Alcohol use and interpersonal violence: alcohol detected in homicide victims

On Lethal Interactions: Differences Between Expressive and Instrumental Homicides in Mexico City

Research on violence in Mexico and Latin America suggests that, in part, due to state attempts to fight organized crime and the widespread availability of firearms, violence and homicides in general have experienced a recent shift from expressive to instrumental. Despite this transformation, however, socioeconomically disadvantaged young males continue to be overwhelmingly present in homicide events. We argue that both the use of a firearm and demographic and traditional socioeconomic factors should independently predict instrumental homicide; however, the association between the use of a firearm and instrumentality should be moderated by the level or category of these traditional characteristics (i.e., socioeconomic status, age, and gender). Our findings are broadly consistent with these claims. We show that the relationship between the use of a firearm and instrumental homicides is larger for homicides involving disadvantaged males as victims because this group is more at risk of suffering homicidal violence to begin with, despite the fact that independently (i.e., with no interactions), higher socioeconomic status, age, and female victimhood are positively associated with instrumentality. We discuss the implications of these findings for research on Latin American violence and the expressive/instrumental distinction.

Trends in alcohol and marijuana detected in homicide victims in 9 US states: 2004-2016

Background

Use of alcohol and other drugs is a major risk factor for assaultive injuries and violent deaths. The purpose of this study was to examine the time trends in the prevalence of alcohol and marijuana detected in homicide victims.

Methods

We analyzed toxicological testing data for homicide victims (n = 12,638) from the 2004–2016 National Violent Death Reporting System in 9 US states (Colorado, Georgia, Massachusetts, New Jersey, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin). We used the Cochran-Armitage test for trend to assess the statistical significance of changes in the prevalence of alcohol and marijuana detected in these homicide victims during the study period.

Results

Overall, 37.5% of the homicide victims tested positive for alcohol, 31.0% positive for marijuana, and 11.4% positive for both substances. During the study period, the prevalence of marijuana increased from 22.3% (95% confidence interval [CI] = 19.6, 25.0) in 2004 to 42.1% (95% CI = 39.2, 44.9) in 2016 (Z = -15.7; P < .001) while the prevalence of alcohol declined slightly (Z = 1.5; P = 0.143). Marked increases in the prevalence of marijuana were observed in both sexes and across age and racial groups.

Conclusions

Marijuana is increasingly detected in homicide victims irrespective of demographic characteristics. Further research is needed to assess the causal role of marijuana use and concurrent use of marijuana and alcohol in homicide victimization.

Intimate Partner Violence-Related Fractures in the United States: An 8 Year Review

BACKGROUND

Fractures associated with intimate partner violence (IPV) are devastating injuries that can have lifelong implications. With exception to the facial region, there are very limited epidemiological reports describing the types and location of IPV-related fractures. The objective of this study is to review a national database and describe trends associated with IPV-related fractures.

METHODS

An analysis of all adults was performed using the National Trauma Data Bank from 2007 through 2014.Data including demographics, age, location of fracture, and drug/alcohol use were described and analyzed.

FINDINGS

There were 1,352 records identified where the patient was diagnosed with an IPV-related fracture. Women accounted for 83% of the population and the mean age was 37.5 years. Approximately 30% of the population was diagnosed with vertebral, trunk, and rib fractures. Variances among fracture location were observed across age groups. Facial fractures were recorded more in the younger population (18-39 years) when compared to other age groups (40-59 years; 60+ years), p<0.0001. Alternatively, rib and femur fractures were more common among survivors aged 60+ when compared to the younger age groups, p<0.0001.

INTERPRETATION

The ability to identify and respond to survivors of IPV in the healthcare setting is critically important. While facial fractures are common, they are not the only type of fractures that are seen. In many cases, healthcare professionals are the first line of defense in identifying suspected IPV cases. The findings of this paper build upon existing literature while also describing IPV-related fractures across the age spectrum.

Aggressiveness, violence, homicidality, homicide, and Lyme disease

BACKGROUND

No study has previously analyzed aggressiveness, homicide, and Lyme disease (LD).

MATERIALS AND METHODS

Retrospective LD chart reviews analyzed aggressiveness, compared 50 homicidal with 50 non-homicidal patients, and analyzed homicides.

RESULTS

Most aggression with LD was impulsive, sometimes provoked by intrusive symptoms, sensory stimulation or frustration and was invariably bizarre and senseless. About 9.6% of LD patients were homicidal with the average diagnosis delay of 9 years. Postinfection findings associated with homicidality that separated from the non-homicidal group within the 95% confidence interval included suicidality, sudden abrupt mood swings, explosive anger, paranoia, anhedonia, hypervigilance, exaggerated startle, disinhibition, nightmares, depersonalization, intrusive aggressive images, dissociative episodes, derealization, intrusive sexual images, marital/family problems, legal problems, substance abuse, depression, panic disorder, memory impairments, neuropathy, cranial nerve symptoms, and decreased libido. Seven LD homicides included predatory aggression, poor impulse control, and psychosis. Some patients have selective hyperacusis to mouth sounds, which I propose may be the result of brain dysfunction causing a disinhibition of a primitive fear of oral predation.

CONCLUSION

LD and the immune, biochemical, neurotransmitter, and the neural circuit reactions to it can cause impairments associated with violence. Many LD patients have no aggressiveness tendencies or only mild degrees of low frustration tolerance and irritability and pose no danger; however, a lesser number experience explosive anger, a lesser number experience homicidal thoughts and impulses, and much lesser number commit homicides. Since such large numbers are affected by LD, this small percent can be highly significant. Much of the violence associated with LD can be avoided with better prevention, diagnosis, and treatment of LD.

