CDC: Homicide Rates At Least 10 Times Higher For Young Adult Blacks Than Whites

MedicalResearch.com Interview with:

Dr. Kameron Sheats PhD Licensed Psychologist; Behavioral Scientist Centers for Disease Control and Prevention

Dr. Sheats

Dr. Kameron Sheats PhD
Licensed Psychologist; Behavioral Scientist
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study?

Response: This study updates literature on racial disparities in violence between black and white youth using data capturing different severity levels in violent outcomes such as homicide versus assault. This study also seeks to increase the understanding of the impact of these disparities by examining associations between disparities in childhood adversity (e.g., child abuse and neglect, exposure to violence, household challenges) and adult health conditions.

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Active Shooter Incidents Involving Semi-automatic Rifles More Deadly

MedicalResearch.com Interview with:

Adil Haider, MD, MPH, FACS Kessler Director for the Center for Surgery and Public Health Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health Deputy Editor of JAMA Surgery

Dr. Haider

Adil Haider, MD, MPH, FACS
Kessler Director for the Center for Surgery and Public Health
Brigham and Women’s Hospital, Harvard Medical School, and
Harvard T.H. Chan School of Public Health
Deputy Editor of JAMA Surgery

MedicalResearch.com: What is the background for this study?

Response: Firearm-related mortality is a public health issue. However, in the US, due in part to lack of funding, there is not enough research to inform the debate about firearms.

The question our group sought to answer was to understand if the presence of a semi-automatic weapon increased the number of victims killed or hurt during an active shooter incident. We chose to focus on these incidents given the availability of an FBI database detailing these active shooter incidents based on a strict definition and the similarities between such incidents that make a comparison valid.

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Alarming Increase in Violent and Unintentional Injuries Since 2014

MedicalResearch.com Interview with:

Dr. Angela Sauaia, MD, PhD Professor of Public Health and Surgery University of Colorado Denver Statistical Editor, Journal of Trauma and Acute Care Surgery Statistical Consultant, Department of Surgery Denver Health Medical Cente

Dr. Sauaia

Dr. Angela Sauaia, MD, PhD
Professor of Public Health and Surgery
University of Colorado Denver
Statistical Editor, Journal of Trauma and Acute Care Surgery
Statistical Consultant, Department of Surgery
Denver Health Medical Center 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: As injury researchers we monitor national trends in injury.

The CDC WISQARS (Web-based Injury Statistics Query and Reporting System) is one of the few available open sources of injury data we can use. During the 1980’s and 1990’s, we saw much improvement in deaths due to most injury mechanisms, such as car accidents fatalities. Our study shows, however, that recent trends seem to be eroding these promising survival gains.

Both violent and unintentional injuries alike seem to be increasing, especially since 2014. We are unclear about the causes of this recent increase in trauma-related deaths, but it is an alarming trend.

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Most Young People Not Against Guns in the Home

MedicalResearch.com Interview with:
“GUNS” by Jessica Spengler is licensed under CC BY 2.0Kendrin R. Sonneville, ScD, RD

Assistant Professor
Department of Nutritional Sciences
University of Michigan School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The results from this come out of MyVoice, a text message cohort of youth ages 14-24 representing every state in the country (http://hearmyvoicenow.org/). Each week we ask the youth in our cohort a series of open-ended to questions, with the goal of gathering the real-time opinions and experiences of youth across the U.S. This study reports the results of questions we asked MyVoice paritpatns between 07/2017 and 01/2018 about guns and gun control. 

(1) What are your thoughts about having guns in your home?

(2) Do you think gun control laws would affect mass shootings? Why?

(3) Who, if anyone, should NOT be allowed to own guns?

We found that about one-third of youth in our diverse sample were “against” guns in the home, and the remaining two-thirds were either “pro” or “conditionally pro” guns in the home, stating that gun ownership is acceptable under certain conditions, such as proper storage, or kept away from children. Youth in our sample largely believed that gun control laws could decrease mass shootings, but one-third felt that gun control laws would not be enough to impact mass shootings. Continue reading

Positive Hopes and Dreams May Protect Urban Youth From Violence

MedicalResearch.com Interview with:

Alison J. Culyba, MD, PhD, MPH Instructor in the Craig-Dalsimer Division of Adolescent Medicine Children's Hospital of Philadelphia

Dr. Culyba

Alison JCulyba, MD, PhD, MPH
Assistant Professor of Pediatrics
UPMC Children’s Hospital of Pittsburgh
University of Pittsburgh School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Homicide is the third leading cause of death among adolescents, and disproportionately affects minority youth in under-resourced urban communities.

