 927 children were injured due to gun violence during the study period. Firearm-injured children were predominantly male (87%), of black race (89%), with a median age of 16 (IQR 15-17). Nearly one-half of all pediatric shootings (47%) occurred in the quintile of highest SDI (Q5). Younger children represented a larger proportion of children shot in neighborhoods within the highest (Q5), compared with the lowest (Q1), SDI quintile (25% vs 5%; p<0.007). After risk adjustment, pediatric firearm-related injury was strongly associated with increasing SDI (Q5 vs Q1; aRR 14; 95% CI 6 to 32). Specific measures of social deprivation (poverty, incomplete schooling, single-parent homes, and rented housing) were associated with significantly greater increases in firearm injury risk for younger, compared with older, children. Component measures of the SDI explained 58% of observed differences between neighborhoods. Conclusions Neighborhood measures of social deprivation are strongly associated with firearm-related injury in children. Younger children appear to be disproportionately affected by specific adverse social determinants compared with older children. Root cause evaluation is required to clarify the interaction with other factors such as the availability of firearms and interpersonal conflict that place children at risk in neighborhoods where gun violence is common. Level of evidence Level III - Observational Study.
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Affiliation(s)
- Jeremy Kauffman
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Nance
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeremy W Cannon
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joseph Victor Sakran
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elliott R Haut
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dane R Scantling
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Grace Rozycki
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James P Byrne
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Ziminski D, Harmon-Darrow C, Westley-Henson K, Ross S. Exploring the Role of Fear, Civic Disengagement, and Economic Disenfranchisement Within Communities that Experience Gun Violence. Psychol Rep 2024:332941241269500. [PMID: 39096345 DOI: 10.1177/00332941241269500] [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: 08/05/2024]
Abstract
A growing body of research has documented how gun violence can affect mental and physical health outcomes among adults. Likewise, the literature is also beginning to reveal negative psychological effects related to distress and hypervigilance and sociological implications around diminished community engagement and economic opportunity. However, there remains a need to fully explore the role of fear related to the experience of gun violence. Through a qualitative inquiry consisting of community resident focus groups and community leader interviews, this study examined how participants' perceptions of fear related to their exposures to and experiences of gun violence. The findings highlight the pervasive emotional experience of existing in a fearful, distressed, and/or anxious state within certain communities, and how civic disengagement, neighborhood disconnection, and economic disenfranchisement exist in communities that disproportionately experience violence.
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Affiliation(s)
- Devon Ziminski
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
- Senator Walter Rand Institute for Public Affairs, Rutgers University - Camden, Camden, NJ, USA
- New Jersey Gun Violence Research Center, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | | | - Kiersten Westley-Henson
- Senator Walter Rand Institute for Public Affairs, Rutgers University - Cadmen, Camden, NJ, USA
- Department of Prevention Science, Rutgers University - Camden, Camden, NJ, USA
| | - Samuel Ross
- Senator Walter Rand Institute for Public Affairs, Rutgers University - Camden, Camden, NJ, USA
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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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Tabb LP, Bayliss R, Xu Y. Spatial and spatio-temporal statistical implications for measuring structural racism: A review of three widely used residential segregation measures. Spat Spatiotemporal Epidemiol 2024; 50:100678. [PMID: 39181606 DOI: 10.1016/j.sste.2024.100678] [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: 02/26/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024]
Abstract
Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality of life outcomes and risks - these social determinants of health often aid in explaining the racial and ethnic health inequities present in the United States (US). The root cause of these social determinants of health has been tied to structural racism, and residential segregation is one such domain of structural racism that allows for the operationalization of the geography of structural racism. This review focuses on three residential segregation measures that are often utilized to capture segregation as a function of race/ethnicity, income, and simultaneously race/ethnicity and income. Empirical findings related to the spatial and spatio-temporal heterogeneity of these residential segregation measures are presented. We also discuss some of the implications of utilizing these three residential segregation measures.
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Affiliation(s)
- Loni Philip Tabb
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Ruby Bayliss
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
| | - Yang Xu
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
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12
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Woods-Jaeger B, Jahangir T, Ash MJ, Komro KA, Belton IJ, Livingston M. The Potential of Minimum Wage Increases to Reduce Youth Homicide Disparities: Diminishing Returns for Black Youth. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:891-897. [PMID: 39112906 DOI: 10.1007/s11121-024-01714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 09/12/2024]
Abstract
We examine and compare the relationship between minimum wage increases and youth homicide rates in three groups: all youth, White youth only, and Black youth only. Using 2001-2019 mortality data from the National Vital Statistics System (NVSS) for all 50 states and Washington DC, we apply a difference in differences (DD) design to compare the change in youth homicides across states with varying changes in the state-specific minimum wage. With the inclusion of state-specific linear time trends, we find that a $1 increase in minimum wage leads to a significant 4% reduction (RR = 0.96, 95%CI [0.92, 0.99]) in homicides among White youth, but no significant reduction among Black youth (RR = 0.98, 95%CI [0.91, 1.04]). Findings are consistent with research on marginalization-related diminished returns for Black youth. While minimum wage increases are a promising step to reduce youth homicides overall, reducing homicide disparities experienced by Black youth requires additional components. Future research should examine policies with the specific intention to dismantle structural racism.
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Affiliation(s)
- Briana Woods-Jaeger
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, #526, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Tasfia Jahangir
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, #526, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Marcia J Ash
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, #526, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Kelli A Komro
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, #526, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Imani J Belton
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, #526, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Melvin Livingston
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, #526, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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13
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Miller ZM, Chapman-Kramer K, Cooper BP, Coffey M, Page K, Meyers JE, Vogel M, Mancini M, Mueller K. Personal goals of young survivors of violent injury: implications for practice. Inj Prev 2024; 30:313-319. [PMID: 38290779 DOI: 10.1136/ip-2023-045032] [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: 07/03/2023] [Accepted: 12/10/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Firearm injuries are the leading cause of death among young people in the USA and disproportionately impact communities of colour and those experiencing socioeconomic distress. Understanding the personal goals of violently injured patients is essential to identifying protective factors and developing interventions that promote them. However, limited research characterising these personal goals exists. OBJECTIVE The objective of this study was to use qualitative thematic analysis to analyse and describe the personal goals of young people who enrolled in a region-wide hospital-based violence intervention programme after surviving a violent injury. METHODS A qualitative coding framework was developed, evaluated, and implemented using data from Life Outside of Violence, the St. Louis Area Hospital-Based Violence Intervention Programme. Chart abstraction procedures were used to compile qualitative data on Life Outside of Violence participants' personal goals documented by clinical case managers during individual treatment planning sessions with participants (n=168). Descriptive analyses are reported and implications for practice are discussed. RESULTS Key findings reveal that (1) violent injury survivors have unmet therapeutic and resource needs, indicating the importance of having service providers with both clinical and case management skills, (2) anger management is a common clinical goal, and (3) employment opportunities are a common resource need. CONCLUSIONS Findings from this study inform the implementation of the Life Outside of Violence programme and offer a roadmap to other hospital-based violence intervention programmes operating nation-wide. Our results provide insight into participants' needs, desires, and motivations, allowing unique opportunities for improved participant engagement and service delivery.
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Affiliation(s)
- Zoe Maya Miller
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Kateri Chapman-Kramer
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Benjamin P Cooper
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Melik Coffey
- Social Work, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri, USA
| | - Keyria Page
- Social Work, St Louis Children's Hospital, St Louis, Missouri, USA
| | - Jessica E Meyers
- St. Louis Area Violence Prevention Commission, Saint Louis, Missouri, USA
| | - Matt Vogel
- Sociology, University at Albany School of Criminal Justice, Albany, New York, USA
| | - Michael Mancini
- School of Social Work, Saint Louis University, Saint Louis, Missouri, USA
| | - Kristen Mueller
- Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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14
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Barcelona V, Condon EM, Jacoby SF. Leveraging biosocial methods to examine and address structural determinants of health and promote health equity. Nurs Outlook 2024; 72:102195. [PMID: 38810533 PMCID: PMC11330731 DOI: 10.1016/j.outlook.2024.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/26/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Biosocial approaches in nursing research have largely focused on the ways that social determinants of health influence individual-level outcomes, including symptom management, family and social support, and educational interventions. PURPOSE Theoretical, methodological, and practical strategies are needed to expand current biosocial methods for nursing science and focus on upstream, structural determinants of health and the policies that underlie health inequities. METHODS This paper summarizes presentations given at the 2023 Council for the Advancement of Nursing Science Advanced Methods Conference, Biosocial Methods to Advance Health Equity, in a panel titled "Individual, community, systems and policy related to biosocial methods." DISCUSSION Nurses are uniquely positioned to examine upstream, structural determinants of health by leveraging expertise in biosocial methods, collaborating with interdisciplinary researchers and community members, and advocating for policy change. By conducting theory-grounded biosocial research, nurse researchers can significantly advance scientific knowledge and promote health equity for individuals and communities. CONCLUSION Nurse scientists are conducting research using biosocial methods and provide recommendations for expansion of this approach in the field.