A comparison of alcohol positive and alcohol negative trauma patients requiring an emergency laparotomy

BACKGROUND

The effect of alcohol exposure on patients undergoing a laparotomy for trauma is unknown. The purpose of this study was to compare outcomes of morbidity and mortality between alcohol positive and alcohol negative trauma patients who required emergent laparotomies using the National Trauma Data Bank (NTDB).

METHODS

A retrospective database analysis was performed using 28,354 NTDB incident trauma cases, from 2007 through 2012, who had been tested for alcohol and who required abdominal operations (using ICD-9-CM procedure codes) within 24h of presentation. Variables used: age, gender, admission year, alcohol presence, ISS, GCS, injury type & mechanism, discharge status, hospital LOS, ICU stay, ventilator use, and hospital complications.

RESULTS

In adjusted analyses, there were no statistically significant differences between the alcohol positive and alcohol negative cohorts when evaluating in-hospital mortality (OR, 0.93; 95% CI: 0.84-1.03), likelihood of earlier hospital discharge (HR, 1.02; 95% CI: 0.99-1.05), and the all-inclusive category of in-hospital complications (OR, 1.04; 95% CI: 0.97-1.12).

CONCLUSIONS

After adjusting for age, gender, admission year, ISS, GCS, and injury mechanism, there were no major differences between the alcohol positive and alcohol negative cohorts when it came to in-hospital mortality, likelihood of earlier hospital discharge, and most of the in-hospital complications measured among adult trauma patients requiring emergency laparotomies.

Alcohol Involvement in Homicide Victimization in the United States

BACKGROUND

Although the association between alcohol and homicide is well documented, there has been no recent study of alcohol involvement in homicide victimization in U.S. states. The objective of this article was to determine the prevalence of alcohol involvement in homicide victimization and to identify socio demographic and other factors associated with alcohol involvement in homicide victimization.

METHODS

Data from homicide victims with a reported blood alcohol content (BAC) level were analyzed from 17 states from 2010 to 2012 using the National Violent Death Reporting System. Logistic regression was used to investigate factors associated with the odds of homicide victims having a BAC ≥ 0.08%.

RESULTS

Among all homicide victims, 39.9% had a positive BAC including 13.7% with a BAC between 0.01% and 0.79% and 26.2% of victims with a BAC ≥ 0.08%. Males were twice as likely as females to have a BAC ≥ 0.08% (29.1% vs. 15.2%; p < 0.001). Characteristics that were independent predictors of homicide victims having a BAC ≥ 0.08 included male sex, American Indian/Alaska Native race, Hispanic ethnicity, history of intimate partner violence, and nonfirearm homicides.

CONCLUSIONS

Alcohol is present in a substantial proportion of homicide victims in the United States, with substantial variation by state, demographic, and circumstantial characteristics. Future studies should explore the relationships between state-level alcohol policies and alcohol involvement among perpetrators and victims of homicide.

The Utility of Correctional Data for Understanding the Drugs-Homicide Connection

Research on the drugs-homicide connection is hampered by data sources that have only limited utility. Following a review of these data sources, this paper examines the drug-relatedness of a sample of homicides perpetrated in New York State as revealed in a specialized correctional department data base. Drug-relatedness is defined according to a tripartite model of the general relationship between drugs and violence. Even though the corrections data base incorporates detailed quantitaive and qualitative data from a variety of criminal justice sources, it was found that drug-relatedness was probably underestimated in the data base. About a quarter of the homicides were clearly drug-related. About two thirds were classified as not drug-related, although some of them may have been. In 10 percent of the cases there was an indication of drug-relatedness but there was not sufficient information to make a classification according to the model. The paper ends by assessing the utility of this correctional data base for understanding the drugs-homicide relationship.

Effect of Alcohol Intake on the Radiographic Quality in Patients with Midfacial Trauma

The initial reports on radiologic examinations in 618 consecutive patients with midfacial injuries were compared with the final clinical diagnoses. Alcohol had to some degree been imbibed by 31 per cent of the patients. Influence of alcohol was 3 times more common outside than within office hours. Radiographic analysis included estimation of blurring, errors in straightness, angulation, beam centering and limitation. Image quality was scored as visibility of ‘the imaginary lines of bony continuity’. There was no statistically significant correlation between the degree of inebriety and image quality or diagnostic performance with the radiographic technique used, with the patient supine. There is no need to postpone midfacial radiography in inebriate patients.

Multimodal technique to eliminate humidity interference for specific detection of ethanol

Multimodal electrochemical technique incorporating both open circuit potential (OCP) and amperometric techniques have been conceptualized and implemented to improve the detection of specific analyte in systems where more than one analyte is present. This approach has been demonstrated through the detection of ethanol while eliminating the contribution of water in a micro fuel cell sensor system. The sensor was interfaced with LMP91000 potentiostat, controlled through MSP430F5529LP microcontroller to implement an auto-calibration algorithm tailored to improve the detection of alcohol. The sensor was designed and fabricated as a three electrode system with Nafion as a proton exchange membrane (PEM). The electrochemical signal of the interfering phase (water) was eliminated by implementing the multimodal electrochemical detection technique. The results were validated by comparing sensor and potentiostat performances with a commercial sensor and potentiostat respectively. The results suggest that such a sensing system can detect ethanol at concentrations as low as 5ppm. The structure and properties such as low detection limit, selectivity and miniaturized size enables potential application of this device in wearable transdermal alcohol measurements.