Most research on youth violence focuses on risk factors, such as weapon carrying and substance abuse. We know much less about factors that protect youth from violence. Future orientation, defined as hopes and plans for the future, is linked to many important positive outcomes for youth, including doing well in school and avoiding illicit substances. However, there has been very little research to examine whether future orientation may also protect youth from violence.

To study links between future orientation and violence perpetration, we surveyed over 850 male youth in lower resource neighborhoods in Pittsburgh as part of a community-based sexual violence prevention study. We found that youth with positive future orientation were significantly less likely to report threatening someone with a weapon or injuring someone with a weapon in the past nine months.

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How Much US Life is Lost to Police Violence?

MedicalResearch.com Interview with:
“police” by istolethetv is licensed under CC BY 2.0Anthony L. Bui, MPH

M.D. Candidate, David Geffen School of Medicine at UCLA
Matthew M. Coates, MPH
Associate, Harvard Medical School, Department of Global Health and Social Medicine
Ellicott C. Matthay, MPH
Ph.D. Candidate, Division of Epidemiology, University of California, Berkeley School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Protests after recent deaths from encounters with law enforcement, the Black Lives Matter movement, and activism over social media platforms have raised the profile of the problem of police violence. Several studies have suggested that the public health community has a duty to address these deaths as a public health problem. These studies have also pointed out that although there is a lack of officially reported statistics on police violence, other journalistic and crowd-sourced efforts such as “The Counted” from The Guardian, FatalEncounters.org, U.S. Police Shootings Database, KilledbyPolice.net, and Mapping Police Violence have relatively complete documentation of deaths from police violence.

To help frame the issue as a public health problem, we calculated years of life lost (YLLs) attributed to deaths from encounters with law enforcement. YLLs are, a metric that measures premature deaths, by age, gender, and race/ethnicity. To do this, we followed established methods, subtracting the age of each death from a corresponding standard life expectancy. For example, if an individual who died at age 25 had a life expectancy of 75, their YLL would be 50.  Continue reading

Mortality From Overdose, Alcohol and Firearms Varies Regionally

MedicalResearch.com Interview with:

Dr. Laura Dwyer-Lindgren PhD Assistant Professor at IHME Institute for Health Metrics and Evaluation 

Dr. Dwyer-Lindgren

Dr. Laura Dwyer-Lindgren PhD
Assistant Professor at IHME
Institute for Health Metrics and Evaluation 

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: This study in the latest in a series of studies IHME has conducted on health and disease on the county level in the United States. We analyzed data provided by the National Center for Health Statistics, the U.S. Census Bureau, and other sources. Main findings include:

  • Nearly 550,000 deaths were attributed to drug use over the 35 years. Nationally, the age-standardized death date increased 238% between 1980 and 2000, and 112% between 2000 and 2014. The death rate from drug use disorders increased in every county, but some counties in Kentucky, West Virginia, Ohio, Indiana, and eastern Oklahoma has increases exceeding 5000%.
  • There were more than a quarter million deaths in the U.S. due to alcohol use; Western counties generally has higher levels than those in other parts of area of the nation, with especially high death rates in Wisconsin, North Dakota, South Dakota, Nebraska, Montana, New Mexico, Arizona, Utah, and Alaska.
  • Neatly 1.3 million suicides were recorded, with especially high rates in Alaska, Nevada, South Dakota, Utah, New Mexico, Arizona, Montana, North Dakota, Oregon, Wyoming and one county in Maryland. While the national death rate due to suicide decreased between 1980 and 2014, there was an increase in the death rate due to suicide in most counties.
  • More than three quarters of a million deaths by homicide occurred in the US between 1980 and 2015. Nationally, the age-standardized death rate due to homicide decreased by about 35% between 1980 and 2000, and by nearly 16% between 2000 and 2014. Counties with the largest decreases were found in Virginia, Florida, Texas, California and New York. 