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Affiliation(s)
| | - Eileen M Condon
- University of Connecticut School of Nursing, Storrs, CT; Department of Pediatrics, University of Connecticut School of Medicine, Storrs, CT
| | - Sara F Jacoby
- Department of Family and Community, University of Pennsylvania School of Nursing, Philadelphia, PA
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15
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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 2024; 50:250-259. [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] [MESH Headings] [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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16
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Marineau LA, Uzzi M, Buggs SA, Ihenacho N, Campbell JC. Risk and Protective Factors for Firearm Assault Injuries Among Black Men: A Scoping Review of Research. TRAUMA, VIOLENCE & ABUSE 2024; 25:2468-2488. [PMID: 38153002 PMCID: PMC11295296 DOI: 10.1177/15248380231217042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.
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Affiliation(s)
| | - Mudia Uzzi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shani A. Buggs
- Department of Emergency Medicine, University of California, Davis, USA
- California Firearm Violence Research Center, Davis, USA
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17
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McClelland E, Shefner RT, Johnson J, Anderson ED. Resident perspectives on a pre-booking diversion program. CONTEMPORARY DRUG PROBLEMS 2024; 51:129-141. [PMID: 39144404 PMCID: PMC11323041 DOI: 10.1177/00914509241246083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Numerous cities are experimenting with pre-booking diversion programs that allow police officers to divert community members to supportive services in instances that would otherwise result in arrest and prosecution. These programs aim to decrease harmful involvement with the criminal justice system while reducing crime and public disorder. Although previous research has explored the experiences of people receiving diversion referrals and of police officers initiating them, none have examined the perspectives of community members who can offer crucial insights into planning, evaluation, and implementation barriers. We administered a survey to 293 people living in four police districts where the Philadelphia Police Department operates a pre-booking diversion program. The survey explored residents' perspectives on the program as well as their broader views on associated issues like decriminalization of substance use, sex work, and minor theft. Bivariate χ2 tests and multivariate logistic regression examined differences in responses between subgroups. Perspectives were diverse and varied based on demographic attributes of the respondents as well as on district level attributes, like crime patterns. Most surveyed community members perceived pre-booking diversion to be a valuable tool for improving the experiences and outcomes of policing. However, residents living in areas with more crime and with more public disorder held significantly less positive perspectives. Their skepticism may reflect the possibility that pre-booking diversion and similar reforms are necessary but not sufficient to transforming individual health and public safety in some areas.
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Affiliation(s)
- Evan McClelland
- Perelman School of Medicine at the University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| | - Ruth T. Shefner
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 W 168 Street, New York, NY, United States
| | - Josephine Johnson
- Pennsylvania State University, Department of Sociology and Criminology, 512 Oswald Tower, University Park, PA 16801, United States
| | - Evan D. Anderson
- Perelman School of Medicine at the University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
- Thomas Jefferson University, 901 Walnut Street, 10 floor, Philadelphia, Pennsylvania, 19107, United States
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18
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Gillum TL, Hampton CJ, Coppedge C. Using the Socio-Ecological Model to Understand Increased Risk of Gun Violence in the African American Community. Psychol Rep 2024:332941241256635. [PMID: 38804858 DOI: 10.1177/00332941241256635] [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: 05/29/2024]
Abstract
Gun violence is a major public health issue of growing concern in the United States (U.S.) with 48,830 lives lost to gun related violence in 2021, documenting the highest number of gun related homicides and suicides ever recorded. The African American community is disproportionately impacted by gun violence and members of this community are almost 14x more likely to die by gun homicide than their white counterparts. The Centers for Disease Control and Prevention (CDC) has identified a socio-ecological framework as a lens through which to better understand violence and inform potential prevention strategies to address it. This model identifies four levels (individual, relationship, community, societal) which help to enhance our understanding of the complex interplay between individuals and their environments. Here, we use this model to understand why the African American community experiences elevated risk of gun violence in the U.S. and propose strategies for prevention. Understanding the issue of gun violence beyond individual level risk, this analysis highlights the interplay between multiple levels including the ways in which societal level factors influence violence. While this paper provides a lens through which to understand the multi-leveled factors that contribute to gun violence in the African American community, it also serves as a call to action for policymakers, scholars, and agencies to develop culturally informed policy and programming efforts specific to those who are most impacted.
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Affiliation(s)
- Tameka L Gillum
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | - Clarice J Hampton
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Chanté Coppedge
- Psychological Counseling Center, State University of New York New Paltz, New Paltz, NY, USA
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19
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Beard JH, Trombley S, Walker T, Roberts L, Partain L, MacMillan J, Midberry J. Public health framing of firearm violence on local television news in Philadelphia, PA, USA: a quantitative content analysis. BMC Public Health 2024; 24:1221. [PMID: 38698393 PMCID: PMC11067069 DOI: 10.1186/s12889-024-18718-0] [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: 11/30/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Firearm violence is an intensifying public health problem in the United States. News reports shape the way the public and policy makers understand and respond to health threats, including firearm violence. To better understand how firearm violence is communicated to the public, we aimed to determine the extent to which firearm violence is framed as a public health problem on television news and to measure harmful news content as identified by firearm-injured people. METHODS This is a quantitative content analysis of Philadelphia local television news stories about firearm violence using a database of 7,497 clips. We compiled a stratified sample of clips aired on two randomly selected days/month from January-June 2021 from the database (n = 192 clips). We created a codebook to measure public health frame elements and to assign a harmful content score for each story and then coded the clips. Characteristics of stories containing episodic frames that focus on single shooting events were compared to clips with thematic frames that include broader social context for violence. RESULTS Most clips employed episodic frames (79.2%), presented law enforcement officials as primary narrators (50.5%), and included police imagery (79.2%). A total of 433 firearm-injured people were mentioned, with a mean of 2.8 individuals shot included in each story. Most of the firearm-injured people featured in the clips (67.4%) had no personal information presented apart from age and/or gender. The majority of clips (84.4%) contained at least one harmful content element. The mean harmful content score/clip was 2.6. Public health frame elements, including epidemiologic context, root causes, public health narrators and visuals, and solutions were missing from most clips. Thematic stories contained significantly more public health frame elements and less harmful content compared to episodic stories. CONCLUSIONS Local television news produces limited public health coverage of firearm violence, and harmful content is common. This reporting likely compounds trauma experienced by firearm-injured people and could impede support for effective public health responses to firearm violence. Journalists should work to minimize harmful news content and adopt a public health approach to reporting on firearm violence.
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Affiliation(s)
- Jessica H Beard
- Department of Surgery, Division of Trauma Surgery and Surgical Critical Care, Lewis Katz School of Medicine, Temple University, 3401 N. Broad St, 4th Floor, Zone C, Philadelphia, PA, 19140, USA.
| | - Shannon Trombley
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Tia Walker
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Leah Roberts
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Laura Partain
- School of Communication, Ohio State University, Columbus, OH, USA
| | - Jim MacMillan
- Philadelphia Center for Gun Violence Reporting, Philadelphia, PA, USA
| | - Jennifer Midberry
- Department of Journalism and Communication, Lehigh University, Bethlehem, PA, USA
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20
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Hussaini SMQ, Fan Q, Barrow LCJ, Yabroff KR, Pollack CE, Nogueira LM. Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes in the United States. JCO Oncol Pract 2024; 20:678-687. [PMID: 38320228 DOI: 10.1200/op.23.00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents were mapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areas with different HOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer-a leading cause of cancer deaths amenable to early detection and treatment. METHODS Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS). RESULTS There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guideline-concordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively. CONCLUSION Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes.
