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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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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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Wulz AR, Miller GF, Hicks L, Wolkin AF. Association between social vulnerability factors and homicide and suicide rates - United States, 2016 - 2020. JOURNAL OF SAFETY RESEARCH 2024; 90:1-8. [PMID: 39251268 DOI: 10.1016/j.jsr.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 05/23/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Differences in social and environmental factors contribute to disparities in fatal injury rates. This study assessed the relationship between social vulnerability and homicide and suicide rates across United States counties. METHODS County-level age-adjusted homicide and suicide rates for 2016-2020 were linked with data from the Centers for Disease Control and Prevention's 2020 Social Vulnerability Index (SVI), a dataset identifying socially vulnerable communities. We conducted negative binomial regressions to examine the association between SVI and homicide and suicide rates, overall and by Census region/division. We mapped county-level data for SVI and homicide and suicide rates in bivariate choropleth maps. RESULTS Overall SVI was associated with homicide rates across U.S. counties. While no association was found for overall SVI and suicide rates, Socioeconomic Status and Racial & Ethnic Minority Status domains were associated. The geographic distribution of SVI and homicide and suicide rates varied spatially; notably, counties in the South had the greatest levels of social vulnerability and greatest homicide rates. CONCLUSIONS Our findings demonstrate county-level social vulnerability is associated with homicide rates but may be more nuanced for suicide rates. A modified SVI for injury should include additional social and structural determinants and exclude variables not applicable to injuries. PRACTICAL APPLICATIONS This study combines the SVI with homicide and suicide data, enabling researchers to examine related social and environmental factors. Modifying the SVI to include relevant predictors could improve injury prevention strategies by prioritizing efforts in areas with high social vulnerability.
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Affiliation(s)
- Avital R Wulz
- Division of Injury Prevention, Centers for Disease Control and Prevention, Chamblee, United States.
| | - Gabrielle F Miller
- Division of Injury Prevention, Centers for Disease Control and Prevention, Chamblee, United States
| | - Lindsay Hicks
- Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Chamblee, United States
| | - Amy F Wolkin
- Division of Injury Prevention, Centers for Disease Control and Prevention, Chamblee, United States
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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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Neiman PU, Spitzer S, Chhabra K, Salim A. The impact of health policy on surgical and trauma patients: Three key examples. Surgery 2024; 176:515-518. [PMID: 38824062 DOI: 10.1016/j.surg.2024.04.019] [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: 12/10/2023] [Accepted: 04/13/2024] [Indexed: 06/03/2024]
Abstract
Health policy impacts the way surgical and trauma patients access, recover from, and pay for the medical care we deliver. In this editorial, we highlight 3 major policy directives that have or will affect millions of surgical and injured patients-Medicaid expansion, surprise billing, and housing in previously redlined districts. In doing so, we aim to elucidate the mechanisms by which health policies impact our patients and encourage participation and inquiry among surgeons when new health policies are being proposed at a national, state, or local level.
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Affiliation(s)
- Pooja U Neiman
- Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| | | | - Karan Chhabra
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
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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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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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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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