Prevention of alcohol-related violence

Four target areas in the prevention of alcohol-related violence are discussed: alcohol-specific, individual, situational and (sub)cultural factors. Important alcohol-specific factors are those determining the prevalence and duration of intoxication events in the population. Traditional prevention of alcohol problems aims to cut down overall alcohol use and/or favors beverages of low alcohol content. More specific prevention programs would locate individuals who are highly violence-prone under alcohol intoxication and specify characteristics of situations and (sub)cultures that are conducive to alcohol-related violence. Presently prevention of bar violence targets the widest range of high-risk factors. Prevention of alcohol-related conflicts and escalation to violence in interactional situations is perhaps the least systematically developed area. The recent emphasis on violence as a public health problem has brought forth new prevention programs. Studying how these general programs affect alcohol-related violence and coordinating the two types of efforts will be a key task for the future.

Screening for alcohol problems in emergency department patients with minor injury: results and recommendations for practice and policy

In order to assess the feasibility of emergency department (ED) physician screening of patients with minor injuries for alcohol problems, a two-part screening process was implemented in an urban ED. Blood alcohol concentration was measured using either a saliva strip or a serum alcohol test. Questions about alcohol use frequency, and consumption quantity were asked in addition to the CAGE questions. Over a one-year period 2,439 adults (age ≥ 18 years) with non-life-threatening injuries were screened. Multiple strategies were used in order to increase compliance over the course of the study. Over the first six months, the overall screening rate increased from 8% to 45% and remained level for most of the duration of the project. Individual variations in rates ranged from 5% to 70%. Screening for alcohol problems is feasible in the ED setting and may be integrated as part of the role of the ED physician.

Alcohol consumption in adolescent homicide victims in the city of Johannesburg, South Africa

AIMS

To describe the blood alcohol concentration (BAC) of adolescent homicide victims in Johannesburg, South Africa and to identify the victim and event characteristics associated with a positive BAC at the time of death.

DESIGN

Logistic regression of mortality data collected by the National Injury Mortality Surveillance System (NIMSS).

SETTING

Johannesburg, South Africa.

PARTICIPANTS

A total of 323 adolescent (15-19 years) homicide victims for the period 2001-9 who had been tested for the presence of alcohol.

MEASUREMENTS

Data on the victims' BAC level, demographics, weapon or method used, scene, day and time of death were drawn from NIMSS.

FINDINGS

Alcohol was present in 39.3% of the homicide victims. Of these, 88.2% had a BAC level equivalent to or in excess of the South African limit of 0.05 g/100 ml for intoxication. Multivariate logistic analysis showed that a positive BAC in homicide victims was associated significantly with the victim's sex [male: odds ratio (OR) = 2.127; 95% confidence interval (CI) = 1.012-4.471], victim's age (18-19 years: OR = 2.364; CI = 1.343-4.163); weapon used (sharp instruments: OR = 2.972; CI = 1.708-5.171); and time of death (weekend: OR = 3.149; CI = 1.842-5.383; night-time: OR = 2.175; CI = 1.243-3.804).

CONCLUSIONS

Excessive alcohol consumption is associated with a substantial proportion of adolescent homicides in Johannesburg, South Africa, and is more prevalent among male and older adolescent victims and in victims killed with sharp instruments over the weekends and during the evenings.

Geographic association of liquor licenses and gunshot wounds in Chicago

BACKGROUND

The association between alcohol and interpersonal violence is well established. Up to 80% of homicide perpetrators and victims are known to have used alcohol before the incident. However, the association between proximity to a liquor-selling establishment and gun violence is more controversial.

METHODS

Scene address data from the Illinois State Trauma Registry from 1999 to 2009 were used to geocode all gunshot wounds (GSWs) presenting to trauma centers in Chicago during the study period. These data were linked to publicly available US Census Demographic Data and City of Chicago Liquor Board data. A combination of ordinary least squares and geographically weighted regression was performed to identify "risk regions" throughout the study area. Logistic regression analysis was then performed to assess the independent effect of proximity to an establishment with a liquor license (LL) on trauma center admissions for GSWs.

RESULTS

A total of 11,744 GSWs were geocoded. No association between LLs and GSWs was identified for the city overall (odds ratio [OR] .97, 95% confidence interval [CI] .96 to .99). However, 5 distinct regions of influence between LLs and GSWs were found. In regions with the highest association, likelihood of a GSW near a packaged LL was extraordinarily high (OR 518.08, 95% CI 10.23 to 1,000), and tavern LLs were also very significant (OR 21.51, 95% CI 1.81 to 255.53).

CONCLUSIONS

We found that proximity to an establishment with an LL was a strong independent predictor of GSW incidence for many areas of the city, even after controlling for neighborhood characteristics. However, this association was not demonstrable for the entire city, and, in fact, marked regional variation was apparent. These data may contribute to our understanding of the interplay between alcohol and violent injury disparities.

Racial/ethnic differences in alcohol-related suicide: a call for focus on unraveling paradoxes and understanding structural forces that shape alcohol-related health

A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns.