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Affiliation(s)
- S M Qasim Hussaini
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Qinjin Fan
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Lauren C J Barrow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - Leticia M Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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21
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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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Fields ND, Tristan Urrutia A, Morris AA, Kramer MR, Lewis TT, Patel SA. Historical Redlining and Heart Failure Outcomes Following Hospitalization in the Southeastern United States. J Am Heart Assoc 2024; 13:e032019. [PMID: 38563370 PMCID: PMC11262499 DOI: 10.1161/jaha.123.032019] [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: 08/01/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Historical redlining, a discriminatory lending practice, is an understudied component of the patient risk environment following hospital discharge. We investigated associations between redlining, patient race, and outcomes following heart failure hospitalization. METHODS AND RESULTS We followed a hospital-based cohort of Black and White patients using electronic medical records for acute heart failure hospitalizations between 2010 and 2018 (n=6800). Patient residential census tracts were geocoded according to the 1930s Home Owners' Loan Corporation map grades (A/B: best/still desirable, C: declining, D: redlined). We used Poisson regression to analyze associations between Home Owners' Loan Corporation grade and 30-day outcomes (readmissions, mortality, and their composite). One-third of patients resided in historically redlined tracts (n=2034). In race-stratified analyses, there was a positive association between historically declining neighborhoods and composite readmissions and mortality for Black patients (risk ratio [RR], 1.24 [95% CI, 1.003-1.54]) and an inverse association between redlined neighborhoods and 30-day readmissions among White patients (RR, 0.58 [95% CI, 0.39-0.86]). Examining racial disparities across Home Owners' Loan Corporation grades, Black patients had higher 30-day readmissions (RR, 1.86 [95% CI, 1.31-2.65]) and composite readmissions and mortality (RR, 1.32 [95% CI, 1.04-1.65]) only in historically redlined neighborhoods. CONCLUSIONS Historical redlining had potentially mixed impacts on outcomes by race, such that residing in less desirable neighborhoods was associated with an elevated risk of an adverse outcome following heart failure hospitalization in Black patients and a reduced risk in White patients. Moreover, racial disparities in patient outcomes were present only in historically redlined neighborhoods. Additional research is needed to explore observed heterogeneity in outcomes.
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Affiliation(s)
- Nicole D. Fields
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
- Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | | | - Michael R. Kramer
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Tené T. Lewis
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Shivani A. Patel
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
- Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGAUSA
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23
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Alers-Rojas F, Ceballo R, Cranford JA, Esqueda AP, Troncoso SC. Adolescents' exposure to community violence and associations with after-school activities across two samples. J Adolesc 2024; 96:659-675. [PMID: 38149771 DOI: 10.1002/jad.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/14/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Exposure to community violence (ECV) continues to be a major public health problem among urban adolescents in the United States. We sought to identify subgroups of adolescents' ECV and examine how after-school activities are related to exposure subgroups across two samples. METHODS In Study 1 there were 1432 adolescents (Cohort 9 n = 717, Mage = 11, and Cohort 12 n = 715, Mage = 14; 52% boys) from the Project on Human Development in Chicago Neighborhoods (1994-2002). Study 2 had a more recent sample of 537 adolescents (Mage = 16 years; 54% girls) from the After-School Activity Study (ASAS; 2015-2017) in Chicago and Detroit. RESULTS Exploratory latent class analyses yielded a three-class solution for Study 1: a "No ECV" class (44%); a "Low ECV" class (36%); and a "High Exposure" class (14%). In Study 2, a four-class solution was the best fit with a "No ECV" class (33%), a "Moderate Witness/Low Victim" class (36%), a "High Witness/Moderate Victim" class (19%), and a "High ECV" class (11%). Home-based activities appeared to be protective against high ECV for adolescents in Study 2. School-based activities were associated with higher ECV across both samples, but community-based activities were only associated with greater violence exposure in Study 1. Adolescents' unstructured socializing in both studies was associated with higher odds of ECV. CONCLUSIONS Results indicate that subgroups of adolescents can be identified based on ECV and highlight the complexity of after-school activities as risk and protective factors in both past and more recent contexts.
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Affiliation(s)
- Francheska Alers-Rojas
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Rosario Ceballo
- Department of Psychology, Georgetown University, Washington, District of Columbia, USA
| | - James A Cranford
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ana Patricia Esqueda
- Department of Psychology and Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Solangel C Troncoso
- Department of Psychology and Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
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24
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DaViera AL, Bailey C, Lakind D, Kivell N, Areguy F, Byrd K. Identifying abolitionist alignments in community psychology: A path toward transformation. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:44-56. [PMID: 37133454 DOI: 10.1002/ajcp.12678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/01/2022] [Accepted: 02/13/2023] [Indexed: 05/04/2023]
Abstract
Psychology is grounded in the ethical principles of beneficence and nonmaleficence, that is, "do no harm." Yet many have argued that psychology as a field is attached to carceral systems and ideologies that uphold the prison industrial complex (PIC), including the field of community psychology (CP). There have been recent calls in other areas of psychology to transform the discipline into an abolitionist social science, but this discourse is nascent in CP. This paper uses the semantic device of "algorithms" (e.g., conventions to guide thinking and decision-making) to identify the areas of alignment and misalignment between abolition and CP in the service of moving us toward greater alignment. The authors propose that many in CP are already oriented to abolition because of our values and theories of empowerment, promotion, and systems change; our areas of misalignment between abolition and CP hold the potential to evolve. We conclude with proposing implications for the field of CP, including commitments to the belief that (1) the PIC cannot be reformed, and (2) abolition must be aligned with other transnational liberation efforts (e.g., decolonization).
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Affiliation(s)
- Andrea L DaViera
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caroline Bailey
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Davielle Lakind
- Department of Clinical Psychology, Mercer University, Atlanta, Georgia, USA
| | - Natalie Kivell
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Fitsum Areguy
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Kymberly Byrd
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA
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25
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Kraus NT, Connor S, Shoda K, Moore SE, Irani E. Historic redlining and health outcomes: A systematic review. Public Health Nurs 2024; 41:287-296. [PMID: 38148621 DOI: 10.1111/phn.13276] [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: 05/31/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to synthesize the existing literature on the associations between historic redlining and modern-day health outcomes across the lifespan. METHOD This review searched PubMed and CINAHL for peer-reviewed, data-based articles examining the relationship between historic redlining and any health outcome. Articles were appraised using the JBI critical appraisal checklist. The results were synthesized using a narrative summary approach. RESULTS Thirty-six articles were included and focused on various health outcomes, including cardiovascular outcomes, breast cancer incidence and mortality, firearm injury or death, birth-related outcomes, and asthma outcomes. Most of the included articles (n = 31; 86%) found significant associations between historic redlining and adverse health outcomes such as increased cardiovascular disease, higher rates of preterm births, increased cancer incidence, reduced survival time after breast cancer diagnosis, and increased firearm injury incidence. DISCUSSION This review demonstrates the persistent effect of historic redlining on individuals' health. Public health nurses should recognize redlining as a form of structural racism when caring for affected communities and should advocate for policies and programs that advance health equity. Nurse researchers should develop and test multilevel interventions to address systemic racism and improve health outcomes in communities affected by redlining.
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Affiliation(s)
- Noa T Kraus
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarah Connor
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krista Shoda
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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26
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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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27
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Wizentier MM, Stephenson BJK, Goodman MS. The measurement of racism in health inequities research. Epidemiol Rev 2023; 45:32-43. [PMID: 37147182 DOI: 10.1093/epirev/mxad004] [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: 10/02/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023] Open
Abstract
There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters-Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.