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Severity of Firearm Injuries Escalates Over Ten Years

MedicalResearch.com Interview with:

Yi Zuo Lead Biostatistician  Center for Clinical Translational Epidemiology and Comparative Effectiveness Research Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118

Yi Zuo

Yi Zuo
Lead Biostatistician
Center for Clinical Translational Epidemiology and Comparative Effectiveness Research
Preventive Medicine & Epidemiology
Department of Medicine
Boston University School of Medicine
Boston, MA 02118 

MedicalResearch.com: What is the background for this study?

Response: Non-fatal firearm injuries constitute approximately 70% of all firearm trauma injuries in the United States. However, patterns of severity of those injuries are poorly understood.
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“Shall Issue” Gun Law States Associated With Higher Homicide and Firearm Death Rates

MedicalResearch.com Interview with:

Michael Siegel, MD, MPH Professor, Department of Community Health Sciences Boston University School of Public Health Boston, MA 02118

Prof. Siegel

Michael Siegel, MD, MPH
Professor, Department of Community Health Sciences
Boston University School of Public Health
Boston, MA 02118

MedicalResearch.com: What is the background for this study?

Response: A central question in the debate about public policies to reduce firearm violence is whether easier access to concealed handguns increases or decreases the rate of firearm-related homicides. Previous studies on the impact of concealed carry permitting laws have yielded inconsistent results. Most of these studies were conducted more than a decade ago. This study provided a reexamination of this research question with more recent data, up to and including the year 2015.

While all states allow certain persons to carry concealed handguns, there are 3 major variations in permitting policy. In 9 states, law enforcement officials have wide discretion over whether to issue concealed carry permits; these are referred to as “may issue” states because police chiefs can deny a permit if they deem the applicant to be at risk of committing violence, even if there is not a criminal history. In 29 states, there is little or no discretion; these are referred to as “shall-issue” states because permits must be issued if requisite criteria are met. In an additional 12 states, no permit is necessary to carry a concealed handgun.

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Requiring Some Firearms To Be Surrendered May Reduce Domestic Homicides

MedicalResearch.com Interview with:

Professor Michael Siegel, MD, MPH Department of Community Health Sciences Boston University School of Public Health Boston, MA 02118

Dr. Siegel

Professor Michael Siegel, MD, MPH
Department of Community Health Sciences
Boston University School of Public Health
Boston, MA 02118

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Each year, more than 1,800 people in the U.S. are killed by their intimate partners. Approximately half of these homicides are committed using firearms. While federal law prohibits people subject to domestic violence restraining orders from possessing firearms, there is no requirement that they surrender guns already in their possession.

To close this loophole, several states have enacted laws that not only prohibit gun possession by people subject to restraining orders, but which also explicitly require that they relinquish weapons that they already have.

In this study, we investigated the impact of state domestic violence-related firearm laws and rates of intimate partner homicide, using data from all 50 states over a 25-year period, 1991-2015.

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Majority of Murdered Women Are Killed By Current or Former Partners

MedicalResearch.com Interview with:

EmikoPetrosky MD M.P.H Science Officer, National Violent Death Reporting System at Centers for Disease Control and Prevention Centers for Disease Control and Prevention Emory University Rollins School of Public Health

Dr. Petrosky

EmikoPetrosky MD M.P.H
Science Officer, National Violent Death Reporting System at Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
Emory University Rollins School of Public Health

MedicalResearch.com: What is the background for this study?

Response: Homicide is one of the leading causes of death for women aged 44 years and younger. In 2015, 3,519 girls and women died by homicide in the United States.  It is the 5th leading cause of death for women under 45 years age (defining women as 18-44 years of age).

The National Violent Death Reporting System (NVDRS) links together data from death certificates, coroner/medical examiner reports, and law enforcement reports, resulting in more information about the circumstances of death than what is available elsewhere.

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Regions With Strict Gun Control Laws Have Lower Rates of Pediatric Gun Injuries

MedicalResearch.com Interview with:

Monika Goyal, M.D., M.S.C.E. Assistant Professor of Pediatrics & Emergency Medicine Director of Research, Division of Emergency Medicine Attending Physician Children’s National Health System The George Washington University

Dr. Monika Goyal

Monika Goyal, M.D., M.S.C.E.
Assistant Professor of Pediatrics & Emergency Medicine
Director of Research, Division of Emergency Medicine and Attending Physician
Children’s National Health System
The George Washington University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As pediatric emergency clinicians, unfortunately, many of us have cared for a number of children who have been victims of gun violence. We wanted to investigate whether gun laws may make a difference in the rates of firearm-related morbidity and mortality in children. We specifically were interested in emergency department visits because they relate directly to the care we provide to pediatric patients.

