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Rice HE, Owen M, Johnson A, Swandell J, Nicholson CP, Provencher S, Horne E, Solomon C, Ratliff W, Knechtle W, Campbell D, Smith R, Graves L. Lived experiences of people impacted by gun violence: qualitative analysis of the prescriptions for repair project. Trauma Surg Acute Care Open 2024; 9:e001503. [PMID: 39005706 PMCID: PMC11243210 DOI: 10.1136/tsaco-2024-001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Background Restorative justice interventions can help address the harm created by gun violence, although few restorative justice programs focus solely on survivors or loved ones of victims of gun violence. Our aim was to assess how gun violence impacts those injured by firearms through qualitative analysis of their lived experiences. Methods From August 2022 to October 2023, we operated a program entitled Prescriptions for Repair in Durham, North Carolina, USA, which was supported by community groups, public government, and academia. Through a series of structured listening sessions using a restorative justice framework, trained community-based facilitators helped 30 participants (11 survivors of gun violence and 19 loved ones of victims of gun violence) tell their stories through a non-judgmental narrative process. We conducted a qualitative thematic analysis of the listening sessions from 19 participants to define the major lessons learned from survivors of gun violence. We summarized participant responses into individual-level and community-level views on how to 'make things as right as possible'. Results The lived experiences of gun violence survivors and their loved ones confirmed the inherent value of structured listening programs, how poverty, race and racism impact gun violence, and the need to focus resources on children and youth. Conclusions Listening to the survivors of gun violence through restorative justice programs can help address the personal and community harm resulting from gun violence. Level of evidence Level IV, prospective observational study.
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Affiliation(s)
- Henry E Rice
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke University Global Health Institute, Durham, North Carolina, USA
| | - Marcia Owen
- Restorative Justice Durham, Durham, North Carolina, USA
| | - Azmen Johnson
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jordan Swandell
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Phifer Nicholson
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Provencher
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth Horne
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christopher Solomon
- Department of Social Work, North Carolina Central University, Durham, North Carolina, USA
| | - William Ratliff
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Will Knechtle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Dwayne Campbell
- Department of Community Safety, City of Durham, Durham, North Carolina, USA
| | - Ryan Smith
- Department of Community Safety, City of Durham, Durham, North Carolina, USA
| | - Lorraine Graves
- Department of Social Work, North Carolina Central University, Durham, North Carolina, USA
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Allem JP, Biyani M, Bushman BJ. Surveillance of Gun-Related Conversations on Twitter. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:380-391. [PMID: 37962708 DOI: 10.1007/s11121-023-01599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
Gun violence in the USA is a documented public health crisis. Publicly accessible data from Twitter posts can be used to rapidly capture and describe the public's recent conversations about guns. Because these gun-related conversations change rapidly, it is important to provide regularly updated information on them. Twitter posts containing gun-related terms were obtained from January 1, 2022 to June 30, 2022. To understand topics of gun-related tweets (N = 449,492), topic modeling was performed with Top2Vec. Gun ownership control, concern about gun safety and its impact on children and schools, and the Second Amendment were major areas of the gun-related discourse on Twitter. Several identified topics in this study were a consequence of the study period, including "Discourse on Capitol Riots," and "Wartime and Military Use of Guns," with the latter topic containing conversations about the Russia-Ukraine War. Conversations around the influence of the National Rifle Association (NRA) on gun policies and pro-gun ownership perspectives were also part of the public discourse. The intersection between alcohol, substance use, and gun use was infrequently observed. Findings suggest that gun-related conversations in social media such as Twitter can inform public health researchers.
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Affiliation(s)
- Jon-Patrick Allem
- Keck School of Medicine, University of Southern California, 1845 N Soto Street, 3rd Floor, SSB 312D, Los Angeles, CA, 90032, USA.
