Depicting "the system": How structural racism and disenfranchisement in the United States can cause dynamics in community violence among males in urban black communities

Exploring adolescent-adult connections, coping, and safety among minoritized youth in neighborhoods impacted by community violence

Dyadic interviews were conducted with 32 youth ages 13-21 and their self-identified key adult supports to illuminate how adult supports help protect youth in communities impacted by high levels of violence. Interview transcripts were analyzed using thematic content analysis. Youth described choosing social interactions carefully, avoiding high-violence areas, and keeping busy with activities. Many youths discussed the necessity of minimizing contact with peers to avoid violence, resulting in isolation from friends and increased engagement with family at home. Adult supports reflected upon an intergenerational transfer of violence avoidance, safety planning, and coping strategies through sharing their own lived experiences. Dyads highlighted the need for intergenerational programming to address social isolation and build supportive social networks.

The Potential of Minimum Wage Increases to Reduce Youth Homicide Disparities: Diminishing Returns for Black Youth

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.

Elusive boundaries: using an attribute framework to describe systems for population physical activity promotion

The cost of physical inactivity is alarming, and calls for whole-of-system approaches to population physical activity promotion (PPAP) are increasing. One innovative approach to PPAP is to use a framework of interdependent attributes and associated dimensions of effective systems for chronic disease prevention. Describing system boundaries can be an elusive task, and this article reports on using an attribute framework as a first step in describing and then assessing and strengthening a provincial system for PPAP in British Columbia, Canada. Interviews were conducted with provincial stakeholders to gather perspectives regarding attributes of the system. Following this, two workshops were facilitated to document important stories about the current system for PPAP and link story themes with attributes. Results from interviews and workshops were summarized into key findings and a set of descriptive statements. One hundred and twenty-one statements provide depth, breadth and scope to descriptions of the system through the lens of an adapted framework including four attributes: (i) implementation of desired actions, (ii) resources, (iii) leadership and (iv) collaborative capacity. The attribute framework was a useful tool to guide a whole-of-system approach and turn elusive boundaries into rich descriptors of a provincial system for PPAP. Immediate implications for our research are to translate descriptive statements into variables, then assess the system through group model building and identify leverage points from a causal loop diagram to strengthen the system. Future application of this approach in other contexts, settings and health promotion and disease prevention topics is recommended.

Intergenerational Continuity of Child Maltreatment, Parenting, and Racism: Commentary on Valentino et al., (2012)

Recent editorials published in Child Maltreatment bring much needed attention to racism in child maltreatment reporting and investigation. In this commentary, we extend these efforts by responding to Valentino et al., (2012) and addressing prior omissions in our race-related work by explicitly discussing the role of racism in our explanation of key study findings. Together with scholars with expertise in the impact of racism on children and families, this commentary (a) discusses theoretical models of child maltreatment and of the influence of racism on parenting and child development; (b) discusses parental responses to racism in relation to the Valentino et al., (2012) findings; and (c) highlights future research directions.

How Funding Policy Maintains Structural Inequity Within Indigenous Community-Based Organizations

Despite efforts to increase investment in Indigenous health and well-being in the United States, disparities remain. The way in which health-promoting organizations are funded is one key mechanism driving the systemic, long-term health disparities experienced by Indigenous people in the US. Using Indigenous-led community-based organizations (ICBOs) that provide psychosocial care as a case study, we highlight multiple ways in which policies that regulate the external funding that ICBOs depend on must change to promote equity and allow the organizations to flourish and address unmet psychosocial needs for Indigenous community members. We use a system dynamics approach to discuss how "capability traps" arise from a misfit between external funding regulations and organizations' needs for sustainability and effective care provision. We provide suggestions for reforming funding policies that focus on improving ICBO sustainability.

Academic Achievement After Violence Exposure: The Indirect Effects of School Attachment and Motivation to Succeed

Disparities in educational outcomes for students living in communities burdened with high rates of violence are striking as they are at an increased risk for misbehavior, low GPA, poor school attendance, and decreased standardized test scores. However, limited research identifies the role that schools play in exacerbating exposure to violence to inform changes that aid in mitigating violence exposure. As such, this study utilizes the Pathways to Desistance Study to explore the mediating roles of school attachment and motivation to succeed on students' academic outcomes after exposure to community violence. Using a serial mediation model, findings indicate that school attachment and motivation to succeed mediate the relationship between exposure to violence and grades. Implications for adapting school programs and policies as well as providing teacher training to increase school attachment and motivation are discussed.