Our main findings from our five-year study were that children are affected by gun violence nationally and, specifically, we saw regional differences in emergency department visits made by children who were victims of firearm violence.

Overall, firearm-related visits by patients 21 and younger to emergency departments remained consistent over time at a rate of 65 per every 100,000 visits until 2013, when they decreased slightly to 51 per 100,000 visits.

We also found that regions with more strict gun laws had lower rates of emergency department visits by children for gun violence compared with those regions with less stringent laws. We used the Brady Score, which looks at various state gun laws and assigns a score, to measure strictness. Then, based on state-level scores, we created regional composite scores.

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Consequences of Interpersonal Violence Against Child Athletes Persist into Adulthood

MedicalResearch.com Interview with:

Tine Vertommen, Criminologist Faculty of Medicine and Health Sciences Universiteitsplein 1 Antwerp, Belgium

Tine Vertommen

Tine Vertommen, Criminologist
Faculty of Medicine and Health Sciences
Universiteitsplein 1
Antwerp, Belgium

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A recent prevalence study into interpersonal violence against child athletes in the Netherlands and Belgium showed that 6% experienced severe sexual violence, 8% experienced severe physical violence, and 9% of respondents experienced severe psychological violence in sport (Vertommen et al., 2016). While general literature has repeatedly shown that exposure to interpersonal violence during childhood is associated with mental health problems in adulthood, this relationship has not yet been demonstrated in (former) athletes. Thus, the objective of the current study is to assess the long-term consequences of these experiences on adult mental health and quality of life.

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Exposure to Violence, Psychological Distress, and Gun Carrying Among Male Adolescents

MedicalResearch.com Interview with:
Joan A. Reid, Ph.D., LMHC

Assistant Professor
Criminology Program DAV 266
University of South Florida St. Petersburg

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Firearm-associated homicide and suicide are leading causes of death among American youth (i.e., 10-24 years old), with disproportionately high rates observed among male youth of color. Notably, gun violence and psychological problems are often conflated in public discourse regarding gun violence and prevention. However, few studies have assessed the impact of exposure to violence, either as a witness or a victim, when exploring the association between gun-carrying behavior and psychological distress.

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More Gun Violence in PG-13 Than R-Rated Films

MedicalResearch.com Interview with:

Daniel Romer, PhD Annenberg Public Policy Center University of Pennsylvania Philadelphia, Pennsylvania

Dr. Daniel Romer

Daniel Romer, PhD
Annenberg Public Policy Center
University of Pennsylvania
Philadelphia, Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have been studying trends in health compromising behaviors in popular films that were released since 1950, and in 2013 we reported that films rated PG-13 had just passed the rate of portrayed gun violence shown in popular R-rated films in 2012. In this report, we updated the trends in gun violence through 2015 and found that the trend has continued. In addition, we noted the strong contribution to this trend of films with comic book heroes whose heavy use of guns omits the harmful and otherwise realistic consequences of blood and suffering.

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Research Into Gun Violence Plunged Over 15 Year Period

MedicalResearch.com Interview with:

Ted Alcorn, MHS, MA Everytown for Gun Safety Brooklyn, New York

Ted Alcorn

Ted Alcorn, MHS, MA
Everytown for Gun Safety
Brooklyn, New York

MedicalResearch.com: What is the background for this study?

Response: Two decades ago, opponents of gun violence prevention recognized that they could curb the development and enactment of effective laws if they halted scientific research on which good policy would be grounded or justified. So they adopted a strategy of intimidation towards the leading federal agencies funding research on this topic and generating data on which analysis relied. Journalists that observed the pattern and scientists that lived through it often described the “chilling effect” this had on the field of gun violence prevention research.

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Neighborhood Violence Associated With Biological Stress in Children

MedicalResearch.com Interview with:

Katherine P. Theall, PhD Associate Professor Global Community Health and Behavioral Services Tulane University School of Public Health and Tropical Medicine New Orleans, Louisiana

Dr. Katherine P. Theall

Katherine P. Theall, PhD
Associate Professor
Global Community Health and Behavioral Services
Tulane University School of Public Health and Tropical Medicine
New Orleans, Louisiana

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are stark health disparities in the U.S. by socioeconomic position as well as between racial and ethnic groups. Many of these health disparities may have a root cause in childhood and be driven by social risk factors. The authors report each neighborhood stressor was associated with biological stress as measured by shortened telomere length and cortisol functioning. Many children are exposed to violence and a greater understanding of the effect on children’s health is critical because social environmental conditions likely contribute to health disparities. Socioeconomically disadvantaged communities have a higher exposure to violence. Limitations of the study include its lack of applicability to other demographic groups. The study also cannot establish causality.

