An intersectional analysis of historical and contemporary structural racism on non-fatal shootings in Baltimore, Maryland

Associations between historical and contemporary measures of structural racism and leukocyte telomere length: The Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

We assessed the link between two manifestations of structural racism-historical redlining and contemporary racial residential segregation-and baseline and 10-year changes in leukocyte telomere length (LTL).

METHODS

We used data on Black and Hispanic/Latinx participants from Exams I and V of the Multi-Ethnic Study of Atherosclerosis Stress Ancillary Study (N = 741, age range = 45-84 years). LTL was defined as the ratio of telomeric DNA to a single copy gene (T/S), and 10-year changes were adjusted for regression to the mean. We used 1930s Home Owners' Loan Corporation maps to assign three historical redlining grades (A&B: best/still desirable, C: declining, D: hazardous/redlined) to participants' neighborhoods (census-tracts) at baseline. The Getis-Ord Gi∗ statistic was used to evaluate census-tract level baseline residential segregation (low/moderate/high).

RESULTS

In mixed-effects regression models accounting for neighborhood clustering, individual characteristics, and current neighborhood environments, those living in highly segregated Black neighborhoods had 0.08 shorter baseline LTL (95% CI: -0.13, -0.04), than those residing in the least segregated neighborhoods. We did not find a relationship between residing in segregated neighborhoods and 10-year LTL changes, and associations between residing in historically redlined neighborhoods and both baseline LTL and 10-year changes in LTL were null. Across discriminatory disinvestment trajectories examined, individuals residing in highly segregated but non-redlined neighborhoods had 0.6 shorter baseline LTL than individuals residing in non-redlined neighborhoods with low/moderate segregation (95% CI: -0.12, -0.01).

CONCLUSIONS

Our results highlight the impact of racial segregation on cellular aging and underscore the need to ameliorate structural inequities within segregated neighborhoods.

Racial capitalism and firearm violence: Developing a theoretical framework for firearm violence research examining structural racism

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.

Historical Redlining and Contemporary Violent Victimization Over the Life Course

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.

Disability and Racial Justice Go Hand in Hand: A Commentary on Black Men and Firearm Violence

Black men in the United States face disproportionately high rates of firearm violence, leading to death and disability more often than males of other racial/ethnic groups. Managing life after such injuries involves significant challenges in daily activities, employment, and pain management. Despite the critical impacts of firearm-related disabilities on Black men, their experiences remain largely unexplored by disability scholars, public health researchers, and practitioners. This oversight is alarming, as Black men with firearm-acquired disabilities encounter considerable structural barriers to achieving health and social objectives. Our team focuses on: (a) the experiences of Black men with firearm-acquired disabilities, (b) the lack of literature on their lived realities, and (c) new pathways for disability and public health research. Recognizing and addressing the invisibility of violently injured Black men in research is crucial for advancing equity, social justice, and representation across society. We argue that disability justice is a vital starting point for acknowledging the social experiences of gunshot wound survivors. More research is needed to understand the experiences of these young Black men who have been largely ignored in public health and disability narratives. It is essential for clinicians and policymakers to grasp how this neglect affects conventional views on health, accessibility, and well-being, underscoring the need for a more inclusive and equitable approach.

Risk and Protective Factors for Firearm Assault Injuries Among Black Men: A Scoping Review of Research

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.

Examining the Influence of Historical Redlining on Firearm Injuries in Current Day Baltimore, Maryland

Firearm injuries are a common and major public health problem in Baltimore, Maryland. The city is also one of the first U.S. cities in which the 1930s discriminatory practice of redlining first emerged. This study examines the association between current day firearm injuries and residence in these historically redlined areas at a neighborhood level using zip codes. Firearm injury outcomes in patients who presented to a hospital in Maryland from 2015 to 2020 were measured from the Health Services Cost Review Commission (HSCRC) in conjunction with both geospatial data from Richmond's Digital Scholarship Lab's Mapping Inequality project and population data from the U.S. Census. A redlining score was calculated to represent the extent of redlining in each zip code. Negative binomial regression models were utilized to measure the association between neighborhood zip codes and rate of firearm injuries. Our adjusted regression model shows that for every one-unit increase of the Home Owners' Loan Corporation (HOLC) redlining score, there is a 2.24-fold increase in the rate of firearm injuries (RR 2.24; 95% CI: 0.31, 1.31, p < 0.001). These findings suggest a strongassociation between historically redlined areas and population risk of firearm injury today. Further research is needed to investigate the underlying mechanisms that may contribute to this relationship, such as access to firearms or social and economic factors. Overall, our study highlights the potential impact of historical redlining policies on contemporary health outcomes in Baltimore.