"The Fight is Two Times as Hard": A Qualitative Examination of a Violence Syndemic Among Young Black Sexual Minority Men

Young Black men who have sex with men (YBMSM) are disproportionately impacted by violence, including violence rooted in anti-Black racism, sexual identity bullying, and neighborhood violence rooted in structural racism and inequities. These multiple forms of violence are frequently co-occurring and interactive creating syndemic conditions that can negatively impact HIV care. This qualitative study is based on in-depth interviews with 31 YBMSM, aged 16-30 years, living with HIV in Chicago, IL, to examine how violence has impacted their lives. Using thematic analysis, we identified five themes that reflect how YBMSM experience violence at the intersection of racism, homonegativity, socioeconomic status, and HIV status: (a) the experience of intersectional violence; (b) long histories of violence contributed to hypervigilance, lack of safety, and lack of trust; (c) making meaning of violence and the importance of strength; (d) normalizing violence for survival; and (e) the cyclical nature of violence. Our study highlights how multiple forms of violence can accumulate across an individual's life and contribute to social and contextual situations that further contribute to violence and negatively impact mental health and HIV care.

Making the invisible visible: Using a qualitative system dynamics model to map disparities in cumulative environmental stressors and children's neurodevelopment

BACKGROUND

The combined effects of multiple environmental toxicants and social stressor exposures are widely recognized as important public health problems, likely contributing to health inequities. However, US policy makers at state and federal levels typically focus on one stressor exposure at a time and have failed to develop comprehensive strategies to reduce multiple co-occurring exposures, mitigate cumulative risks and prevent harm. This research aimed to move from considering disparate environmental stressors in isolation to mapping the links between environmental, economic, social and health outcomes as a dynamic complex system using children's exposure to neurodevelopmental toxicants as an illustrative example. Such a model can be used to support a broad range of child developmental and environmental health policy stakeholders in improving their understanding of cumulative effects of multiple chemical, physical, biological and social environmental stressors as a complex system through a collaborative learning process.

METHODS

We used system dynamics (SD) group model building to develop a qualitative causal theory linking multiple interacting streams of social stressors and environmental neurotoxicants impacting children's neurodevelopment. A 2 1/2-day interactive system dynamics workshop involving experts across multiple disciplines was convened to develop the model followed by qualitative survey on system insights.

RESULTS

The SD causal map covered seven interconnected themes: environmental exposures, social environment, health status, education, employment, housing and advocacy. Potential high leverage intervention points for reducing disparities in children's cumulative neurotoxicant exposures and effects were identified. Workshop participants developed deeper level of understanding about the complexity of cumulative environmental health risks, increased their agreement about underlying causes, and enhanced their capabilities for integrating diverse forms of knowledge about the complex multi-level problem of cumulative chemical and non-chemical exposures.

CONCLUSION

Group model building using SD can lead to important insights to into the sociological, policy, and institutional mechanisms through which disparities in cumulative impacts are transmitted, resisted, and understood.

The cumulative effect of gun homicide-related loss on neighborhood perceptions among street-identified black women and girls: A mixed-methods study

Racial disparities in death indicate that Black women and girls are disproportionately bereaved by violent loss across their lifetime. Yet the context and consequences of this loss remain largely understudied. This study examines the effect of gun homicide-related loss of relative/friends on subjective neighborhood perceptions among street-identified Black women and girls (ages 16 to 54). The study used a convergent mixed-methods design, with simultaneous quantitative and qualitative components. Data were collected from two low-income, high-crime neighborhoods in Wilmington, Delaware. Quantitative data (n = 277) included a community-based survey on health, opportunity and violence. Qualitative data (n = 50) included semi-structured interviews primarily from a sub-group of the survey population. This study used a street participatory action research (Street PAR) methodology, which included members of the target population onto the research project. OLS regression analyses predicted the effect of exposure to gun homicide on perceptions of neighborhood social environment (i.e., safety, aesthetic quality, walkability, social cohesion, and availability of healthy foods). Interviews were analyzed using grounded theory. Approximately 87% of those surveyed were exposed to a relative/friend gun homicide. All interviewees were exposed to a relative/friend gun homicide. Exposure to the gun homicide of either a relative or friend alone was nonsignificant. But the combination of exposure to gun homicides of both a relative and friend was significantly related to poorer neighborhood perceptions, even when controlling for co-occurring factors. Mixed-method findings indicate that the cumulative impact of gun homicide-related loss matters most in shaping negative neighborhood perceptions. Qualitative data suggest that losing multiple members of one's familial and peer networks to homicide is a powerful form of co-victimization that alters how participants conceptualize and navigate public space. Interventions to decrease gun violence should consider how traumatic loss has unintended consequences on the quality of life of co-victims and those in close proximity to street life.

The relationship between national racism and child abuse among Palestinians in Israel: The moderating role of coping strategies

BACKGROUND

Exposure to ethnic- and race-related stress (e.g., racism, racial discrimination, and micro-aggression) can impair parenting and parent-child relations.