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Affiliation(s)
- Marina Mautner Wizentier
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
| | - Briana Joy K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Melody S Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
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28
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Bushman G, Kondo MC, Rupp LA, Hohl BC, Gong CH, Zimmerman MA. Associations between land bank ownership and stewardship of vacant properties and crime, violence, and youth victimization in Flint, MI. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:428-442. [PMID: 37846198 DOI: 10.1002/ajcp.12706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/15/2023] [Accepted: 08/29/2023] [Indexed: 10/18/2023]
Abstract
Land banks across the United States are managing expanding vacant property inventories. By maintaining vacant properties and engaging residents in the process, land banks facilitate processes integral to building safe neighborhoods and may play a role in violence prevention. Using generalized additive mixed model regression, adjusted for spatial and temporal dependencies, we examined whether land bank ownership and stewardship of vacant properties in Flint, Michigan were associated with trends in serious, violent, and firearm-involved crime, between 2015 and 2018. We tested for differences in trends in crime density between properties owned by the Genesee County Land Bank Authority (GCLBA; n = 7151) and comparison properties not owned by the land bank (n = 6,245). In addition, we tested for differences in crime density trends between vacant properties that received different levels of land bank stewardship, including biannual mowing, GCLBA standard stewardship, and GCLBA-sponsored community-engaged stewardship. We found that GCLBA ownership was associated with net declines in densities of all types of crime and violence, over time, relative to properties not owned by the GCLBA. When we distinguished between levels of stewardship, we found that GCLBA stewardship, both with and without community engagement, was associated with net declines in serious and violent crime relative to comparison properties. Only community-engaged GCLBA stewardship was associated with declines in firearm-involved crime and firearm-involved crime with a youth victim over time, relative to comparison properties. Land bank stewardship of vacant properties may be protective against crime, violence, and youth victimization in legacy cities like Flint, MI that experience high rates of vacant properties and violent crime.
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Affiliation(s)
- Gregory Bushman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Michelle C Kondo
- USDA Forest Service, Northern Research Station, Philadelphia Field Station, Philadelphia, Pennsylvania, USA
| | - Laney A Rupp
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Bernadette C Hohl
- Penn Injury Science Center, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine H Gong
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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29
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Spitzer SA, Vail DG, Dey T, Salim A, Jarman MP. The Impact of Redlining on Modern-Day Firearm Injuries: A Nationwide Study of Federal Policy. Ann Surg 2023; 278:e1123-e1127. [PMID: 37051903 DOI: 10.1097/sla.0000000000005860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To evaluate whether exposure to the United States discriminatory housing practice of redlining, which occurred in over 200 cities in the 1930s, is associated with modern-day, community-level incidence of firearm injury. BACKGROUND Firearm violence is a public health epidemic within the United States. Federal policies are crucial in both shaping and reducing the risk of firearm violence; identifying policies that might have contributed to risks also offers potential solutions. We analyzed whether 1930s exposure to the discriminatory housing practices that occurred in over 200 US cities was associated with the modern-day, community-level incidence of firearm injury. METHODS We performed a nationwide retrospective cohort study between 2014 and 2018. Urban Zip Code Tabulation Areas (ZCTAs) historically exposed to detrimental redlining (grades C and D) were matched to unexposed ZCTAs based on modern-day population-level demographic characteristics (ie, age, Gini index, median income, percentage Black population, and education level). Incidence of firearm injury was derived from the Gun Violence Archive and aggregated to ZCTA level counts. Our primary outcome was the incidence of firearm injury, modeled using zero-inflated negative binomial regression. RESULTS When controlling for urban firearm risk factors, neighborhoods with detrimental redlining were associated with 2.6 additional firearm incidents annually compared with nonredlined areas with similar modern-day risk factors. Over our study period, this accounts for an additional 23,000 firearm injuries. CONCLUSIONS Historic, discriminatory Federal policies continue to impact modern-day firearm violence. Policies aimed at reversing detrimental redlining may offer an economic means to reduce firearm violence.
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Affiliation(s)
- Sarabeth A Spitzer
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- The Gillian Reny Stepping Strong Center for Trauma Innovation, Brigham and Women's Hospital, Boston, MA
- The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Daniel G Vail
- New York Eye and Ear Infirmary of Mt. Sinai, New York, NY
| | - Tanujit Dey
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- The Gillian Reny Stepping Strong Center for Trauma Innovation, Brigham and Women's Hospital, Boston, MA
| | - Molly P Jarman
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- The Gillian Reny Stepping Strong Center for Trauma Innovation, Brigham and Women's Hospital, Boston, MA
- The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
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30
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Maliniak ML, Moubadder L, Nash R, Lash TL, Kramer MR, McCullough LE. Census Tracts Are Not Neighborhoods: Addressing Spatial Misalignment in Studies Examining the Impact of Historical Redlining on Present-day Health Outcomes. Epidemiology 2023; 34:817-826. [PMID: 37732846 DOI: 10.1097/ede.0000000000001646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Research examining the effects of historical redlining on present-day health outcomes is often complicated by the misalignment of contemporary census boundaries with the neighborhood boundaries drawn by the US Home Owners' Loan Corporation (HOLC) in the 1930s. Previous studies have used different approaches to assign historical HOLC grades to contemporary geographies, but how well they capture redlining exposure is unknown. METHODS Our analysis included 7711 residences identified in the Multiple Listing Service database in Atlanta, Georgia (2017-2022). We evaluated the classification of HOLC grade assignment (A, B, C, D, or ungraded) when assigning exposure under four area-level approaches (centroid, majority land area, weighted score, and highest HOLC) compared with using complete address data (gold standard). We additionally compared approaches across three 2020 census geographies (tract, block group, and block). RESULTS When comparing the use of census tracts to complete address data, sensitivity was highest for the weighted score approach, which correctly identified 77% of residences in truly A-D graded neighborhoods as compared with the majority land area (44%), centroid (54%), and highest HOLC (59%) approaches. Regarding specificity, the majority land area approach best-classified residences in truly ungraded neighborhoods (93%) as compared with the weighted score (65%), centroid (81%), and highest HOLC (54%) approaches. Classification improved regardless of approach when using census block compared with the census tract. CONCLUSIONS Misclassification of historical redlining exposure is inevitable when using contemporary census geographies rather than complete address data. This study provides a framework for assessing spatial misalignment and selecting an approach for classification.
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Affiliation(s)
- Maret L Maliniak
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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31
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Omar D, Syder N, Brown-Korsah JB, McKenzie S, Elbuluk N, Taylor S. Racial and ethnic disparities in clinical research and the dermatology workforce: Part 2. J Am Acad Dermatol 2023; 89:895-902. [PMID: 35390428 DOI: 10.1016/j.jaad.2022.03.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
Although racial and ethnic demographics are shifting in this country, it is not reflected in the diversity of clinical trial research participants; science, technology, engineering, and mathematics pipeline programs; or the workforce in the field of dermatology. Barriers to recruitment of minority patients for research studies also exist for numerous reasons including lack of education of prospective subjects, lack of awareness of ongoing trials, and mistrust within the health care system. Gaps in the science, technology, engineering, and mathematics pipeline for racial and ethnic minorities, particularly Black, Hispanic/Latinx, and American Indian or Alaska Native, are due in large part to structural racism. Lack of exposure as well as lack of educational, mentorship, and research opportunities contribute to gaps in the dermatology workforce. Having a representative population in the dermatology workforce and in clinical research trial patients is essential for optimum patient care, excellence in the specialty, and knowledge of appropriate treatments for minority populations. This article will discuss knowledge gaps for increasing minority subjects who participate in clinical research trials and discuss mechanisms to engage this community in trial recruitment. Additionally, this article addresses lack of racial and ethnic diversity of the dermatology workforce and performance gaps in the recruitment of racial/ethnic minorities into dermatology.