Evaluating Firearm Violence After New Jersey's Cash Bail Reform

Importance

Reducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence.

Objective

To evaluate changes in firearm violence after New Jersey's 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention.

Design, Setting, and Participants

This case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024.

Exposure

Implementation of New Jersey's cash bail reform law in 2017.

Main Outcomes and Measures

Quarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people.

Results

Although New Jersey's pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, -0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, -0.24 deaths per 100 000), or within racialized groups during the postpolicy period.

Conclusions and Relevance

Incarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.

A social problem analysis of the 1993 Brady Act and the 2022 Bipartisan Safer Communities Act

In June 2022, the U.S. federal government passed its first major firearm policy since the Brady Handgun Violence Prevention Act of 1993, the Bipartisan Safer Communities Act (BSCA). Summative content analysis was used to explore how the social problem of firearm violence was outlined in both policies, with the goal of extracting the social issue's definition from the policies' approaches to solving it. Both policies do not outline the various types of firearm violence, nor the disproportionate effect of firearm violence on certain populations. This work informs the role of federal policy in defining and monitoring firearm violence as a public health issue, identifying both individual and structural risk and protective factors from an asset-based lens, and allocating preventative efforts in communities that are most affected.

Development of an interactive dashboard for gun violence pattern analysis and intervention design at the local level

Introduction

Gun violence remains a concerning and persistent issue in our country. Novel dashboards may integrate and summarize important clinical and non-clinical data that can inform targeted interventions to address the underlying causes of gun violence.

Methods

Data from various clinical and non-clinical sources were sourced, cleaned, and integrated into a customizable dashboard that summarizes and provides insight into the underlying factors that impact local gun violence episodes.

Results

The dashboards contained data from 7786 encounters and 1152 distinct patients from our Emergency Department's Trauma Registry with various patterns noted by the team. A multidisciplinary executive team, including subject matter experts in community-based interventions, epidemiology, and social sciences, was formed to design targeted interventions based on these observations.

Conclusion

Targeted interventions to reduce gun violence require a multimodal data sourcing and standardization approach, the inclusion of neighborhood-level data, and a dedicated multidisciplinary team to act on the generated insights.

Historical redlining and the epidemiology of present-day firearm violence in the United States: A multi-city analysis

Firearm violence is a major cause of morbidity, mortality, and racial health disparities in the United States. Previous studies have identified associations between historically racist housing discrimination (i.e., redlining practices) and firearm violence; however, these studies generally have been limited to a single city and have yet to provide sufficient evidence through which to determine the extent and dynamics of the impact of this relationship across the country. The aim of our study was (1) to estimate the association of historical redlining on both violent and firearm death across the country in nested models; and (2) to examine spatial non-stationarity to determine whether the impact of historical redlining on violent and firearm death was the same across the U.S. We used multilevel Bayesian conditional autoregressive Poisson models to determine the relationship between redlining as illustrated through Home Owners' Loan Corporation maps and 2019 violent and firearm deaths at the ZIP code-level nested within 21 cities across the U.S. We found that at the ZIP code level, there was a dose-responsive relationship between HOLC grading and the incidence of present-day firearm deaths. In general, redlined ZIP codes had higher relative incidence of firearm deaths. Associations were not stable across cities. For example, associations were relatively stronger in Baltimore, MD and weaker in Los Angeles, CA. This research reinforces the findings of previous studies examining the impact of redlining on firearm death across the extent of the entire country in 21 cities and claim that HOLC grades are associated with present-day violence.