OBJECTIVE

This study examines the exposure of Palestinian parents in Israel to two levels of racism, interpersonal racism (IPR) and perceived collective racism (PCR), and the relationship of each to perpetrating child abuse. Further, the study examines the moderating role of coping strategies on these relationships.

PARTICIPANTS AND SETTING

The study was conducted among a systematic semi-random sample of 770 Palestinian parents in Israel (500 mothers and 270 fathers) aged 21-66 (M = 38.7, SD = 7.84).

METHODS

Participants filled out a self-administered questionnaire that included items from several instruments.

RESULTS

Regression analysis revealed that PCR and avoidance coping significantly predict psychological, R² = 0.072, p < 0.001, and physical, R² = 0.088, p < 0.001, child abuse. Interestingly, the moderating effects of coping strategies varied somewhat. High avoidance-coping (e.g., distraction, denial, withdrawal) worsened PCR's effect on child abuse, while low avoidance-coping mitigated it but augmented IPR's effect on child abuse. Further, frequently using problem-oriented coping (e.g., analyzing the situation) worsened IPR's effect on child abuse. Child abuse risk increased when parents experienced high PCR levels and frequently used avoidance coping. Likewise, it increased when they experienced high IPR levels and used either high problem-oriented coping or low avoidance-coping.

CONCLUSIONS

Understanding when coping strategies buffer the impact of racism on the parent-child relationship and when they exacerbate it can contribute to interventions with parents experiencing IPR and PCR.

Anti-Racist Violence Prevention: Partnering With Black Youth to Identify Intervention Priorities

In this study, academic researchers partnered with Black youth to engage in critical analysis of the intersection between racism and community violence to promote anti-racist social action that advances health equity. Through youth participatory action research, we examined perspectives and experiences of Black youth to develop a shared understanding of how to approach community violence prevention with an anti-racist lens. Thirteen youth from Kansas City and Atlanta who identified as Black or African American participated in a photovoice project to explore the intersection of racism and community violence. Youth generated photo assignments, took photos that reflected the assignment, shared their photos as a group, and chose one photo to explore in depth each week using a structured method to guide photo-discussion. Qualitative analysis of youth photo-discussions identified themes related to Black youth's experiences of racism at multiple levels and identified suggestions for anti-racist interventions, including promoting Black history knowledge and nurturing Black mentoring relationships. Grounded in these findings, we propose an anti-racist approach to community violence prevention among Black youth that engages Black youth as equitable partners to build from their expertise and strengths in developing comprehensive solutions.

When primary healthcare meets queerstory: community-based system dynamics influencing regional/rural LGBTQ + people's access to quality primary healthcare in Australia

BACKGROUND

Lesbian, gay, bisexual, transgender, Queer, and people of any other minority sexuality or gender identity (LGBTQ + or "Queer") are often marginalised from accessing quality primary healthcare (PHC) in their local community. This is largely due to Queerphobic, cis-heteronormative/sexist systems pathologising Queer life and identities. The study aims were to: (1) identify key priorities for increasing Queer people's access to quality PHC as told by Queer people themselves, (2) identify the feedback loops that reduce or support Queer people's access to quality PHC in non-metropolitan, regional/rural communities, and (3) identify potential action areas to improve system structures to increase Queer people's access to quality PHC.

METHODS

Group Model Building (GMB) workshops were held with a small group (n = 8) of LGBTQ + people in regional Victoria with lived experience of using PHC services. This participatory approach permits exploration and visual mapping of local structures causing behaviour patterns of community concern over time - in this case, Queer people's ability to access quality PHC in the Geelong-Barwon region. This is the first study that specially applies GMB in Queer PHC in the non-metropolitan regional/rural context.

RESULTS

Key community identified PHC priorities were: (a) providers' level of Queer Literacy, (b) the responsibility of Queer Advocacy (at individual, systemic, and collective levels), (c) support from safe Queer Spaces, (d) strength from a Queer Presence, and (e) power from Intersectional Queer Life. These priorities interconnected, creating system-level feedback loops reinforcing barriers and enablers to Queer people's access to quality PHC in the Geelong-Barwon region; with potential action areas identified.

CONCLUSIONS

Improving Queer people's access to quality PHC in the Geelong-Barwon region requires embedding principles of Queer Literacy, Queer Advocacy, Queer Space, Queer Presence, and Intersectional Queer Life within practices and service systems. The study findings were distilled into a novel, preliminary set of Queer Equity Principles. These need to be taken back to regional Queer communities for further co-design and planning for translation across PHC practices and systems, with potential applicability in other areas of the healthcare spectrum.