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Adverse Life Experiences are a Major Risk Factor for Youth Firearm Violence

MedicalResearch.com Interview with:

Steven A. Sumner, MD, MSc Centers for Disease Control and Prevention National Center for Injury Prevention and Control, Division of Violence Prevention Atlanta GA

Dr. Steven A. Sumner

Steven A. Sumner, MD, MSc
Centers for Disease Control and Prevention
National Center for Injury Prevention and Control, Division of Violence Prevention
Atlanta GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In 2014, CDC was invited to Wilmington, Delaware, to conduct a study because the city had been experiencing a high level of homicides and shootings. Our investigation looked at multiple risk factors for youth violence involvement across a wide variety of areas of young people’s lives. For example, youth who had previously experienced a gunshot wound injury were 11 times more likely to later commit a gun crime than youth who had not been similarly injured. Study investigators looked at histories of violence victimization, educational problems, unemployment histories, child welfare experiences, and prior criminal involvement. The more adverse life experiences a young person had, the more likely they were to commit firearm violence.

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Risk of Serious Injury or Death After Police Stops Do Not Vary By Race

MedicalResearch.com Interview with:

Ted Miller, PhD Senior Research Scientist II Pacific Institute for Research and Evaluation Calverton, Maryland

Dr. Ted Miller

Ted Miller, PhD
Senior Research Scientist II
Pacific Institute for Research and Evaluation
Calverton, Maryland

MedicalResearch.com: What are the main findings?

Response: Police use of undue force is an enduring tinderbox issue in America. We tried to solve it by passing the 14th Amendment after the civil war, thru the civil rights movement, the riots of the 1960s, the Rodney King riot. The discussion has focused on racial disparities in per capita rates of deaths, stops, and arrests. This article digs deeper. Its aims are to use health data sets to examine nonfatal injuries inflicted during police action and apply better denominators. Looking at nonfatal injuries is especially important as shootings with firearms or tasers account for virtually all deaths but few other injuries in police encounters.

This study measures exposure as the sum of arrests plus traffic stops with search plus stops on the street. Those data come from FBI arrest reports, state arrest reports, and the 2011 Police-Public Contact Survey. Blacks have long had the highest per capita rates of stops and arrests. We believe this study is the first to assess the probability of being arrested when stopped. Those probabilities also are skewed, with police arresting 85% of Blacks and 82% of Hispanics who are stopped, well above the 71% of Whites and Native Americans and 61% of Asian-Americans. Arrest probabilities do not differ by sex or age group.

The study used a newspaper census of deaths and took injury counts from the 2012 Health Care Cost and Utilization Program nationwide samples, counting people whose injuries resulted from “legal intervention.” In 2012, US police killed or injured an estimated 55, 400 people during stops and arrests. The daily toll was 3 deaths and 150 hospital-treated injuries. In 1 in 11 US homicides and legal intervention deaths, a police officer pulled the trigger. Surprisingly, the probability that a serious injury was fatal did not vary by race. Nor did the ratio of serious and fatal injuries to stops and arrests. Teenagers and to a lesser extent young adults were less likely than people age 30 and over to die or suffer a hospital-treated injury when stopped or arrested.

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Tool Helps Identify Released Prisoners At High Risk of Violent Repeat Offenses

MedicalResearch.com Interview with:
Zheng Chang, PhD
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet
Stockholm

Medical Research: What is the background for this study? What are the main findings?

Dr. Chang: More than 30 million people are released from prison worldwide every year. Despite reported decreases in violence in many countries, repeat offending remains high across many high-income and middle-income countries. Because there is considerable inconsistency and inefficiency in identifying those who are at high risk of reoffending and most in need of interventions, we developed and validated a clinical prediction rule to determine this risk in released prisoners.

