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Abasilim C, Friedman LS, Shannon B, Holloway-Beth A. Relationship between Civilian Injuries Caused during Contact with Law Enforcement and Community-Level Sociodemographic Characteristics. J Urban Health 2024:10.1007/s11524-024-00865-9. [PMID: 38806992 DOI: 10.1007/s11524-024-00865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/30/2024]
Abstract
Civilian injuries caused during contact with law enforcement personnel erode community trust in policing, impact individual well-being, and exacerbate existing health inequities. We assessed the relationship between ZIP code-level rates of civilian injuries caused during legal interventions and community-level sociodemographic characteristics using Illinois hospital data from 2016 to 2022. We developed multivariable Poisson regression models to examine whether legal intervention injury rates differed by race-ethnicity and community economic disadvantage across three geographic regions of Illinois representing different levels of urbanization. Over the study period, 4976 civilian injuries were treated in Illinois hospitals (rate of 5.6 per 100,000 residents). Compared to non-Hispanic white residents, non-Hispanic Black residents demonstrated 5.5-10.5 times higher injury rates across the three geographic regions, and Hispanic-Latino residents demonstrated higher rates in Chicago and suburban Cook County, but lower rates in the rest of the state. In most regions, models showed that as the percent of minority residents in a ZIP code increased, injury rates among non-Hispanic Black and Hispanic-Latino residents decreased. As community economic disadvantage increased at the ZIP code level, civilian injury rates increased. Communities with the highest injury rates involving non-Hispanic white residents were significantly more economically unequal and disadvantaged. While the injury rates were consistently and substantially higher among non-Hispanic Black residents throughout the state, the findings illustrate that the association between overall civilian injuries caused during contact with law enforcement and community sociodemographic characteristics varied across regions. Data on local law enforcement agency policies and procedures are needed to better identify appropriate interventions.
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Affiliation(s)
- Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA
| | - Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA.
| | - Brett Shannon
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA
| | - Alfreda Holloway-Beth
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor St (Room 1057), Chicago, IL, 60612, USA
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Khan H, Miller M, Barber C, Azrael D. Fatal Police Shootings of Victims with Mental Health Crises: A Descriptive Analysis of Data from the 2014-2015 National Violent Death Reporting System. J Urban Health 2024; 101:262-271. [PMID: 38453763 PMCID: PMC11052937 DOI: 10.1007/s11524-024-00833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
One in five fatal police shooting victims may have been experiencing a mental health crisis (MHC) at the time of their death [1]. We use data on fatal police shootings from the National Violent Death Reporting System (2014-2015) to (a) identify incidents where the victim is reported to have experienced an MHC at the time of their death, (b) describe the characteristics of these incidents, and (c) compare the characteristics of MHC to fatal police shootings where the victim was not experiencing an MHC at the time of their death. We systematically coded 633 fatal police shootings from 27 states. Descriptive statistics characterized fatal police shootings, including victim characteristics; their mental health status; and contextual information regarding the police encounter (e.g., reason for police call). Overall, 203 of 633 fatal police encounters (32%) involved victims who showed signs of an MHC at the time of their death. Victims were predominantly white, male, and in possession of a firearm. In 3 of 4 cases, the MHC manifested as suicidal ideation despite any relevant documented history among most victims. Among half of suicidal victims, suicidal ideation was expressed verbally and in-person to a family member/intimate partner who subsequently called the police. Dispatch was aware of the MHC in 1 of 4 of total police calls. Overall, fatal police encounters involving those experiencing an MHC accounted for 1 in 3 of our caseloads. Approximately, 3 of 4 mental health calls involved a suicidal person who mainly expressed intent to a loved one in-person.