Heterogeneous effects of spatially proximate firearm homicide exposure on anxiety and depression symptoms among U.S. youth

The burden of firearm homicide in the United States is not evenly distributed across the population; rather, it disproportionately affects youth in disadvantaged and marginalized communities. Research is limited relevant to the impacts of exposure to firearm violence that occurs near where youth live or attend school - spatially proximate firearm violence - on youths' mental health and whether those impacts vary by characteristics that shape youths' risk for experiencing that exposure in the first place. Using a dataset linking the Fragile Families and Child Wellbeing Study with the Gun Violence Archive (N = 3086), we employed propensity score matching and multilevel stratification to examine average and heterogeneous associations between spatially proximate firearm homicide exposure and anxiety and depression among all youth and then separately for boys and girls. We found a statistically significant average association between firearm homicide exposure and symptoms of depression among youth. Furthermore, heterogeneous effects analyses yielded evidence that the average association is driven by youth, and particularly boys, who are the most disadvantaged and have the highest risk of firearm homicide exposure. The results of this study suggest that the accumulation of stressors associated with structural disadvantage and neighborhood disorder, coupled with exposure to spatially proximate and deadly firearm violence, may make boys and young men, particularly Black boys and young men, uniquely vulnerable to the mental health impacts of such exposure. Ancillary analyses of potential effect moderators suggest possible future areas of investigation.

Listening to the "HITS:" Screening for IPV in African American Co-Parents of Young Children

Relationships among African American (AA) parents living apart can be contentious. A common assumption is that men are the perpetrators and women are the victims of violence. Research examining the symmetry of intimate partner violence (IPV) has not focused enough on AA parents who are co-parenting their young children while living apart. The purpose of this study is to explore reports of IPV among non-cohabiting AA co-parents of 2-6-year-old children enrolled in the Dedicated African American Dad Study (DAADS). Our objectives for this study are to characterize the nature of intimate partner relationships among non-co-residing co-parents by exploring the association between the quality of relationship and co-parenting fathers' and mothers' Hurt, Insult, Threaten, and Scream (HITS) scores. The HITS is a domestic violence screening tool for use in the community. As part of the screening protocol for study inclusion, we administered the HITS to father-mother dyads. Fathers were ineligible for participation if either parent reported HITS cut-off scores >10 and identified safety concerns for themselves when interacting with their co-parent. Among DAAD study parenting dyads, we noted symmetry in reports of IPV (i.e., both parents reported elevated HITS scores). The most frequently elevated HITS items were "insult or talk down to" and "scream or curse" indicating the preponderance of verbal conflict among parents in the study. The nature of IPV among co-parents in this study is predominantly verbal. In light of the potential for reciprocity in IPV, interventions for families in this context should focus on communication and problem solving to support fathers and mothers and minimize child harm.

Mapping the complex causal mechanisms of drinking and driving behaviors among adolescents and young adults

BACKGROUND

The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S.

METHODS

We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review.

RESULTS

The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving.

CONCLUSION

This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.

Diverse Approaches to Creating and Using Causal Loop Diagrams in Public Health Research: Recommendations From a Scoping Review

Objectives: Complex systems thinking methods are increasingly called for and used as analytical lenses in public health research. The use of qualitative system mapping and in particular, causal loop diagrams (CLDs) is described as one promising method or tool. To our knowledge there are no published literature reviews that synthesize public health research regarding how CLDs are created and used. Methods: We conducted a scoping review to address this gap in the public health literature. Inclusion criteria included: 1) focused on public health research, 2) peer reviewed journal article, 3) described and/or created a CLD, and 4) published in English from January 2018 to March 2021. Twenty-three articles were selected from the search strategy. Results: CLDs were described as a new tool and were based upon primary and secondary data, researcher driven and group processes, and numerous data analysis methods and frameworks. Intended uses of CLDs ranged from illustrating complexity to informing policy and practice. Conclusion: From our learnings we propose nine recommendations for building knowledge and skill in creating and using CLDs for future public health research.

The association between perceived community violence, police bias, race, and firearm carriage among urban adolescents and young adults

Firearms are a leading cause of death among youth and young adults. Given community violence is an important correlate of youth firearm carriage, we evaluated: 1) If the association between perceived community violence and firearm carriage is stronger when perceived police bias is greater; and 2) If this moderated association differs by race. Cross-sectional data came from screening data for a longitudinal study of firearm behaviors among young adults seeking urban emergency department treatment between July 2017-June 2018 (N = 1264). We estimated Poisson regressions with robust error variance to evaluate associations between perceived community violence, police bias, race, and firearm carriage. Community violence was positively associated with firearm carriage (average marginal effect [AME]: 0.05; 95% Confidence Interval [CI]: 0.03, 0.07). We also found that the positive association between community violence and firearm carriage increased with higher perceptions of police bias (interaction p < 0.05). We did not find evidence of a three-way interaction by which the moderated association between violence exposure and firearm carriage by perceived police bias varied by race of the respondents. Our findings suggest that community-level strategies to reduce violence and police bias may be beneficial to decrease youth firearm carriage in socio-economically disadvantaged urban settings.