The incidence, pathology of trauma and victim profiles of homicidal deaths in Pretoria, South Africa (2007-2008)

This study aimed to establish the incidence of homicide, associated pathology of trauma and victim profiles in cases admitted to or managed as homicidal deaths at the Pretoria Medico-Legal Laboratory (PMLL) over the period of 2007-2008. A total of 1088 cases were reviewed. Homicides accounted for 22.7% of all cases admitted to the PMLL. The majority of homicide victims were male individuals (87.0%). The most common cause of death was gunshot wounds (42.6%), followed by blunt force trauma (25.1%). Homicides are most likely to occur at the victim's place of residence (28.5%) and only 37.4% of victims survive long enough to receive hospital care. The results of this study seem to concur with international findings for the most part, with a few interesting deviations. Highlighting at-risk groups, as well as dangerous locations and incident times, creates the potential to decrease the occurrence of unnecessary deaths by generating an awareness of the trends.

The Relation between the Number of Hours That Authorize the Sale of Alcoholic Beverages and Violence

BACKGROUND

La Victoria was considered, the most violent area in Lima City, the local government enforced a public policy regarding number of hours for selling of alcoholic beverages in January 2007. The study was designed to compare its results in Violence between one district with the law and other without the law.

METHODS

This retrospective cross-sectional was an ecological study with a chronological and geographical comparison between La Victoria, with the restriction and Cercado de Lima without the ban. The participants in the study were patients from a local National Hospital, with aggressions from fighting, or were wounded in traffic accidents, and violent death bodies at National Institute of Legal Medicine. Data were analyzed, using clinical histories (2006 vs. 2007-8) and necropsies (2005-6 vs. 2007-8) RESULTS: The reduction of aggression rates at La Victoria in 2007 and 2008 in comparison to 2006, were 40.7% and 36.4% respectively (P< 0.05). It was related to the number of hours of liquor authorized selling Y= -11.25+27.32 X (P<0.05). There was a reduction of 44% in homicide (P<0.05) and 35% in suicide rates between biennia's. The female/ male ratio of homicides changed from 1/7.3 to 1/4.6. A significant increase in the rate of alcohol positive dead bodies was observed (20.3% to 41.5%), (Relative Risk (RR) = 2.03, (95% Confidence Interval (CI) = (1.09-3.8), χ(2)(1)=5.24, ( P< 0.05).

CONCLUSIONS

The reduction of violence was probably due to the ban, indicating the importance of programs to control alcohol consumption which lead to decrease the rate of violence and its' consequences like homicides, impulsive violence.

The role of race/ethnicity in alcohol-attributable injury in the United States

A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns.

A meta-analysis of alcohol toxicology study findings among homicide victims

AIM

To synthesize the results of alcohol toxicology reports for homicide victims and examine variations in these results across person and setting characteristics.

METHODS

We meta-analyzed 61 independent studies from 57 published manuscripts which met the study inclusion criteria and reported alcohol toxicology test results for homicide victims. A total of 71, 031 toxicology test results, derived from 78, 265 homicide victims across 13 countries (most from the United States), were examined.

RESULTS

On average, 48% of homicide victims tested positive for alcohol and 33% (using the 0.08 threshold) or 35% (using the 0.10 threshold) were determined to be intoxicated. The proportion of homicide victims testing positive for alcohol appeared to be decreasing over time. Further, the proportion testing positive increased with age is higher for female than for male victims, and differs by race. Finally, the overall estimates were relatively stable across study sites.

CONCLUSION

Alcohol toxicology test results remain an important method for measuring the success of efforts to manage the consequences of alcohol. However, future toxicology studies should focus upon collecting information on evidence processing time, establishing measurement standards for reporting data and ensuring that subgroup estimates are included for purposes of cross-site comparisons.

Alcohol consumption in homicide victims in the city of São Paulo

AIMS

To assess the association between alcohol use and victimization by homicide in individuals autopsied at the Institute of Legal Medicine in São Paulo, Brazil.

DESIGN

Cross-sectional study.

SETTING

Excessive consumption of alcohol is a serious public health issue and a major factor in triggering violent situations, which suggests a strong association between alcohol ingestion and becoming a victim of homicide.

PARTICIPANTS

Data from 2042 victims of homicides in 2005 were obtained from medical examiner reports.

MEASUREMENTS

The victim's gender, age, ethnicity and blood alcohol concentration (BAC) were collected. The method of death and homicide circumstances, as well as the date, time and place of death were also studied.

FINDINGS

Alcohol was detected in blood samples of 43% of the victims, and mean BAC levels were 1.55 +/- 0.86 g/l. The prevalence of positive BAC levels was higher among men (44.1%) than women (26.6%), P < 0.01. Firearms caused most of the deaths (78.6%), and alcohol consumption was greater among victims of homicide by sharp weapons (P < 0.01). A greater proportion of victims with positive BAC were killed at weekends compared to weekdays (56.4 and 38.5%, respectively; P < 0.01), and the correlation between homicide rates and the average BAC for the central area of the city was positive (r(s) = 0.90; P < 0.01).

CONCLUSIONS

These results highlight alcohol as a contributing factor for homicide victimization in the greatest urban center in South America, supporting public strategies and future research aiming to prevent homicides and violence related to alcohol consumption.

Alcohol consumption, alcohol outlets, and the risk of being assaulted with a gun

BACKGROUND

We conducted a population-based case-control study to better delineate the relationship between individual alcohol consumption, alcohol outlets in the surrounding environment, and being assaulted with a gun.

METHODS

An incidence density sampled case-control study was conducted in the entire city of Philadelphia from 2003 to 2006. We enrolled 677 cases that had been shot in an assault and 684 population-based controls. The relationships between 2 independent variables of interest, alcohol consumption and alcohol outlet availability, and the outcome of being assaulted with a gun were analyzed. Conditional logistic regression was used to adjust for numerous confounding variables.