We did a cohort study of 47 326 prisoners released in Sweden between 2001 and 2009. We developed a 14-item model to predict violent reoffending, which includes modifiable risk factors and has been externally validated. The model showed good measures of discrimination and calibration. The study uses the methods to develop the prediction model on the basis of TRIPOD guidelines, and it is a brief, easy to use, and scalable tool. This tool has also been translated into a freely available web application (OxRec).

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Could Busy Streets and Improved Environment Reduce Teen Homicides?

MedicalResearch.com Interview with:

Alison Culyba, MD MPH Adolescent Medicine Advanced Research Fellow Craig-Dalsimer Division of Adolescent Medicine Children’s Hospital of Philadelphia PhD Candidate, Epidemiology Department of Epidemiology and Biostatistics Perelman School of Medicine at the University of Pennsylvania

Dr.Alison Culyba

Alison Culyba, MD MPH
Adolescent Medicine Advanced Research Fellow
Craig-Dalsimer Division of Adolescent Medicine
Children’s Hospital of Philadelphia
PhD Candidate, Epidemiology
Department of Epidemiology and Biostatistics
Perelman School of Medicine at the University of Pennsylvania 

MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Culyba: Youth violence is a major public health problem. Homicide is the second leading cause of death among all adolescents in the U.S., and the number one cause of death among African American adolescents. Prom prior research, we know that where you live and where you spend time has a major impact on health, and that making changes to environments, such as greening vacant lots and remediating abandoned buildings, can significantly reduce crime. However, much less is known about the relationship between adolescent’s immediate surroundings and the risk of homicide. The goal of this study was to examine associations between neighborhood environmental features, such as streets, buildings, and natural surroundings and adolescent homicide. We conducted a population-based case control study of 143 adolescents, ages 13 to 20, who were victims of homicides in Philadelphia and 155 matched controls in the same range, who were outdoors in Philadelphia at the same time that the homicides occurred. To assess features in the immediate environments of homicide victims and control individuals, trained field staff stood on the street corner of each homicide and control location and took a series of photographs that we stitched together into 360-degree high resolution panoramas, which we assessed for environmental features. After accounting for many individual and neighborhood contextual factors, we found that the odds of homicide was significantly lower in locations with street lighting, pedestrian infrastructure, public transportation, parks, and maintained vacant lots.

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US Youth Nearly 50 Times More Likely To Die By Guns Than Other High Income Nations

MedicalResearch.com Interview with:

Erin Grinshteyn, PhD Assistant Professor University of Nevada-Reno School of Community Health Science

Dr. Grinshteyn

Erin Grinshteyn, PhD
Assistant Professor
University of Nevada-Reno
School of Community Health Science

Medical Research: What is the background for this study? What are the main findings?

Dr. Grinshteyn: Gun deaths are a serious public health issue in the United States. This paper compared the US to 22 other high-income nations, and found that Americans are ten times more likely to be killed by a gun than their counterparts in the developed world. Gun homicide rates are 25 times higher in the U.S. and, while the overall suicide rate is on par with other high-income nations, the U.S. gun suicide rate is eight times higher. Ninety percent of women, 91% of all children aged 0 to 14 years, and 92% of youth aged 15 to 24 years who were killed by firearms were in the United States.

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Standard Risk Assessments For Violence After Discharge Mostly Futile

MedicalResearch.com Interview with:
Simone Ullrich, PhD
Senior Lecturer in Forensic Mental Health
Violence Prevention Research Unit
Queen Mary University of London

Medical Research: What is the background for this study? What are the main findings?

Dr. Ullrich: There are currently thought to be more than three hundred risk assessment instruments used by professionals such as psychiatrists, psychologists, and probation officers to assess the risks of violence and sexual offending among psychiatric patients, prisoners, and the general population. In some mental health services the hospital does not get paid unless staff have carried out a risk assessment on their patients. Producing risk assessment instruments has become an ‘industry’ and new instruments are being produced annually, on every form of violence and criminal activity. The Queen Mary research group believe that none of these instruments have any advantage over those produced before. Furthermore, their best predictions for future violence get 30% wrong.