| | - Manan Biyani
- Keck School of Medicine, University of Southern California, 1845 N Soto Street, 3rd Floor, SSB 312D, Los Angeles, CA, 90032, USA
| | - Brad J Bushman
- School of Communication, The Ohio State University, Columbus, OH, USA
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Schenck CS, Dodington J, Paredes L, Gawel M, Nedd A, Vega P, O’Neill KM. Implementation of an emerging hospital-based violence intervention program: a multimethod study. Trauma Surg Acute Care Open 2023; 8:e001120. [PMID: 38020854 PMCID: PMC10660964 DOI: 10.1136/tsaco-2023-001120] [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: 03/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Individuals who experience assaultive firearm injury are at elevated risk for violent reinjury and multiple negative physical and psychological health outcomes. Hospital-based violence intervention programs (HVIPs) may improve patient outcomes through intensive, community-based case management. Methods We conducted a multimethod evaluation of an emerging HVIP at a large trauma center using the RE-AIM framework. We assessed recruitment, violent reinjury outcomes, and service provision from 2020 to 2022. Semistructured, qualitative interviews were performed with HVIP participants and program administrators to elicit experiences with HVIP services. Directed content analysis was used to generate and organize codes from the data. We also conducted clinician surveys to assess awareness and referral patterns. Results Of the 319 HVIP-eligible individuals who presented with non-fatal assaultive firearm injury, 39 individuals (12%) were enrolled in the HVIP. Inpatient admission was independently associated with HVIP enrollment (OR 2.6, 95% CI 1.3 to 5.2; p=0.01). Facilitators of Reach included engaging with credible messengers, personal relationships with HVIP program administrators, and encouragement from family to enroll. Fear of disclosure to police was cited as a key barrier to enrollment. For the Effectiveness domain, enrollment was not associated with reinjury (OR 0.70, 95% CI 0.16 to 3.1). Participants identified key areas of focus where needs were not met including housing and mental health. Limited awareness of HVIP services was a barrier to Adoption. Participants described strengths of Implementation, highlighting the deep relationships built between clients and administrators. For the long-term Maintenance of the program, both clinicians and HVIP clients reported that there is a need for HVIP services for individuals who experience violent injury. Conclusions Credible messengers facilitate engagement with potential participants, whereas concerns around police involvement is an important barrier. Inpatient admission provides an opportunity to engage patients and may facilitate recruitment. HVIPs may benefit from increased program intensity. Level of evidence IV.
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Affiliation(s)
| | - James Dodington
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lucero Paredes
- Department of Surgery, Maine Medical Center, Portland, Maine, USA
| | - Marcie Gawel
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Antwan Nedd
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Pepe Vega
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Kathleen M O’Neill
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Gallen K, Sonnenberg J, Loughran C, Smith MJ, Sheppard M, Schuster K, Kaufman E, Song JS, Hall EC. Health Effects of Policing in Hospitals: a Narrative Review. J Racial Ethn Health Disparities 2023; 10:870-882. [PMID: 35267188 DOI: 10.1007/s40615-022-01275-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Law enforcement activity, in the form of outside agencies or hospital security forces, is increasingly common in American healthcare. Little is known about the potential effects of this prevalent, modifiable exposure on hospital staff and patient health. This narrative review characterizes existing evidence on the direct and indirect health effects of law enforcement activity in hospitals. OBSERVATIONS Law enforcement activity in hospitals can affect health outcomes through four mechanisms: (1) physical health effects related to workplace violence, restraint use, excessive force, and weapon use; (2) mental health effects involving perceptions of safety and psychological distress; (3) social effects related to the patient-provider relationship, mistrust, and bias and discrimination; and (4) legal and ethical considerations affecting overall well-being. CONCLUSIONS AND RELEVANCE Unchecked law enforcement activity in hospitals may risk patient physical and mental health, reduce patient trust, result in bias and discrimination, and contribute to legal and ethical rights violations. Importantly, law enforcement activity in hospitals may also contribute to staff perceptions of safety. To fill knowledge gaps on the measurable impact of law enforcement activity in the hospital on staff and patients, hospitals should collect and publicly share robust data on law enforcement activity in their facilities, create and adopt patient-centered policies to ensure safety and protect patient health and privacy, and implement evidence-based interventions that safely reduce law enforcement involvement with patients.
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Affiliation(s)
- Kate Gallen
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | | | - Mildred Sheppard
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Kirsten Schuster
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ji Seon Song
- School of Law, University of California, Irvine, CA, USA
| | - Erin C Hall
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA.