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Affiliation(s)
- Deega Omar
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicole Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jessica B Brown-Korsah
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Shanice McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Susan Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Bruce MM, Robinson AJ, Wiebe DJ, Shults J, Richmond TS. The Contribution of Neighborhood Characteristics to Psychological Symptom Severity in a Cohort of Injured Black Men. J Racial Ethn Health Disparities 2023; 10:2284-2293. [PMID: 36085354 PMCID: PMC10454987 DOI: 10.1007/s40615-022-01407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Traumatic injury is not evenly distributed by race and class in the USA. Black men are marginalized in the society, often reside in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury. Post-traumatic stress disorder (PTSD) and depressive symptom severity are among several problematic and disabling conditions faced by injury survivors. While much research has examined individual factors that lead to increased post-injury psychological symptom severity, the contribution of the social and physical environment has been relatively understudied. OBJECTIVE To examine the contribution of neighborhood characteristics to PTSD and depressive symptom severity in Black men following traumatic injury. DESIGN Prospective cohort study. Participant data were linked via GIS to neighborhood characteristics (constructs established by factor analysis) to spatially model factors associated with increased post-injury psychological symptom severity using a GEE regression analysis, adjusting for injury mechanism and severity, age, and insurance. PARTICIPANTS Four hundred fifty-one adult Black males hospitalized for traumatic injury. RESULTS The 4 constructs were neighborhood disconnectedness, concentrated disadvantage/deprivation, crime/violence/vacancy, and race/ethnicity. High depressive and PTSD symptom severity was reported by 36.8% and 30.4% of participants, respectively. Higher PTSD symptom severity was associated with crime/violence/vacancy, and higher depressive symptom severity was associated with neighborhood disconnectedness. PTSD and depressive symptom severity were associated with intentional injury mechanisms and Medicaid/no insurance. Higher injury severity was associated with depressive symptoms. CONCLUSION Neighborhood characteristics are associated with psychological symptom severity after injury.
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Affiliation(s)
- Marta M Bruce
- University of Pennsylvania School of Nursing, Claire Fagin Hall, Room 418 Curie Blvd, Philadelphia, PA, 19104, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew J Robinson
- University of Pennsylvania School of Nursing, Claire Fagin Hall, Room 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Justine Shults
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Therese S Richmond
- University of Pennsylvania School of Nursing, Claire Fagin Hall, Room 418 Curie Blvd, Philadelphia, PA, 19104, USA.
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Mueller KL, Cooper BP, Moran V, Lew D, Ancona R, Landman JM, Spruce M, Marotta P, Liss DB, Mancini MA, Schuerer D, Ranney ME, Foraker RE. Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019 : A Cohort Study. Ann Intern Med 2023; 176:1163-1171. [PMID: 37639717 DOI: 10.7326/m23-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Firearm injuries are a public health crisis in the United States. OBJECTIVE To examine the incidence and factors associated with recurrent firearm injuries and death among patients presenting with an acute (index), nonfatal firearm injury. DESIGN Multicenter, observational, cohort study. SETTING Four adult and pediatric level I trauma hospitals in St. Louis, Missouri, 2010 to 2019. PARTICIPANTS Consecutive adult and pediatric patients (n = 9553) presenting to a participating hospital with a nonfatal acute firearm injury. MEASUREMENTS Data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and death were collected from the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository. The Centers for Disease Control and Prevention (CDC) Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the probability of experiencing a recurrent firearm injury. RESULTS We identified 10 293 acutely firearm-injured patients of whom 9553 survived the injury and comprised the analytic sample. Over a median follow-up of 3.5 years (IQR, 1.5 to 6.4 years), 1155 patients experienced a recurrent firearm injury including 5 firearm suicides and 149 fatal firearm injuries. Persons experiencing recurrent firearm injury were young (25.3 ± 9.5 years), predominantly male (93%), Black (96%), and uninsured (50%), and resided in high social vulnerability regions (65%). The estimated risk for firearm reinjury was 7% at 1 year and 17% at 8 years. LIMITATIONS Limited data on comorbidities and patient-level social determinants of health. Inability to account for recurrent injuries presenting to nonstudy hospitals. CONCLUSION Recurrent injury and death are frequent among survivors of firearm injury, particularly among patients from socially vulnerable areas. Our findings highlight the need for interventions to prevent recurrence. PRIMARY FUNDING SOURCE Emergency Medicine Foundation-AFFIRM and Missouri Foundation for Health.
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Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., R.A., D.B.L.)
| | - Benjamin P Cooper
- Institute for Public Health, Washington University in St. Louis School of Medicine, St. Louis, Missouri (B.P.C., R.E.F.)
| | - Vicki Moran
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri (V.M.)
| | - Daphne Lew
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri (D.L.)
| | - Rachel Ancona
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., R.A., D.B.L.)
| | - Joshua M Landman
- Institute for Informatics, Data Science, and Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri (J.M.L.)
| | - Marguerite Spruce
- Division of Acute & Critical Care Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri; and Civilian Institutions Program, Air Force Institute of Technology, Wright-Patterson Air Force Base, Ohio (M.S.)
| | - Phillip Marotta
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri (P.M.)
| | - David B Liss
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., R.A., D.B.L.)
| | - Michael A Mancini
- Saint Louis University School of Social Work, St. Louis, Missouri (M.A.M.)
| | - Douglas Schuerer
- Division of Acute & Critical Care Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri (D.S.)
| | - Megan E Ranney
- School of Public Health, Yale University, New Haven, Connecticut (M.E.R.)
| | - Randi E Foraker
- Institute for Public Health, Washington University in St. Louis School of Medicine, St. Louis, Missouri (B.P.C., R.E.F.)
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Rauk L, Rupp L, Hohl BC, Kondo MC, Ornelas L, Carter PM, Zimmerman MA. Lessons learned from local vacant land management organizations for engaging youth in greening. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:187-202. [PMID: 37327062 DOI: 10.1002/ajcp.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
Youth living in areas with high concentrations of vacant properties may be at particular risk for poor health outcomes given the associations between deteriorated vacant properties, poor mental health, and community violence. Vacant lot greening has emerged as a key strategy to mitigate the harms of deteriorated properties. Youth engagement in greening has documented benefits for youth, yet few organizations responsible for managing vacant properties currently engage youth. Further, few researchers have examined the best practices that organizations can employ to effectively engage youth in greening programs. The purpose of this study was to understand how high functioning vacant land management organizations with robust youth engagement capabilities engage youth in their greening work. Based on in-depth interviews with staff from vacant land management organizations, we explored three research questions: (1) what are their identified best practices for youth engagement?; (2) what are the major challenges that impede their youth engagement work?; (3) what solutions are these organizations employing to address these challenges? Findings from this study emphasize the important themes of engaging youth in vacant lot greening in areas of planning, leadership, and decision-making. Youth engagement in vacant lot greening may be a key mechanism for preventing violence through cultivating youth empowerment and development.
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Affiliation(s)
- Leigh Rauk
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laney Rupp
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Bernadette C Hohl
- Perelman School of Medicine, Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle C Kondo
- USDA Forest Service, Northern Research Station, Philadelphia, Pennsylvania, USA
| | - Lexie Ornelas
- Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Patrick M Carter
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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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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Poulson MR, Neufeld MY, Laraja A, Allee L, Kenzik KM, Dechert T. The effect of historic redlining on firearm violence. J Natl Med Assoc 2023; 115:421-427. [PMID: 37365061 DOI: 10.1016/j.jnma.2023.06.003] [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: 07/31/2022] [Revised: 05/01/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Firearm homicides disproportionately affect young Black men, which in turn have lasting impact of communities of color as a whole. Previous cross-sectional studies have highlighted the role of discriminatory housing policies on the incidence of urban firearm violence. We sought to estimate the effects of racist housing policies on firearm incidence. METHODS Firearm incident data were obtained from the Boston Police Department and point locations spatially joined with vector files outlining the original 1930 Home Owner Loan Corporation (HOLC) Redlining maps. A regression discontinuity design was used to assess the increased rate of firearm violence crossing from historically "desirable" neighborhoods (Green) to historically "hazardous" neighborhoods (Red and Yellow) based on HOLC definitions. Linear regression models were fit on either side of the geographic boundaries with firearm incidents graphed at varying distances and the regression coefficient calculated at the boundary. RESULTS Crossing from desirable to Red hazardous designation there was a significant discontinuity with an increase of 4.1 firearm incidents per 1,000 people (95% CI 0.68,7.55). Similarly, when crossing from desirable areas to the Yellow hazardous designation there was a significant discontinuity and increase of 5.9 firearm incidents per 1,000 people (95% CI 1.85,9.86). There was no significant discontinuity between the two hazardous HOLC designations (coefficient -0.93, 95% CI -5.71, 3.85). CONCLUSIONS There is a significant increase in firearm incidents in historically redlined areas of Boston. This suggests that interventions should focus on downstream socioeconomic, demographic, and neighborhood detriments of historically discriminatory housing policies in order to address firearm homicides.