Professor Coid and colleagues believe that no further progress can be made because researchers have been too obsessed with predicting the future of whether a patient will be violent rather than looking for the causes of why they become violent. All previous studies have used special statistical techniques which are designed to measure predictive accuracy. The Queen Mary research group say there is nothing wrong with being accurate or measuring accuracy, but there is no point in trying to develop new instruments which can never improve on getting it right more than 70% of the time. It may be helpful to know that your patient has a high or low risk of being violent if you release them from hospital, but this is not going to tell you what you should do to stop them being violent. Furthermore, if the risk assessment says that their risk is high then it is likely that you will not release them. The problem is that professionals will always play safe and, although there is a good chance (around 30%) that they are totally wrong, the patient will not be released. This is probably one of the most important reasons why patients are staying longer and longer in secure mental health services. These instruments achieve little more than making healthcare professionals risk averse.

The National Institute for Health Research (NIHR) funded a study where 409 male and female patients who were discharged from medium secure services in England and Wales were followed up after release into the community. They received assessments with two ‘state of the art’ assessment instruments, the HCR-20 which aims to guide clinicians in their assessment of violence, and the SAPROF, another instrument aimed to guide clinicians on which factors protect patients from becoming violent. Both instruments were developed on the basis of predictive statistics. Measures were taken with these instruments prior to release into the community, then after 6 and 12 months following discharge.

Information on violence was gathered via individual case notes and a search of the police national computer. By 6 months following discharge, 54 (14%) had committed a violent act, between 6 and 12 months 43 (13%) had been violent.

The authors used two methods to investigate the associations between these risk/ protective factors and violence. They first tested the standard approach of risk assessment for the factors that occurred in the past 6 months which were then used to statistically predict violence in the following 6 months (predictive model). They then used a second approach which looked at the co-occurrence of the risk/ protective factors and violence within the same 6 month time window (causal model).

Using the traditional approach and looking at accuracy, the predictive model produced statistical coefficients of low size, suggesting that the risk and protective factors were poor in identifying who would be violent and who would not. Because many associations between the factors and violence were weak, few appeared useful in identifying those which should be targeted to manage future violence. Surprisingly, symptoms of major mental disorder did not show an association with violence, even though most of the patients in the study suffered from major mental disorder. It might have been expected that some patients would relapse, with more symptoms, leading to violence.

When the researchers used a causal approach aiming to confirm which risk and protective factors resulted in violence, the findings were very different. Symptoms of major mental disorder, the patients’ living condition, and whether they were taking medication were highly important factors. Secondly, the effects of risk and protective factors on violence were much bigger using the causal approach. For example, the effects of violent thoughts and ruminations, being in an unstable life situation, were about 3 times stronger using the causal model. The effects of being under stress and unable to cope were more than 4 times stronger than using the traditional predictive approach. They concluded that the causal approach was much better in identifying the key factors that need to be considered in the assessment and management of violence.

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Study Exposes Deep Structural Racial Differences in Exposure To Firearm Violence

Bindu Kalesan PhD MPH Director Evan’s Center for Translational Epidemiology and Comparative Effectiveness Research Assistant Professor of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118MedicalResearch.com Interview with:
Bindu Kalesan PhD MPH
Director
Evan’s Center for Translational Epidemiology and
Comparative Effectiveness Research
Assistant Professor of Medicine
Preventive Medicine & Epidemiology
Department of Medicine
Boston University School of Medicine
Boston, MA 02118 

Medical Research: What is the background for this study? What are the main findings?

Dr. Kalesan: Firearm injuries are one of the 3 major causes of death in children in the US. for every 7 pediatric firearm deaths there are 8 children non-fatally injured by a gun. Those that survive will live with disability and severe morbidity. From our earlier studies, we found that this burden of survivorship and injury is different according to race/ethnicity. There is also evidence that Injury related hospitalizations are also associated low-income households and neighborhoods. In the background of gun (violence) control, frequently comparisons are drawn between firearm injuries and motor vehicle accidents.

In this study we use nationally representative hospitalization data and compared pediatric firearm-related hospitalization and pedestrian motor vehicle accident hospitalizations to assess whether the risk of firearm related hospitalizations among minorities varies depending on the neighborhood they live.

We found that black children were at substantially greater risk of firearm hospitalization as compared to pedestrian motor vehicle hospitalization. This greater risk of firearm hospitalization among black children persisted across neighborhoods. Simply put, the risk of firearm hospitalization versus pedestrian motor vehicle hospitalization among black children was high, regardless of whether they lived in low income or high income neighborhoods.We also found that all minority race children (black, Hispanic and other race) as compared to white children were at a greater likelihood of homicide-firearm hospitalization than of pedestrian motor vehicle hospitalization and all minority race children were significantly less likely to be hospitalized for unintentional firearm than pedestrian injuries in comparison to white children. Therefore, overall we found a minority race disadvantage regardless of whether they lived in high and low-income neighborhoods.