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Kaufman EJ, Khatri U, Hall EC, Alur R, Song J, Beard JH, Jacoby SF. Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma. Trauma Surg Acute Care Open 2023; 8:e001022. [PMID: 36937171 PMCID: PMC10016311 DOI: 10.1136/tsaco-2022-001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
Background Trauma patients frequently come into contact with law enforcement officers (LEOs) during the course of their medical care, but little is known about how LEO presence affects processes of care. We surveyed members of the American Association for the Surgery of Trauma (AAST) to assess their perspectives on frequency, circumstances, and implications of LEO presence in trauma bays nationwide. Methods Survey items addressed respondents' experience with the frequency and context of LEO presence and their perspectives on the impact of LEO presence for patients, clinical care, and public safety. Respondent demographics, professional characteristics, and practice setting were collected. The survey was distributed electronically to AAST members in September and October of 2020. Responses were compared by participant age, gender, race, ethnicity, urban versus rural location using χ2 tests. Results Of 234 respondents, 189 (80.7%) were attending surgeons, 169 (72.2%) identified as white, and 144 (61.5%) as male. 187 respondents (79.9%) observed LEO presence at least weekly. Respondents found LEO presence was most helpful for public safety, followed by clinical care, and then for patients. Older respondents rated LEO presence as helpful more often than younger respondents regarding the impact on patients, clinical care, and public safety (p<0.001 across all domains). When determining LEO access, respondents assessed severity of the patient's condition, the safety of emergency department staff, the safety of LEOs, and a patient's potential role as a threat to public safety. Conclusions Respondents described a wide range of perspectives on the impact and consequence of LEO in the trauma bay, with little policy to guide interactions. The overlap of law enforcement and healthcare in the trauma bay deserves attention from institutional and professional policymakers to preserve patient safety and autonomy and patient-centered care. Level of evidence IV, survey study.
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Affiliation(s)
- Elinore J Kaufman
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Utsha Khatri
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Erin C Hall
- Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rucha Alur
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jamie Song
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jessica H Beard
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sara F Jacoby
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gallen KM, Smith MJ, Crane J, Loughran C, Schuster K, Sonnenberg J, Reese M, Girard VW, Song JS, Hall EC. Law Enforcement and Patient Privacy Among Survivors of Violence: A Nationwide Mixed-Methods Study. J Surg Res 2023; 283:648-657. [PMID: 36455418 DOI: 10.1016/j.jss.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION During the emergent treatment of violently injured patients, law enforcement (LE) officers and health care providers frequently interact. Both have duties to protect patient health, rights, and public health, however, the balance of these duties may feel at odds. The purpose of this study is to assess hospital-based violence intervention program (HVIP) representatives' experiences with LE officers among survivors of violence and the impact of hospital policies on interactions with LE officers. MATERIALS AND METHODS A nationwide survey was distributed to the 35 HVIPs that form the Health Alliance for Violence Intervention. Data regarding respondent affiliation, programs, and perceptions of hospital policies outlining LE activity were collected. Follow-up video interviews were open coded and qualitatively analyzed using grounded theory. RESULTS Respondents from 32 HVIPs completed the survey (91%), and 22 interviews (63%) were conducted. Common themes from interviews were: police-patient interactions; racism, bias, and victims' treatment as suspects; and training and education. Only 39% of respondents knew that policies existed and were familiar with them. Most representatives believed their hospitals' existing policies were inadequate, ineffective, or biased. Programs that reported good working relationships with LE officers offered insight on how their programs maintain these partnerships and work with LE officers towards a common goal. CONCLUSIONS Unclear or inadequate policies relating to LE activity may jeopardize the health and privacy of violently injured patients. Primary areas identified for improvement include clarifying and revising hospital policies, education of staff and LE officers, and improved communication between health care providers and LE officers to better protect patient rights.
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Affiliation(s)
- Kate M Gallen
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Michael J Smith
- Georgetown University Law Center, Washington, District of Columbia
| | - Joshua Crane
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Carly Loughran
- Georgetown University Law Center, Washington, District of Columbia
| | - Kirsten Schuster
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, California
| | - Mildred Reese
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Vicki W Girard
- Georgetown University Law Center, Washington, District of Columbia
| | - Ji Seon Song
- University of California, Irvine School of Law, Irvine, California
| | - Erin C Hall
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, District of Columbia.
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