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Affiliation(s)
- Harun Khan
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Matthew Miller
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA
- Bouve School of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Catherine Barber
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA
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Yu PT, Goodman LF, Riley JS, Giron A, Guner YS, Peranteau WH, Schomberg J. Racial Disparity among Youth Decedents of Legal Intervention Trauma. J Am Coll Surg 2024; 238:226-235. [PMID: 37861230 DOI: 10.1097/xcs.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Legal intervention trauma (LIT) is defined as injury due to any encounter with law enforcement. This study investigates associations between demographics, violent status, and law enforcement tactics among youth decedents of LIT. STUDY DESIGN Decedents of LIT age 26 years or younger were identified using the CDC's National Violent Death Reporting System from 2003 to 2018. Decedents were classified as "violent" if they possessed a weapon, were committing a violent crime, or if law enforcement reported justified use of force. All others were classified as "nonviolent." Law enforcement tactics were stratified into "lethal" (firearm with standard ammunition) or "less lethal" (any other) force. Differences in the racial distribution across these classifications were assessed using chi-square tests of proportions. RESULTS We identified 1,281 youth decedents of LIT; of which, 92.5% met violent criteria. Black youths were less likely than White youths to possess a weapon (71.6% vs 77.4%, p = 0.02) and were not more likely to be committing a violent crime (63.6% vs 60.4%, p = 0.27). They were, however, more likely than White youths to experience force reported as justified by law enforcement (89.9% vs 82.4%, p = 0.002) and to experience exclusively lethal force not preceded by less-lethal tactics (94.0% vs 88.7%, p = 0.001). Among the subset of 85 cases where law enforcement reported justified use of force despite the decedent not possessing a weapon or committing a violent crime, the precipitating event was more often a traffic stop for Black youths than for White youths (28.5% vs 6.66%, p = 0.02). CONCLUSIONS These findings indicate a racial disparity among youth decedents of LIT.
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Affiliation(s)
- Peter T Yu
- From the Division of Pediatric General and Thoracic Surgery (Yu, Goodman, Guner), Children's Hospital of Orange County, Orange, CA
- Department of Surgery, University of California Irvine Medical Center, Orange, CA (Yu, Goodman, Guner)
| | - Laura F Goodman
- From the Division of Pediatric General and Thoracic Surgery (Yu, Goodman, Guner), Children's Hospital of Orange County, Orange, CA
- Department of Surgery, University of California Irvine Medical Center, Orange, CA (Yu, Goodman, Guner)
| | - John S Riley
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Riley, Peranteau)
| | - Annie Giron
- Department of Surgery, Montefiore Medical Center, The Bronx, NY (Giron)
| | - Yigit S Guner
- From the Division of Pediatric General and Thoracic Surgery (Yu, Goodman, Guner), Children's Hospital of Orange County, Orange, CA
- Department of Surgery, University of California Irvine Medical Center, Orange, CA (Yu, Goodman, Guner)
| | - William H Peranteau
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Riley, Peranteau)
| | - John Schomberg
- Trauma and Nursing Administration (Schomberg), Children's Hospital of Orange County, Orange, CA
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Raza S, Thiruchelvam D, Redelmeier DA. Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada. JAMA Netw Open 2023; 6:e2335831. [PMID: 37768661 PMCID: PMC10539992 DOI: 10.1001/jamanetworkopen.2023.35831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Police shootings can cause serious acute injury, and knowledge of subsequent health outcomes may inform interventions to improve care. Objective To analyze long-term health care costs among survivors of police shootings compared with those surviving nonfirearm police enforcement injuries using a retrospective design. Design, Setting, and Participants This population-based cohort analysis identified adults (age ≥16 years) who were injured by police and required emergency medical care between April 1, 2002, and March 31, 2022, in Ontario, Canada. Exposure Police shootings compared with other mechanisms of injury involving police. Main Outcomes and Measures Long-term health care costs determined using a validated costing algorithm. Secondary outcomes included short-term mortality, acute care treatments, and rates of subsequent disability. Results Over the study, 13 545 adults were injured from police enforcement (mean [SD] age, 35 [12] years; 11 637 males [86%]). A total of 13 520 individuals survived acute injury, and 8755 had long-term financial data available (88 surviving firearm injury, 8667 surviving nonfirearm injury). Patients surviving firearm injury had 3 times greater health care costs per year (CAD$16 223 vs CAD$5412; mean increase, CAD$9967; 95% CI, 6697-13 237; US $11 982 vs US $3997; mean increase, US $7361; 95% CI, 4946-9776; P < .001). Greater costs after a firearm injury were not explained by baseline costs and primarily reflected increased psychiatric care. Other characteristics associated with increased long-term health care costs included prior mental illness and a substance use diagnosis. Conclusions and Relevance In this longitudinal cohort study of long-term health care costs, patients surviving a police shooting had substantial health care costs compared with those injured from other forms of police enforcement. Costs primarily reflected psychiatric care and suggest the need to prioritize early recognition and prevention.