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Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Miriam Y Neufeld
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | | | - Lisa Allee
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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Needham BL, Ali T, Allgood KL, Ro A, Hirschtick JL, Fleischer NL. Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis. J Racial Ethn Health Disparities 2023; 10:1997-2019. [PMID: 35994173 PMCID: PMC9395863 DOI: 10.1007/s40615-022-01381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.
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Affiliation(s)
- Belinda L. Needham
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Talha Ali
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA
| | - Kristi L. Allgood
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California-Irvine Program in Public Health, Irvine, CA USA
| | - Jana L. Hirschtick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
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Conrick KM, Adhia A, Ellyson A, Haviland MJ, Lyons VH, Mills B, Rowhani-Rahbar A. Race, structural racism and racial disparities in firearm homicide victimisation. Inj Prev 2023; 29:290-295. [PMID: 36564165 DOI: 10.1136/ip-2022-044788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To identify an approach in measuring the association between structural racism and racial disparities in firearm homicide victimisation focusing on racism, rather than race. METHODS We examined associations of six measures of structural racism (Black/white disparity ratios in poverty, education, labour force participation, rental housing, single-parent households and index crime arrests) with state-level Black-white disparities in US age-adjusted firearm homicide victimisation rates 2010-2019. We regressed firearm homicide victimisation disparities on four specifications of independent variables: (1) absolute measure only; (2) absolute measure and per cent Black; (3) absolute measure and Black-white disparity ratio and (4) absolute measure, per cent Black and disparity ratio. RESULTS For all six measures of structural racism the optimal specification included the absolute measure and Black-white disparity ratio and did not include per cent Black. Coefficients for the Black-white disparity were statistically significant, while per cent Black was not. CONCLUSIONS In the presence of structural racism measures, the inclusion of per cent Black did not contribute to the explanation of firearm homicide disparities in this study. Findings provide empiric evidence for the preferred use of structural racism measures instead of race.
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Affiliation(s)
- Kelsey M Conrick
- School of Social Work, University of Washington, Seattle, Washington, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
| | - Avanti Adhia
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Alice Ellyson
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miriam Joan Haviland
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
| | - Vivian H Lyons
- Social Development Research Group, School of Social Work, Department of Psychiatry, University of Washington Allies in Healthier Systems for Health & Abundance in Youth, Seattle, Washington, USA
| | - Brianna Mills
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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Mentias A, Mujahid MS, Sumarsono A, Nelson RK, Madron JM, Powell-Wiley TM, Essien UR, Keshvani N, Girotra S, Morris A, Sims M, Capers Q, Yancy C, Desai MY, Menon V, Rao S, Pandey A. Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries. Circulation 2023; 148:210-219. [PMID: 37459409 PMCID: PMC10797918 DOI: 10.1161/circulationaha.123.064351] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The association of historical redlining policies, a marker of structural racism, with contemporary heart failure (HF) risk among White and Black individuals is not well established. METHODS We aimed to evaluate the association of redlining with the risk of HF among White and Black Medicare beneficiaries. Zip code-level redlining was determined by the proportion of historically redlined areas using the Mapping Inequality Project within each zip code. The association between higher zip code redlining proportion (quartile 4 versus quartiles 1-3) and HF risk were assessed separately among White and Black Medicare beneficiaries using generalized linear mixed models adjusted for potential confounders, including measures of the zip code-level Social Deprivation Index. RESULTS A total of 2 388 955 Medicare beneficiaries (Black n=801 452; White n=1 587 503; mean age, 71 years; men, 44.6%) were included. Among Black beneficiaries, living in zip codes with higher redlining proportion (quartile 4 versus quartiles 1-3) was associated with increased risk of HF after adjusting for age, sex, and comorbidities (risk ratio, 1.08 [95% CI, 1.04-1.12]; P<0.001). This association remained significant after further adjustment for area-level Social Deprivation Index (risk ratio, 1.04 [95% CI, 1.002-1.08]; P=0.04). A significant interaction was observed between redlining proportion and Social Deprivation Index (Pinteraction<0.01) such that higher redlining proportion was significantly associated with HF risk only among socioeconomically distressed regions (above the median Social Deprivation Index). Among White beneficiaries, redlining was associated with a lower risk of HF after adjustment for age, sex, and comorbidities (risk ratio, 0.94 [95% CI, 0.89-0.99]; P=0.02). CONCLUSIONS Historical redlining is associated with an increased risk of HF among Black patients. Contemporary zip code-level social determinants of health modify the relationship between redlining and HF risk, with the strongest relationship between redlining and HF observed in the most socioeconomically disadvantaged communities.
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Affiliation(s)
- Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Mahasin S Mujahid
- Division of Epidemiology, UC Berkeley, School of Public Health, Berkeley CA
| | - Andrew Sumarsono
- Division of Hospital Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Utibe R. Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles, CA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Alanna Morris
- Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Quinn Capers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Milind Y. Desai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Venu Menon
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Shreya Rao
- Division of Cardiology, Department of Internal Medicine, UTHSC San Antonio, San Antonio, TX
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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Lee EK, Donley G, Ciesielski TH, Freedman DA, Cole MB. Spatial availability of federally qualified health centers and disparities in health services utilization in medically underserved areas. Soc Sci Med 2023; 328:116009. [PMID: 37301106 DOI: 10.1016/j.socscimed.2023.116009] [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: 10/26/2022] [Revised: 05/11/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
Federally qualified health centers (FQHCs) improve access to care for important health services (e.g., preventive care), particularly among marginalized and underserved communities. However, whether spatial availability of FQHCs influences care-seeking behavior for medically underserved residents is unclear. The objective of this study was to examine the relationships of present-day zip-code level availability of FQHCs, historic redlining, and health services utilization (i.e., at FQHCs and any health clinic/facility) in six large states. We further examined these associations by states, FQHC availability (i.e., 1, 2-4 and ≥5 FQHC sites per zip code) and geographic areas (i.e., urbanized vs. rural, redlined vs. non-redlined sections of urban areas). Using Poisson and multivariate regression models, we found that in medically underserved areas, having at least one FQHC site was associated with greater likelihood of patients seeking health services at FQHCs [rate ratio (RR) = 3.27, 95%CI: 2.27-4.70] than areas with no FQHCs available, varying across states (RRs = 1.12 to 6.33). Relationships were stronger in zip codes with ≥5 FQHC sites, small towns, metropolitan areas, and redlined sections of urban areas (HOLC D-grade vs. C-grade: RR = 1.24, 95%CI: 1.21-1.27). However, these relationships did not remain true for routine care visits at any health clinic or facility (β = -0.122; p = 0.008) or with worsening HOLC grades (β = -0.082; p = 0.750), potentially due to the contextual factors associated with FQHC locations. Findings suggest that efforts to expand FQHCs may be most impactful for medically underserved residents living in small towns, metropolitan areas and redlined sections of urban areas. Because FQHCs can provide high quality, culturally competent, cost-effective access to important primary care, behavioral health, and enabling services that uniquely benefit low-income and marginalized patient populations, particularly those who have been historically denied access to health care, improving availability of FQHCs may be an important mechanism for improving health care access and reducing subsequent inequities for these underserved groups.
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Affiliation(s)
- Eun Kyung Lee
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Gwendolyn Donley
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA.
| | - Timothy H Ciesielski
- Mary Ann Swetland Center for Environmental Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Darcy A Freedman
- Mary Ann Swetland Center for Environmental Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Megan B Cole
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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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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Jay J, Allen K. Curbing the Epidemic of Community Firearm Violence after the Bruen Decision. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2023; 51:77-82. [PMID: 37226753 PMCID: PMC10209991 DOI: 10.1017/jme.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Supreme Court's decision in New York State Rifle & Pistol Association Inc. v. Bruen undermines the ability of cities and states to regulate firearms safety. Nonetheless, we remain hopeful that firearm violence can decline even after the Bruen decision. Several promising public health approaches have gained broader adoption in recent years. This essay examines the key drivers of community firearm violence and reviews promising strategies to reverse those conditions, including community violence intervention (CVI) programs and place-based and structural interventions.