RESULTS

After adjustment, heavy drinkers were 2.67 times as likely to be shot in an assault when compared with nondrinkers (p < 0.10) while light drinkers were not at significantly greater risk of being shot in an assault when compared with nondrinkers. Regression-adjusted analyses also demonstrated that being in an area of high off-premise alcohol outlet availability significantly increased the risk of being shot in an assault by 2.00 times (p < 0.05). Being in an area of high on-premise alcohol outlet availability did not significantly change this risk. Heavy drinkers in areas of high off-premise alcohol outlet availability were 9.34 times (p < 0.05) as likely to be shot in an assault.

CONCLUSIONS

This study finds that the gun assault risk to individuals who are near off-premise alcohol outlets is about the same as or statistically greater than the risk they incur from heavy drinking. The combination of heavy drinking and being near off-premise outlets resulted in greater risk than either factor alone. By comparison, light drinking and being near on-premise alcohol outlets were not associated with increased risks for gun assault. Cities should consider addressing alcohol-related factors, especially off-premise outlets, as highly modifiable and politically feasible approaches to reducing gun violence.

Differences in female and male involvement in lethal violence in Russia

Relatively little is known of the distributions of homicide event characteristics in non-Western nations in which women relative to men are involved. This article utilizes unique homicide narratives drawn from Russian court and police records to compare homicide victim, offender, and event characteristics by sex of victim and separately by sex of offender. Results from logistic regression show that homicides in which a female was the victim or offender were more likely to occur between intimates and to occur in the home, whereas homicides involving males were more likely to occur in a public place, to be alcohol-related, to involve a firearm, and to involve a victim and offender who did not know each other well. These results not only present an important first glimpse at women as homicide victims and offenders in Russia specifically, but also provide a point of comparison with findings from similar analyses undertaken in the West, and present further initial observations upon which to construct a cohesive theory about female involvement in serious violent events.

A Comparison of Victim, Offender, and Event Characteristics of Alcohol- and Non-Alcohol-Related Homicides

The authors used narrative data from court and police records of homicides in Russia to compare alcohol- and non-alcohol-related incidents on victim, offender, and event characteristics. Binary logistic regression models were estimated for neither participant drinking, offender drinking, victim drinking, and both drinking. Consistent differences were found between alcohol- and non-alcohol-related homicides across the models. Alcohol-related homicides were significantly more likely to occur overnight, to occur on weekends, and to result from acute arguments and significantly less likely to occur between strangers, to be profit motivated or premeditated, and to be carried out to hide other crimes. No significant differences between the drinking and nondrinking samples were found for victim's gender, primary weapon used, or event location. The authors place these findings into the literature on the situational context of crime and create a tentative typology of homicide events, grounded in the results of their inductive approach, based on alcohol use by homicide offenders and victims.

A psychiatric and social matched case series comparison of victims of criminal homicide and homicide perpetrators in Sweden

The aim of the present study was to compare the psychosocial profiles of criminal homicide victims with those of a matched sample of perpetrators. The hypothesis was that chance determines whether someone becomes a victim or a perpetrator. In a retrospective examination of forensic psychiatric records as well as hospital records, the following variables were studied: nationality, education, substance abuse and psychiatric diagnoses. A comparative study was performed of 88 perpetrators and 83 victims in Sweden during a time period of 17 years (1978-1994). All subjects had been treated as psychiatric inpatients before the homicide. The results support the hypothesis that perpetrators and victims of homicide are similar with regard to psychiatric morbidity and social functioning. The majority were born in Sweden, and the educational level was low in both groups. Substance abuse was common in both groups: 96.7% of male and 65.3% of female victims compared with 76.6% of male and 75% of female perpetrators. Many in both of the groups had criminal records. The only major difference between the groups was recorded for psychotic disorder diagnoses, with a higher rate among perpetrators as well as a lower rate of substance abuse in this group.

State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003

Two of every three American homicide victims are killed with firearms, yet little is known about the role played by household firearms in homicide victimization. The present study is the first to examine the cross sectional association between household firearm ownership and homicide victimization across the 50 US states, by age and gender, using nationally representative state-level survey-based estimates of household firearm ownership. Household firearm prevalence for each of the 50 states was obtained from the 2001 Behavioral Risk Factor Surveillance System. Homicide mortality data for each state were aggregated over the three-year study period, 2001-2003. Analyses controlled for state-level rates of aggravated assault, robbery, unemployment, urbanization, per capita alcohol consumption, and a resource deprivation index (a construct that includes median family income, the percentage of families living beneath the poverty line, the Gini index of family income inequality, the percentage of the population that is black and the percentage of families headed by a single female parent). Multivariate analyses found that states with higher rates of household firearm ownership had significantly higher homicide victimization rates of men, women and children. The association between firearm prevalence and homicide victimization in our study was driven by gun-related homicide victimization rates; non-gun-related victimization rates were not significantly associated with rates of firearm ownership. Although causal inference is not warranted on the basis of the present study alone, our findings suggest that the household may be an important source of firearms used to kill men, women and children in the United States.

Homicide in Tours (Indre-et-Loire, France): A four-year review

This retrospective study examined homicides in two French departments located in the West of France (Indre-et-Loire and Loir-et-Cher) for a four-year period from 2000 to 2003. During this period 63 homicidal deaths were investigated at the Institute of Forensic Science of Tours (Indre-et-Loire). There were 45 male and 18 female victims with an average homicide rate of 1.55 per 100,000 persons. The mean age of the victims was 42 years-old. Forty-five assailants were identified; their mean age was 38 years-old. The most common method of homicide was the use of firearms (40% of the cases), followed by blunt-force injury (36%) and sharp-force injury (16%). 51% of the victims knew their assailant, a family member in 26% of the cases. Spousal homicides occurred in 16% of the cases. Dyadic death occurred in six cases. A review of the literature compares these findings to other populations.