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Affiliation(s)
- Sheharyar Raza
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
| | - Donald A. Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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Liu GS, Nguyen BL, Lyons BH, Sheats KJ, Wilson RF, Betz CJ, Fowler KA. Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2023; 72:1-38. [PMID: 37220104 DOI: 10.15585/mmwr.ss7205a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Problem/Condition In 2020, approximately 71,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2020. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. Period Covered 2020. Description of System NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2020. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (35 California counties, representing 71% of its population, and four Texas counties, representing 39% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results For 2020, NVDRS collected information on 64,388 fatal incidents involving 66,017 deaths that occurred in 48 states (46 states collecting statewide data, 35 California counties, and four Texas counties), and the District of Columbia. In addition, information was collected for 729 fatal incidents involving 790 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 66,017 deaths, the majority (58.4%) were suicides, followed by homicides (31.3%), deaths of undetermined intent (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 35-44 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. When circumstances were known, the three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a substance use problem (other than alcohol use).Other causes of death included unintentional firearm deaths and deaths of undetermined intent. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. Interpretation This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2020. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black male victims. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Public Health Action Violence is preventable, and states and communities can use data to guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the Colorado Violent Death Reporting System (VDRS), Kentucky VDRS, and Oregon VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In Colorado, VDRS data were used to examine the increased risk for suicide among first and last responders in the state. Kentucky VDRS used local data to highlight how psychological and social effects of the COVID-19 pandemic might increase risk for suicide, particularly among vulnerable populations. Oregon VDRS used their data to develop a publicly available data dashboard displaying firearm mortality trends and rates in support of the state's firearm safety campaign. Similarly, states participating in NVDRS have used their VDRS data to examine homicide in their state. Illinois VDRS, for example, found that state budget cuts were associated with notable increases in homicides among youths in Chicago. With an increase of participating states and jurisdictions, this report marks progress toward providing nationally representative data.
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Affiliation(s)
- Grace S Liu
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Brenda L Nguyen
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Bridget H Lyons
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Kameron J Sheats
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Rebecca F Wilson
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Carter J Betz
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Katherine A Fowler
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
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Dang LN, Kahsay ET, James LN, Johns LJ, Rios IE, Mezuk B. Research utility and limitations of textual data in the National Violent Death Reporting System: a scoping review and recommendations. Inj Epidemiol 2023; 10:23. [PMID: 37161610 PMCID: PMC10170777 DOI: 10.1186/s40621-023-00433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Many studies of injury deaths rely on mortality data that contain limited contextual information about decedents. The National Violent Death Reporting System (NVDRS) is unique among such data systems in that each observation includes both quantitative variables and qualitative texts (called "narratives") abstracted from original source documents. These narratives provide rich data regarding salient circumstances that can be used to inform prevention efforts. This review provides a comprehensive summary of peer-reviewed research using NVDRS narratives over the