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Affiliation(s)
- Jonathan Jay
- BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH, BOSTON, MASSACHUSETTS, USA
| | - Kalice Allen
- BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH, BOSTON, MASSACHUSETTS, USA
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Egede LE, Walker RJ, Campbell JA, Linde S, Hawks LC, Burgess KM. Modern Day Consequences of Historic Redlining: Finding a Path Forward. J Gen Intern Med 2023; 38:1534-1537. [PMID: 36746831 PMCID: PMC9901820 DOI: 10.1007/s11606-023-08051-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
There is emerging evidence that structural racism is a major contributor to poor health outcomes for ethnic minorities. Structural racism captures upstream historic racist events (such as slavery, black code, and Jim Crow laws) and more recent state-sanctioned racist laws in the form of redlining. Redlining refers to the practice of systematically denying various services (e.g., credit access) to residents of specific neighborhoods, often based on race/ethnicity and primarily within urban communities. Historical redlining is linked to increased risk of diabetes, hypertension, and early mortality due to heart disease with evidence suggesting it impacts health through suppressing economic opportunity and human capital, or the knowledge, skills, and value one contributes to society. Addressing structural racism has been a rallying call for change in recent years-drawing attention to the racialized impact of historical policies in the USA. Unfortunately, the enormous scope of work has also left people feeling incapable of effecting the very change they seek. This paper highlights a path forward by briefly discussing the origins of historical redlining, highlighting the modern-day consequences both on health and at the societal level, and suggest promising initiatives to address the impact.
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Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sebastian Linde
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura C Hawks
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaylin M Burgess
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Mueller KL, Chapman-Kramer K, Cooper BP, Kaser T, Mancini M, Moran V, Vogel M, Foraker RE, Anwuri V. A Regional Approach to Hospital-Based Violence Intervention Programs Through LOV. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:306-316. [PMID: 36961541 DOI: 10.1097/phh.0000000000001716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
CONTEXT Community violence is an underaddressed public health threat. Hospital-based violence intervention programs (HVIPs) have been used to address the root causes of violence and prevent reinjury. OBJECTIVE In this article, we describe the methodology of the St Louis Region-wide HVIP, Life Outside Violence (LOV) program, and provide preliminary process outcomes. DESIGN Life Outside Violence mentors intervene following a violent injury to decrease risk of subsequent victimization and achieve goals unique to each participant by providing therapeutic counseling and case management services to patients and their families. PARTICIPANTS AND SETTING Eligible patients are victims of violent injury between the ages of 8 and 24 years, who are residents of St Louis, Missouri, and present for care at a LOV partner adult or pediatric level I trauma hospital. INTERVENTION Enrolled participants receive program services for 6 to 12 months and complete an individual treatment plan. MAIN OUTCOME MEASURES In this article, we report LOV operational methodology, as well as process metrics, including program enrollment, graduation, and qualitative data on program implementation. RESULTS From August 15, 2018, through April 30, 2022, 1750 LOV-eligible violently injured patients presented to a partner hospital, 349 were approached for program enrollment, and 206 consented to enroll in the program. During this pilot phase, 91 participants graduated from the LOV program and have process output data available for analysis. CONCLUSIONS Life Outside Violence has been implemented into clinical practice as the first HVIP to influence across an entire region through partnership with multiple university and hospital systems. It is our hope that methods shared in this article will serve as a primer for organizations hoping to implement and expand HVIPs to interrupt community violence at the regional level.
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Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri (Dr Mueller); Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, Missouri (Mss Chapman-Kramer, Kaser, and Anwuri, Mr Cooper, and Dr Foraker); Saint Louis University School of Social Work, St Louis, Missouri (Dr Mancini); Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, Missouri (Dr Moran); and School of Criminal Justice, University at Albany, Albany, New York (Dr Vogel)
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Kang JA, Barcelona V. A comparison of conceptual frameworks to examine health inequities in End-of-Life care. J Adv Nurs 2023; 79:2025-2041. [PMID: 35909090 PMCID: PMC9887096 DOI: 10.1111/jan.15393] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
AIMS To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence. DESIGN Discussion paper. DATA SOURCES We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022. IMPLICATIONS FOR NURSING There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health. CONCLUSION We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in end-of-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender. IMPACT Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care. NO PATIENT OR PUBLIC CONTRIBUTION This discussion paper focused on reviewing existing evidence.
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Affiliation(s)
- Jung A Kang
- Columbia University School of Nursing, New York, New York, USA
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46
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Pino EC, Jacoby SF, Dugan E, Jay J. Exposure to Neighborhood Racialized Economic Segregation and Reinjury and Violence Perpetration Among Survivors of Violent Injuries. JAMA Netw Open 2023; 6:e238404. [PMID: 37099300 PMCID: PMC10134006 DOI: 10.1001/jamanetworkopen.2023.8404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/02/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Much is unknown about how individual and neighborhood factors converge in the association with risk for violent reinjury and violence perpetration. Objectives To investigate the association of exposure to neighborhood racialized economic segregation with reinjury and use of violence against others among survivors of violent penetrating injury. Design, Setting, and Participants This retrospective cohort study was performed using data obtained from hospital, police, and state vital records. The study was performed at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. The cohort included all patients treated for a nonfatal violent penetrating injury from 2013 to 2018. Patients with no Boston metropolitan area home address were excluded. Individuals were followed up through 2021. Data were analyzed from February to August 2022. Exposure American Community Survey data were used to measure neighborhood deprivation using the racialized economic Index of Concentration at the Extremes (ICE) for patient residential address upon hospital discharge. ICE was measured on a scale from -1 (most deprived) to 1 (most privileged). Main Outcomes and Measures Primary outcomes were violent reinjury and police-reported perpetration of violence within 3 years of an index injury. Results Of 1843 survivors of violence (median [IQR] age, 27 [22-37] years; 1557 men [84.5%]; 351 Hispanic [19.5%], 1271 non-Hispanic Black [70.5%], and 149 non-Hispanic White [8.3%] among 1804 patients with race and ethnicity data), the cohort was skewed toward residing in neighborhoods with higher racialized economic segregation (median [IQR] ICE = -0.15 [-0.22 to 0.07]) compared with the state overall (ICE = 0.27). There were police encounters for violence perpetration among 161 individuals (8.7%) and violent reinjuries among 214 individuals (11.6%) within 3 years after surviving a violent penetrating injury. For each 0.1-unit increase in neighborhood deprivation, there was a 13% (hazard ratio [HR], 1.13; 95% CI, 1.03 to 1.25; P = .01) increase in risk of violence perpetration but no difference in risk for violent reinjury (HR, 1.03; 95% CI, 0.96 to 1.11; P = .38). The greatest occurrence for each outcome was within the first year after index injury; for example, incidents of violence perpetration occurred among 48 of 614 patients (7.8%) at year 1 vs 10 of 542 patients (1.8%) at year 3 in tertile 3 of neighborhood deprivation. Conclusions and Relevance This study found that living in a more economically deprived and socially marginalized area was associated with increased risk of using violence against others. The finding suggests that interventions may need to include investments in neighborhoods with the highest levels of violence to help reduce downstream transmission of violence.
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Affiliation(s)
- Elizabeth C. Pino
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sara F. Jacoby
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
| | - Elizabeth Dugan
- Boston Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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Taylor NL, Porter JM, Bryan S, Harmon KJ, Sandt LS. Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019. Am J Public Health 2023; 113:420-428. [PMID: 36888942 PMCID: PMC10003496 DOI: 10.2105/ajph.2022.307192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 03/10/2023]
Abstract
Objectives. To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. Methods. We analyzed 2010-2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners' Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining. Results. In an adjusted multivariable analysis, tracts graded D ("Hazardous") had a 2.60 (95% confidence interval = 2.26, 2.99) incidence rate ratio (per residential population) of pedestrian fatalities compared with tracts graded A ("Best"). We found a significant dose‒response relationship: as grades worsened from A to D, rates of pedestrian fatalities increased. Conclusions. Historical redlining policy, initiated in the 1930s, has an impact on present-day transportation inequities in the United States. Public Health Implications. To reduce transportation inequities, understanding how structurally racist policies, past and present, have an impact on community-level investments in transportation and health is crucial. (Am J Public Health. 2023;113(4):420-428. https://doi.org/10.2105/AJPH.2022.307192).