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Young Black Men Who Feel Powerless Engage In More High Risk Behaviors

Alvin Thomas, Ph.D. Assistant Professor Associate Director Center For Excellence in Diversity Palo Alto University Palo Alto, CA  94304MedicalResearch.com Interview with:
Alvin Thomas, Ph.D.
Assistant Professor
Associate Director Center For Excellence in Diversity
Palo Alto University
Palo Alto, CA  94304

Walking Away Hurt, Walking Around Scared: A Cluster Analysis of Violence Exposure Among Young Black Males

Alvin Thomas and Elan C. Hope

Using a person-centered approach, we examine phenomenological variations in exposure to violence for Black males and describe risk and protective factors associated with patterns of violence exposure. We ran K-means iterative cluster analysis to determine patterns of violence exposure and conducted analysis of variance to test whether clusters differed. Data are from 287 Black males (M = 18.9) who participated in the Black Youth Project–Youth Culture Survey. Participants in the current study self-identified as Black or African American and male, and completed the political participation, health, and demographic portions of the survey questionnaire. We found four clusters of violence exposure that were related to demographic characteristics, maternal closeness, neighborhood condition, and sociopolitical inequity. Our findings highlight the heterogeneity of exposure to violence among young Black males and the individual and environmental risk and protective factors that are related to types and levels of exposure. This examination of quality of violence exposure in the context of available risks and protective factors may help clinicians and researchers improve their intervention efforts.

Medical Research: What is the background for this study?

Dr. Thomas: It is a fact that young Black males are more likely than any other demographic to be exposed to violence. However there is an incorrect assumption of homogeneity of the violence experienced by young Black males. These assumptions have deleterious effects for young Black males. Against the backdrop of high murder rates in cities like Chicago and increased deadly police interactions with this population across the US it is important to understand the phenomenology of violence exposure for young Black males.

Medical Research: What are the main findings?

Dr. Thomas: We found phenomenological differences in young Black males’ exposure to violence as victims and perpetrators. A large portion of the young men in this sample had a few experiences with violence and primarily as victims. Some youth attempted to fend of victimization by carrying weapons or engaging in fights to protect themselves.

Youth with the highest rate of victimization and perpetration also had poorest outcomes, and felt most disenfranchised. Many of these young people felt that their access to resources like education and justice was limited compared to other youth, and they felt powerless to effect change on the status quo. This feeling of powerlessness is related to high-risk behaviors. Young Black males who had been more exposed to violence were at highest risk of feeling disenfranchised, discriminated against, and disconnected from society.

Medical Research: What should clinicians and patients take away from your report?

Dr. Thomas: Clinicians need to be aware of the very real effect of the violence experiences of young Black males on their health, and assess the effect of these as part of an overall plan of treatment. Retention of minority clients in mental and physical health treatment is as critical an issue as service utilization within this same population. The disenfranchisement and disconnect from the status quo that young Black males feel owing partly to their life experiences is a critical consideration as clinicians seek to provide much needed services. Assessment of trauma exposure and effects for clients who have a history of violence exposure may be an important element in triage and treatment.

Patients should be aware that exposure to violent experiences could affect their inter and intra-personal relationships. They should discuss this psychosocial history with their mental and physical health service providers to determine whether their exposure to violence is contributing to their current health concerns.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Thomas: Researchers should explore the effectiveness of youth programs that focus on young Black males. Such programs should help youth explore issues of social disconnect, disenfranchisement, and disillusionment, while also providing skills to empower youth to effect personal and systemic change. Policy research and inclusion efforts have to address the very real experiences of young Black males and make real changes to the way the representatives of the sociopolitical system interact with young Black males. We know the quality of many of the risks facing young Black males in America, the research on how to protect these young Black males must mushroom, and the findings applied.

Citation:

Alvin Thomas and Elan C. Hope

Walking Away Hurt, Walking Around Scared: A Cluster Analysis of Violence Exposure Among Young Black Males
Journal of Black Psychology 0095798415603539, first published on September 8, 2015 doi:10.1177/0095798415603539

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Alvin Thomas, Ph.D. (2015). Young Black Men Who Feel Powerless Engage In More High Risk Behaviors