past 20 years, including the limitations of these texts and provides recommendations on utilizing and improving narrative quality for researchers and practitioners. MAIN BODY Studies that used narratives to examine deaths related to suicide, homicide, undetermined intent, accidental firearm, or legal intervention were identified by a title/abstract screening, followed by a full-text review. The search was conducted on English-language, peer-reviewed literature and government reports published from 2002 to 2022 in PubMed, PsycInfo, Scopus, and Google Scholar. Abstracted elements focused on the methodologies used to analyze the narratives, including approaches to explore potential biases in these texts. Articles were abstracted independently by two reviewers, with disagreements resolved through consensus discussion. During the 20-year period, 111 articles used narratives. Two-thirds studied suicide (n = 48, 43%) and homicides (n = 25, 23%). Most studies analyzed the narratives using manual review (n = 81, 73%) and keyword searches (n = 9, 8%), with only 6 (5%) using machine learning tools. Narratives were mainly used for case finding (n = 49, 44%) and characterization of circumstances around deaths (n = 38, 34%). Common challenges included variability in the narratives and lack of relevant circumstantial details for case characterization. CONCLUSION Although the use of narratives has increased over time, these efforts would be enhanced by detailed abstraction of circumstances with greater salience to injury research and prevention. Moreover, researchers and practitioners would benefit from guidance on integrating narratives with quantitative variables and standardized approaches to address variability in the completeness and length of narratives. Such efforts will increase the reliability of findings and set the stage for more widespread applications of data science methods to these texts.
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Affiliation(s)
- Linh N Dang
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Eskira T Kahsay
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - LaTeesa N James
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Lily J Johns
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Isabella E Rios
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Briana Mezuk
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
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AbiNader MA, Graham LM, Kafka JM. Examining Intimate Partner Violence-Related Fatalities: Past Lessons and Future Directions Using U.S. National Data. JOURNAL OF FAMILY VIOLENCE 2023; 38:1-12. [PMID: 36685752 PMCID: PMC9838333 DOI: 10.1007/s10896-022-00487-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 05/25/2023]
Abstract
Purpose Among homicides in the United States, intimate partners kill almost 50% of female and 10% of male victims. Intimate partner violence (IPV) also contributes to an estimated 6% of suicides. These trends suggest that opportunities for IPV interventions prior to the fatalities may have been missed. Thus, researchers must investigate the context and circumstances of IPV-related fatalities to inform effective prevention strategy development. There are two primary national fatality databases that can be used to examine such factors: the National Violent Death Reporting System (NVDRS, homicide and suicides); and the Uniform Crime Reporting-Supplementary Homicide Reports (UCR-SHR, homicides). These datasets include data on many IPV-related violent deaths but are limited by variations in data quality. Method This critical review summarizes opportunities and challenges when examining IPV-related fatalities using these national datasets. To document how the current literature is conceptualizing IPV, a rapid review on IPV-related homicide and suicide articles was performed (2019-2022). Missingness analyses were conducted to describe limitations in key dataset variables. Results These datasets enable tracking IPV-related fatalities nationally over time. However, issues with the operationalization of variables that record IPV circumstances, particularly in the UCR-SHR, and high levels of missingness represent significant barriers to research. Novel methodologies can optimize the use of these datasets. Conclusion National-level datasets enable researchers to examine IPV-related fatalities, evaluate policy differences between states, and monitor trends and disparities. This research can inform key recommendations for interventions to prevent IPV-related fatalities. Supplementary Information The online version contains supplementary material available at 10.1007/s10896-022-00487-2.