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Affiliation(s)
- Nandi L Taylor
- Nandi L. Taylor is with the Injury Prevention Research Center and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Jamila M. Porter is with the Office of the CEO, de Beaumont Foundation, Bethesda, MD. Shenee Bryan is with S. Bryan Consulting LLC, Atlanta, GA. Katherine J. Harmon is with Injury Prevention Research Center and Highway Safety Research Center, University of North Carolina at Chapel Hill. Laura S. Sandt is with the Highway Safety Research Center, University of North Carolina at Chapel Hill
| | - Jamila M Porter
- Nandi L. Taylor is with the Injury Prevention Research Center and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Jamila M. Porter is with the Office of the CEO, de Beaumont Foundation, Bethesda, MD. Shenee Bryan is with S. Bryan Consulting LLC, Atlanta, GA. Katherine J. Harmon is with Injury Prevention Research Center and Highway Safety Research Center, University of North Carolina at Chapel Hill. Laura S. Sandt is with the Highway Safety Research Center, University of North Carolina at Chapel Hill
| | - Shenee Bryan
- Nandi L. Taylor is with the Injury Prevention Research Center and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Jamila M. Porter is with the Office of the CEO, de Beaumont Foundation, Bethesda, MD. Shenee Bryan is with S. Bryan Consulting LLC, Atlanta, GA. Katherine J. Harmon is with Injury Prevention Research Center and Highway Safety Research Center, University of North Carolina at Chapel Hill. Laura S. Sandt is with the Highway Safety Research Center, University of North Carolina at Chapel Hill
| | - Katherine J Harmon
- Nandi L. Taylor is with the Injury Prevention Research Center and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Jamila M. Porter is with the Office of the CEO, de Beaumont Foundation, Bethesda, MD. Shenee Bryan is with S. Bryan Consulting LLC, Atlanta, GA. Katherine J. Harmon is with Injury Prevention Research Center and Highway Safety Research Center, University of North Carolina at Chapel Hill. Laura S. Sandt is with the Highway Safety Research Center, University of North Carolina at Chapel Hill
| | - Laura S Sandt
- Nandi L. Taylor is with the Injury Prevention Research Center and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Jamila M. Porter is with the Office of the CEO, de Beaumont Foundation, Bethesda, MD. Shenee Bryan is with S. Bryan Consulting LLC, Atlanta, GA. Katherine J. Harmon is with Injury Prevention Research Center and Highway Safety Research Center, University of North Carolina at Chapel Hill. Laura S. Sandt is with the Highway Safety Research Center, University of North Carolina at Chapel Hill
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ROCHE JESSICAS, CARTER PATRICKM, ZEOLI APRILM, CUNNINGHAM REBECCAM, ZIMMERMAN MARCA. Challenges, Successes, and the Future of Firearm Injury Prevention. Milbank Q 2023; 101:579-612. [PMID: 37096629 PMCID: PMC10126989 DOI: 10.1111/1468-0009.12621] [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: 05/09/2022] [Revised: 10/21/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Firearm injury is a leading cause of death in the United States, with fatality rates increasing 34.9% over the past decade (2010-2020). Firearm injury is preventable through multifaceted evidence-based approaches. Reviewing past challenges and successes in the field of firearm injury prevention can highlight the future directions needed in the field. Adequate funding, rigorous and comprehensive data availability and access, larger pools of diverse and scientifically trained researchers and practitioners, robust evidence-based programming and policy implementation, and a reduction in stigma, polarization, and politicization of the science are all needed to move the field forward.
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Affiliation(s)
| | - PATRICK M. CARTER
- University of Michigan Institute for Firearm Prevention
- University of Michigan Injury Prevention Center
- University of Michigan School of Medicine
- University of Michigan School of Public Health
- Michigan Youth Violence Prevention CenterUniversity of Michigan School of Public Health
| | - APRIL M. ZEOLI
- University of Michigan Institute for Firearm Prevention
- University of Michigan School of Public Health
| | - REBECCA M. CUNNINGHAM
- University of Michigan Institute for Firearm Prevention
- University of Michigan Injury Prevention Center
- University of Michigan School of Medicine
- University of Michigan School of Public Health
| | - MARC A. ZIMMERMAN
- University of Michigan Institute for Firearm Prevention
- University of Michigan Injury Prevention Center
- University of Michigan School of Public Health
- Michigan Youth Violence Prevention CenterUniversity of Michigan School of Public Health
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Doucette ML, McCourt AD, Crifasi CK, Webster DW. Impact of Changes to Concealed-Carry Weapons Laws on Fatal and Nonfatal Violent Crime, 1980-2019. Am J Epidemiol 2023; 192:342-355. [PMID: 36104849 DOI: 10.1093/aje/kwac160] [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: 11/19/2021] [Revised: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022] Open
Abstract
The United States faces rapidly rising rates of violent crime committed with firearms. In this study, we sought to estimate the impact of changes to laws that regulate the concealed carrying of weapons (concealed-carry weapons (CCW) laws) on violent crimes committed with a firearm. We used augmented synthetic control models and random-effects meta-analyses to estimate state-specific effects and the average effect of adopting shall-issue CCW permitting laws on rates of 6 violent crimes: homicide with a gun, homicide by other means, aggravated assault with a gun, aggravated assault with a knife, robbery with a gun, and robbery with a knife. The average effects were stratified according to the presence or absence of several shall-issue permit provisions. Adoption of a shall-issue CCW law was associated with a 9.5% increase in rates of assault with a firearm during the first 10 years after law adoption and was associated with an 8.8% increase in rates of homicide by other means. When shall-issue laws allowed violent misdemeanants to acquire CCW permits, the laws were associated with higher rates of gun assaults. It is likely that adoption of shall-issue CCW laws has increased rates of nonfatal violent crime committed with firearms. Harmful effects of shall-issue laws are most clear when provisions intended to reduce risks associated with civilian gun-carrying are absent.
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Siegel M, Wiklund E. The relationship between state-level structural racism and disparities between the non-hispanic black and non-hispanic white populations in multiple health outcomes. J Natl Med Assoc 2023; 115:207-222. [PMID: 36801076 DOI: 10.1016/j.jnma.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
AIMS While several studies have examined the impact of individual indicators of structural racism on single health outcomes, few have explicitly modeled racial disparities in a wide range of health outcomes using a multidimensional, composite structural racism index. This paper builds on the previous research by examining the relationship between state-level structural racism and a wider array of health outcomes, focusing on racial disparities in mortality from firearm homicide, infant mortality, stroke, diabetes, hypertension, asthma, HIV, obesity, and kidney disease. METHODS We used a previously developed state structural racism index that consists of a composite score derived by averaging eight indicators across five domains: (1) residential segregation; (2) incarceration; (3) employment; (4) economic status/wealth; and (5) education. Indicators were obtained for each of the 50 states using Census data from 2020. We estimated the Black-White disparity in each health outcome in each state by dividing the age-adjusted mortality rate for the non-Hispanic Black population by the age-adjusted mortality rate for the non-Hispanic White population. These rates were obtained from the CDC WONDER Multiple Cause of Death database for the combined years 1999-2020. We conducted linear regression analyses to examine the relationship between the state structural racism index and the Black-White disparity in each health outcome across the states. In multiple regression analyses, we controlled for a wide range of potential confounding variables. RESULTS Our calculations revealed striking geographic differences in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Higher levels of structural racism were significantly associated with greater racial disparities in mortality for all but two of the health outcomes. CONCLUSIONS There is a robust relationship between structural racism and Black-White disparities in multiple health outcomes across states. Programs and policies to reduce racial heath disparities must include strategies to help dismantle structural racism and its consequences.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Emma Wiklund
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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