Factors associated with state variations in homicide, suicide, and unintentional firearm deaths

This study examined the relationship of 16 variables with homicide, suicide, and unintentional firearm deaths. This cross-sectional analysis, using adjusted partial correlation coefficients, found that state-level firearm homicide rates significantly varied by the prevalence of firearms and by percent of the population which was African American. Whereas, state-level variations in firearm suicide mortality significantly varied by firearm prevalence, per capita alcohol consumption, percent of the population which was African American, and level of urbanization. None of the variables were significantly (p < or = .05) related to state-level variations in unintentional firearm mortality. Furthermore, state gun laws had only a limited effect on firearm-related homicide deaths. Although the current study cannot determine causation, firearm mortality in its various forms is most commonly related to the prevalence of firearms and the percent of the population that is African American.

Epidemiology of child homicide in Jefferson County, Alabama

OBJECTIVE

The purpose of this study was to present the epidemiology of homicide among children younger than 6 years of age in Jefferson County, Alabama. This study focused on obtaining great detail on homicides and suspicious deaths occurring within a fixed population.

METHODS

For purposes of this study, cases included Jefferson County deaths attributed to "homicide" or that were "undetermined" as noted in the coroner files among children younger than 6 years of age who were born and died between January 1, 1988 and December, 31, 1998. Victim and offender characteristics were obtained from the Jefferson County Coroner/Medical Examiner Office records. Environmental factors and circumstances surrounding the death were noted as well.

RESULTS

The 53 study subjects were mainly female (55%), Black (69%), younger than 2 years of age (85%), had single mothers (38%), and a history of abuse (53%). Offenders were more likely to be male (64%), Black (73%), and a parent of the victim (53%). Homicides primarily resulted from an angry impulse (61%), with hands the most common weapon (61%).

CONCLUSIONS

The majority of deaths in this study occurred among children younger than age 2, with a high proportion of fatalities among Black children of unmarried mothers. The offender most often knew the victim, with half of all homicides and two-thirds of all infant homicides involving a parent. More than half of the homicides resulted from an angry impulse, while the most common scenario for deaths with undetermined intent involved the caretaker finding the child unresponsive.

Dangerous to your health: the role of chronic drug use in serious injuries and trauma

OBJECTIVES

This study estimated the differential risks of serious injury or trauma for a community-based sample of chronic drug users (CDUs; n = 926) and a matched group of nondrug users (NDUs; n = 553). The study also estimated whether CDUs and NDUs differed in their utilization of health care services for serious injury or trauma.

MATERIALS AND METHODS

Data were collected in 1996 and 1997 through community outreach activities in Miami-Dade County, Florida. The analysis estimated the effects of drug use on (1) any lifetime serious injury or trauma, (2) any serious injury or trauma during the past 12 months, and (3) utilization of health care services for serious injury or trauma. All analyses were gender specific and the models were also estimated with a measure of problematic alcohol use in addition to CDU. To examine the potential endogeneity of drug use, various specification tests were conducted.

RESULTS

For females, CDUs experienced significantly more serious injury, trauma, or both (both lifetime and past year) than nonusers. Drug use status was not a significant predictor of serious injury or trauma (lifetime and past year) for males. Regardless of gender, conditional on experiencing any serious injury or trauma during the past year, CDUs and NDUs did not differ in their utilization of health care services. Various statistical tests determined that CDU was exogenous in all specifications and the findings were largely unchanged when problematic alcohol use was included in the models.

CONCLUSIONS

The elevated risk for serious injury or trauma for female CDUs renders these persons vulnerable to severe medical problems. Specific training in substance abuse issues may be necessary if health care providers are to identify, engage, knowledgeably serve, and refer CDUs for appropriate services.

Rates of household firearm ownership and homicide across US regions and states, 1988-1997

OBJECTIVES

In this study we explored the association between rates of household firearm ownership and homicide across the United States, by age groups.

METHODS

We used cross-sectional time-series data (1988-1997) to estimate the association between rates of household firearm ownership and homicide.

RESULTS

In region- and state-level analyses, a robust association between rates of household firearm ownership and homicide was found. Regionally, the association exists for victims aged 5 to 14 years and those 35 years and older. At the state level, the association exists for every age group over age 5, even after controlling for poverty, urbanization, unemployment, alcohol consumption, and nonlethal violent crime.

CONCLUSIONS

Although our study cannot determine causation, we found that in areas where household firearm ownership rates were higher, a disproportionately large number of people died from homicide.

Vodka and violence: alcohol consumption and homicide rates in Russia

In Russia, rates of alcohol consumption and homicide are among the highest in the world, and already-high levels increased dramatically after the breakup of the Soviet Union. Rates of both, however, vary greatly among Russia's 89 regions. We took advantage of newly available vital statistics and socioeconomic data to examine the regional covariation of drinking and lethal violence. Log-log models were employed to estimate the impact of alcohol consumption on regional homicide rates, controlling for structural factors thought to influence the spatial distribution of homicide rates. Results revealed a positive and significant relationship between alcohol consumption and homicide, with a 1% increase in regional consumption of alcohol associated with an approximately 0.25% increase in homicide rates. In Russia, higher regional rates of alcohol consumption are associated with higher rates of homicide.