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Affiliation(s)
- Millan A. AbiNader
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104 USA
| | - Laurie M. Graham
- School of Social Work, University of Maryland-Baltimore, Baltimore, MD USA
| | - Julie M. Kafka
- School of Medicine, University of Washington, Seattle, WA USA
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Prater LC, Ellyson AM, Shawon RA, Lyons VH, Cheung A, Rivara F, Rowhani-Rahbar A, Zatzick D. Suicide, Firearms, and Terminal Illness: A Latent Class Analysis Using Data From the National Violent Death Reporting System. Psychiatr Serv 2022:appips202100733. [PMID: 36475825 DOI: 10.1176/appi.ps.202100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Firearms are highly lethal when used for suicide and are used more frequently as a suicide method by persons of older age. Individuals with terminal illness are at high risk for suicide, yet little research has explored how firearms may be used for self-harm in this population. The authors sought to understand the patterns of psychiatric diagnoses, substance use disorders diagnoses, and suicide mechanisms for individuals with terminal illness who died by suicide as well as their demographic and circumstantial characteristics. METHODS A latent class analysis using data from the National Violent Death Reporting System was undertaken to better understand typologies of individuals with terminal illness who died by suicide in 2003-2018 (N=3,072). To develop the classes, the authors considered diagnoses of mental illness and of alcohol or substance use disorders, suicidal thoughts and behaviors, and mechanism of suicide (firearm or no firearm). Demographic and circumstantial variables were examined across classes. RESULTS The analysis revealed four classes of persons with terminal illness who died from suicide: depression and nonfirearm methods (N=375, 12%), suicidal intent and firearm use (N=922, 30%), alcohol or substance use disorder and nonfirearm methods (N=70, 2%), and firearm use only (N=1,705, 56%). CONCLUSIONS Firearm access is an important consideration for terminally ill persons at risk for suicide. Screening for psychiatric and substance use disorders may not identify terminally ill persons who are at increased suicide risk because of the presence of a firearm in the home. This population may benefit from tailored interventions in specialty care settings to address firearm safety.
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Affiliation(s)
- Laura C Prater
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Alice M Ellyson
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Riffat Ara Shawon
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Vivian H Lyons
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Angel Cheung
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Frederick Rivara
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Ali Rowhani-Rahbar
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Douglas Zatzick
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
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Hemenway D, Shawah C, Lites E. Defensive gun use: What can we learn from news reports? Inj Epidemiol 2022; 9:19. [PMID: 35778756 PMCID: PMC9250204 DOI: 10.1186/s40621-022-00384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background In the past decade, most people who buy and own guns are doing so for self-defense. Yet little is known about actual defensive gun use in the USA. Methods To discover what information newspaper articles and local news reports might add, we read the news reports of defensive use incidents assembled by the Gun Violence Archive. We examined a sample of more than a quarter of the incidents from 2019, the last year before the pandemic. We examined all cases from four months—January, April, July, and October. We created a typology of defensive gun use incidents. Results Of 418 incidents, in about half, the perpetrator was armed with a firearm. In almost 90% of the cases, the victim fired their firearm—315 perpetrators were shot and about half of them died. The average number of perpetrators shot per incident was 0.75; the average number of victims shot was 0.25. We estimate that in 2019 fewer than 600 potential perpetrators were killed in defensive gun use incidents that made the news. Among the thirteen categories of shooting were drug-related (4% of incidents), gang-like combat (6%), romantic partner disputes (11%), escalating arguments (13%), store robberies (9%), street robberies (5%), unoccupied vehicle theft (5%), unarmed burglaries (7%), home invasions (20%), and miscellaneous (6%). Conclusion We believe the Gun Violence Archive dataset includes the large majority of news reports of defensive gun use—and especially those in which the perpetrator is shot and dies. Some of the strengths of using news reports as a data source are that we can be certain that the incident occurred, and the reports provide us with a story behind the incident, one usually vetted in part by the police with occasional input from the victims, perpetrator, family, witnesses, or neighbors. Defensive gun use situations are quite diverse, and among the various categories of defensive gun use, a higher percentage of incidents in some of the categories seemed far less likely to be socially beneficial (e.g., drug-related, gang-like, escalating arguments) than in others (e.g., home invasions).