Homicide by firearms in two Scandinavian capitals

In the Oslo and Copenhagen areas, 83 homicides by firearms were registered in the 10-year period 1985 to 1994, accounting for 19.3% of all homicides in that period. The majority of the victims were between 20 and 50 years old, and 58% were male, 42% female. The yearly number of firearm homicides varied between 4 and 15, with neither an increase nor decrease throughout the period. Most of the victims had no detectable blood alcohol at autopsy. Female victims were typically shot in their own domicile with a shotgun by their spouse, mostly because of jealousy or in a family argument, whereas male victims were shot on different locations, predominantly with a handgun, for many different reasons. Most victims were shot in the head, and few had entrance wounds in more than one anatomic region.

Homicide by sharp force in two Scandinavian capitals

In the Oslo and Copenhagen capital areas, 141 homicides by sharp force were committed in the ten-year period 1985-1994. This method accounted for 33% of the homicides in this period. Thirty-five percent of the victims were female, and most of the victims were between 20 and 50 years of age. The majority of the male victims were killed by an acquaintance, the females by their spouse. Sixty-five percent of the male and 37% of the female victims had alcohol in their blood. The majority of the female victims had lesions in 3-4 anatomical regions, while the males most often had lesions in only one anatomical region. Seventy-nine percent of the females and 36% of the males had self-defence injuries in the upper extremities. In 21 cases (15%) the offender was a woman, 19 of their victims being male; the weapon in these cases was most often a kitchen knife. Seventy-eight percent of the females and 49% of the males were killed in their own home. The most common circumstance was family row when the victim was female, while a fight was the most common circumstance when the victim was male. Three offenders committed suicide after having committed homicide(s) (seven victims; three offenders).

Alcohol and drug use in victims of life-threatening trauma

OBJECTIVE

Alcohol and drug use has been implicated as a contributing factor to all types of trauma. This investigation seeks to determine the prevalence of alcohol and drug use in patients who are victims of life-threatening injuries and the association of alcohol and drug use with intentional trauma.

METHODS

The Medical Center of Louisiana at New Orleans (Charity Campus) trauma registry was used to identify patients sustaining life-threatening injuries that presented to our American College of Surgeons Level 1 trauma center over a 6-month period. Serum ethanol levels and urine toxicology were assessed at initial presentation for all patients.

RESULTS

A total of 557 patients were evaluated. Seventy percent (n = 319) of tested patients (n = 450) had positive serum ethanol and/or urine toxicology results. Male gender (75% vs. 55%; p < 0.001) was associated with positive screens; ethnicity was not. No difference in hospital days or mortality was seen between positive and negative screens. Victims of intentional trauma showed a higher percent of positive screens (80% vs. 63%; p < 0.005).

CONCLUSION

These data suggest that alcohol and drug use is associated with life-threatening injury, especially intentional injury. Prevention of substance abuse is essential for the prevention of trauma.

Homicides in two Scandinavian capitals

In this study we investigated homicides in the two Scandinavian capitals, Copenhagen, Denmark and Oslo, Norway, for the 10-year period from 1985 to 1994. The total number of homicides was 431; 63.8% occurred in Copenhagen and 36.2% in Oslo. The average homicide rate was 1.6/100,000 in Copenhagen and 1.8/100,000 in Oslo. Blunt force, sharp force, and strangulation were the most common methods. Firearms were also used but did not account for >20% in either of the two cities. This is probably due to strict gun laws in both countries. There was no clear difference between the homicide victim populations in the two cities with regard to age, gender, or social and marital status. The proportion of alcoholics and unemployed persons was much higher than in the background population and to a similar extent in both cities, indicating that the homicide victim populations differ from the background populations. The perpetrator knew the victim in the majority of the cases. The most frequent motives or circumstances in both cities were fights, family rows, financial controversies, or jealousy.

Guns at college

A random sample of more than 15,000 undergraduate students from 130 4-year colleges answered a mailed questionnaire concerning firearm possession. Approximately 3.5% of the sampled students reported they had a working firearm at college. Students with guns were more likely to be male, White, or Native American; to binge drink and need to start the day with alcohol; to be members of a fraternity or sorority; to live off campus; and to live with a spouse or significant other. Having a gun was positively associated with driving after binge drinking, being arrested for driving under the influence of alcohol, and damaging property as a result of alcohol ingestion. Students with guns were also more likely to be injured severely enough to require medical attention, especially for injuries occurring in fights or car crashes. Overall, students with guns at college were more likely than others to engage in activities that put themselves and others at risk for injury.

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study

OBJECTIVE

The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured).

METHOD

Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine.

RESULTS

Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.

Correlation of alcohol intoxication with life-threatening assaults

The number of violent crimes has increased substantially over the past decade with an associated increase in injury-related mortality. The influence of alcohol intoxication on accidents involving motor vehicles has been investigated extensively, but few studies have examined the influence of alcohol and drug intoxication on life-threatening assaults. This study examined the correlation of alcohol intoxication with life-threatening victimization by penetrating torso trauma. Retrospective evaluation of patients presenting with penetrating nonmissile anterior torso trauma to an urban Level 1 trauma center between January 1988 and December 1991 was performed. Serum ethanol levels and urine toxicology studies were assessed at initial presentation for all patients. Sixty-two patients with anterior abdominal stab wounds were evaluated, of which 51 (82%) were male. Ethnic distribution paralleled that of the surrounding community, with 50 (81%) African-American, 8 (13%) Latino, and 4 (6%) white patients. The mean age was 32 years. Fifty-two (84%) patients tested positive for alcohol, with 39 (63%) having serum levels of ethanol above the legal intoxication limit. Twelve (19%) patients tested positive for cocaine on urine toxicology screen. Polysubstance use was evident in 10 (16%) patients with positive test results for both alcohol and cocaine. These data demonstrate a strong correlation between alcohol use and life-threatening assaults.

Consequences of violence. Premature death, violence recidivism, and violent criminality

The burden of violence is born disproportionately by the youngest of our country. In this article, three important aspects of violence are discussed: premature death, violence recidivism, and violent criminality. The author emphasizes the role of the pediatrician in preventing these consequences.

Relationships between ambulance transports for alcohol intoxication and assault

OBJECTIVE

To evaluate the association between ambulance transports for assault and those for alcohol intoxication.

METHODS

A retrospective analysis of emergency medical services (EMS) calls was performed. The authors used logistic regression models to compare patients transported for alcohol intoxication with a control group of patients transported for respiratory distress (asthma or shortness of breath) with respect to whether they had been transported on a separate occasion for a chief complaint of assault.

RESULTS

Patients transported for alcohol intoxication had 9 times the risk of transport for assault as compared with the control group (OR = 9.3; 95% CI = 6.4, 13.6). The odds of transport for assault among the alcohol patients increased 17.1% with each alcohol transport (OR = 1.17; 95% CI = 1.14, 1.20) but decreased for the control group (OR = 0.34; 95% CI = 0.26, 0.44). Repeat transports for assault were more common among the alcohol patients than among the control group (OR = 3.3; 95% CI = 1.1, 11.3). The mean number of assault transports was higher among the alcohol patients than among the patients never transported for alcohol intoxication (p < 0.0001).

CONCLUSIONS

Patients transported on multiple occasions for acute alcohol intoxication are at relatively high risk for assault. This risk group should be targeted for focused assault prevention interventions that include components designed to reduce incidents of repeat alcohol intoxication.

Understanding and preventing substance abuse by adolescents: a guide for primary care clinicians

Psychoactive drug use by teens is a common occurrence. This article examines the influences that promote and deter experimentation with and hazardous use of psychoactive substances. Clinical guidance is offered on how to assess and intervene with teens and their parents at various developmental phases and levels of involvement with drugs. Understanding how youth make decisions to change their behavior can assist a clinician in helping a teenager avoid these problems.

Substance Use and Issues of Violence among Low-Income, Pregnant Women: The California Perinatal Needs Assessment

An analysis of how violence affects the lives of pregnant, low-income women was undertaken, drawing from needs assessment data from two diverse California counties. Self-report screening was used to determine risk for heavier or problem substance use. Of 1,147 women, 401 met the screening threshold. The 401 at-risk respondents report significantly higher levels of substance-related violence when compared to the other 746 respondents. Among all respondents, neighborhood substance-related problems, being United States-born, meeting the screening threshold, and being a woman of color were associated with reported substance-related violence among acquaintances. Among the substance-involved sample, neighborhood drug problems, being a woman of color, and being hurt, beaten or taken advantage of due to drugs were associated with violence reports. The implications are that substance-related violence prevention strategies need to focus on the community as well as on the individual and the family.

Women and injuries--factors influencing recovery

This study focuses on female patients of working age, hospitalized due to moderate, mostly orthopaedic injuries. The aim was to highlight the medical and non-medical factors affecting outcome. Two groups of women, those who 12 months after the injury reported disability within at least three out of five possible areas (work, family, household, social life and leisure-time; n = 34), were compared with women reporting disability within two areas or less (n = 59). Four factors were predictive of outcome according to the multivariate analysis: injury severity as measured by the Abbreviated Injury Scale (AIS), self-perceived injury-related mental and physical health measured by the Visual Analogue Scale (VAS) during hospitalization and a history of three or more previous injuries requiring medical care. Sociodemographic background factors did not affect the outcome. By integrating information from AIS and VAS with the number of previous injuries, three quarters of the women were correctly classified; i.e., it was possible to detect a majority of those reporting a poorer outcome one year after the injury already during hospitalization. Simple screening instruments like these seem to be useful in the early detection of vulnerable patients. This study further suggests that more attention should be paid to non-medical factors, the importance of which may have been underestimated regarding a poorer outcome among female patients hospitalized due to injuries. Thus, psychosocial support should not only be offered to patients with major trauma or an obvious psychiatric disorder, but to all injured patients and should be considered as an integral part of medical care.

Hospitalizations for injury in New Zealand: prior injury as a risk factor for assaultive injury

OBJECTIVES

This study sought to determine the degree to which injury hospitalization, especially for assaultive injury, is a risk for subsequent hospitalization due to assault.

METHODS

A New Zealand hospitalization database was used to perform a retrospective cohort study. Exposure was defined as an injury hospitalization, stratified into assaultive and nonassaultive mechanisms. Hospitalizations for an assault during a 12-month follow-up period were measured.

RESULTS

Individuals with a prior nonassaultive injury were 3.2 times more likely to be admitted for an assault than those with no injury admission (95% confidence interval [CI] = 2.7, 3.9). The relative risk associated with a prior assault was 39.5 (95% CI = 35.8, 43.5), and the subsequent admission rate did not vary significantly by sex, race, or marital or employment status. Among those readmitted for an assault, 70% were readmitted within 30 days of the initial hospitalization.

CONCLUSIONS

Prior injury is a risk for serious assault, and the risk is even greater if the injury is due to assault. Risk of readmission for assault is largely independent of demographic factors and greatest within 30 days of the initial assault.