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Affiliation(s)
- David Hemenway
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
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Ormseth CH, Mooney AC, Mitchell O, Hsia RY. Association of Residential Racial and Ethnic Segregation With Legal Intervention Injuries in California. JAMA Netw Open 2022; 5:e2219217. [PMID: 35767261 PMCID: PMC9244606 DOI: 10.1001/jamanetworkopen.2022.19217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The continued harm of Black individuals in the US by law enforcement officers calls for reform of both law enforcement officers and structural racism embedded in communities. OBJECTIVE To examine the association between county characteristics and racial and ethnic disparities in legal intervention injuries. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study was conducted among 27 671 patients presenting to California hospitals from January 1, 2016, to December 31, 2019, with legal intervention injuries (defined as any injury sustained as a result of an encounter with any law enforcement officer) as identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. MAIN OUTCOMES AND MEASURES Legal intervention injuries were classified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision external cause of injury code Y35. Expected injury counts were calculated for each county by multiplying statewide median rates of injury per capita for each age-racial and ethnic group, and then observed to expected injury ratios were measured. The association between county injury ratio, percentage of Black individuals, and residential segregation (measured using an index of dissimilarity) was modeled, stratifying by race and ethnicity. RESULTS A total of 27 671 patients (24 159 male patients [87.3%]; 1734 Asian and Pacific Islander [6.3%], 5049 Black [18.2%], 11 250 Hispanic [40.7%], and 9638 White [34.8%]; mean [SD] age, 34.2 [12.5] years) presented with legal intervention injuries in California from 2016 to 2019. Observed to expected injury ratios ranged from 0 to 7 for Black residents and from 0 to 5 for White residents. High observed to expected injury ratios for Black residents (408 observed vs 60 expected; ratio = 7) were clustered around San Francisco Bay Area counties and corresponded with a higher proportion of Black residents. High observed to expected injury ratios for White residents (57 observed vs 11 expected; ratio = 5) clustered around rural northern California counties and corresponded with higher mean percentage of residents with income below the federal poverty level and fewer urban areas. CONCLUSIONS AND RELEVANCE This study suggests that residential segregation may be associated with increased legal intervention injury rates for Black residents of California counties with a large percentage of Black residents. Reform efforts to address racial and ethnic disparities in these injuries should carefully consider and address the legacy of discriminatory policies that has led to segregated communities in California and the United States.
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Affiliation(s)
| | - Alyssa C. Mooney
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ojmarrh Mitchell
- School of Criminology and Criminal Justice, Arizona State University, Tempe
| | - Renee Y. Hsia
- Philip R. Lee Institute for Health Policy Studies, Department of Emergency Medicine, University of California, San Francisco
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Wilson RF, Liu G, Lyons BH, Petrosky E, Harrison DD, Betz CJ, Blair JM. Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2022; 71:1-40. [PMID: 35588398 PMCID: PMC9129903 DOI: 10.15585/mmwr.ss7106a1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION In 2019, approximately 67,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 42 states, the District of Columbia, and Puerto Rico in 2019. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. PERIOD COVERED 2019. DESCRIPTION OF SYSTEM NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2019. Data were collected from 39 states with statewide data (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Hawaii, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming), three states with data from counties representing a subset of their population (30 California counties, representing 57% of its population, and 47 Illinois counties and 40 Pennsylvania counties, representing at least 80% of their populations), the District of Columbia, and Puerto Rico. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. RESULTS For 2019, NVDRS collected information on 50,374 fatal incidents involving 51,627 deaths that occurred in 42 states (39 states collecting statewide data, 30 California counties, 47 Illinois counties, and 40 Pennsylvania counties), and the District of Columbia. In addition, information was collected for 831 fatal incidents involving 897 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 51,627 deaths, the majority (64.1%) were suicides, followed by homicides (25.1%), deaths of undetermined intent (8.7%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged 45-54 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White (White) persons had the highest suicide rates among all racial and ethnic groups. Among males, the most common method of injury for suicide was a firearm, whereas poisoning was the most common method of injury among females. Among all suicide victims, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 25-29 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. The three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a mental health or substance use problem (other than alcohol use). Unintentional firearm deaths were most frequently experienced by males, White persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. The rate of deaths of undetermined intent was highest among males, particularly among Black and AI/AN males, and among adults aged 30-44 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. INTERPRETATION This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2019. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. PUBLIC HEALTH ACTION Violence is preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the New Hampshire Violent Death Reporting System (VDRS), Indiana VDRS, and Colorado VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In New Hampshire, VDRS data have been used to monitor the increase in suicide rates during 2014-2018 and guide statewide collaborative prevention efforts. Indiana VDRS used local data to demonstrate differences in suicide and other related mental health problems among Black persons and highlight a need for improved suicide awareness and culturally competent mental health care. The Colorado VDRS conducted geospatial and demographic analysis, considering local VDRS data with existing suicide prevention efforts and resources, to identify regions with high suicide rates regions and populations at high risk for suicide. Similarly, states participating in NVDRS have used their VDRS data to examine related to homicide in their state. In North Carolina for example, where homicide rates among AI/AN and Black persons were approximately 2.5 times higher than the statewide homicide rate, the North Carolina VDRS program aims to partner with historically Black colleges and universities in the state to train researchers to use VDRS data to address health equity issues in and around their immediate community.
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Bailey JA, Jacoby SF, Hall EC, Khatri U, Whitehorn G, Kaufman EJ. Compounding Trauma: the Intersections of Racism, Law Enforcement, and Injury. CURRENT TRAUMA REPORTS 2022; 8:105-112. [PMID: 35578594 PMCID: PMC9096065 DOI: 10.1007/s40719-022-00231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review
Traumatic injury sits at the nexus of law enforcement and structural racism. This narrative review aims to explore the major impacts of law enforcement on health, its intersections with US structural racism, and their joint impacts on traumatic injury and injury care. Recent Findings Many of the same forces of systemic disadvantage that put Black people, other people of color, and other marginalized groups at risk for violent injury also expose these same individuals and communities to intensive policing. Recent evidence speaks to the broad impact of police exposure and police violence on individual and community physical and mental health. Moreover, injured patients who are exposed to law enforcement during their care are at risk for erosion of trust in and relationships with their healthcare providers. To optimize the role of law enforcement agencies in injury prevention, collaboration across sectors and with communities is essential. Summary A broad approach to the prevention of injury and violence must incorporate an understanding of the intersecting impacts of law enforcement and structural racism on health and traumatic injury. Clinicians who seek to provide trauma-informed injury care should incorporate an understanding of the role of law enforcement in individual and community health.
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Affiliation(s)
- Joanelle A. Bailey
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Sara F. Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, PA USA
| | - Erin C. Hall
- Trauma Surgery and Critical Care Medicine, MedStar Health, Washington, DC USA
| | - Utsha Khatri
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Gregory Whitehorn
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Elinore J. Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
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Let’s “Talk” about the police: The role of race and police legitimacy attitudes in the legal socialization of youth. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02709-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sheats KJ, Wilson RF, Lyons BH, Jack SP, Betz CJ, Fowler KA. Surveillance for Violent Deaths — National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018. MMWR. SURVEILLANCE SUMMARIES 2022; 71:1-44. [PMID: 35085227 PMCID: PMC8807052 DOI: 10.15585/mmwr.ss7103a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Problem/Condition In 2018, approximately 68,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 39 states the District of Columbia, and Puerto Rico in 2018. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. Period Covered 2018. Description of System NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner reports, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2018. Data were collected from 36 states with statewide data (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), three states with data from counties representing a subset of their population (21 California counties, 28 Illinois counties, and 39 Pennsylvania counties), the District of Columbia, and Puerto Rico. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results For 2018, NVDRS collected information on 52,773 fatal incidents involving 54,170 deaths that occurred in 39 states and the District of Columbia. In addition, information was collected on 880 fatal incidents involving 975 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 54,170 deaths, the majority (64.1%) were suicides, followed by homicides (24.8%), deaths of undetermined intent (9.0%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns and circumstances varied by manner of death. The suicide rate was higher among males than among females and was highest among adults aged 35–64 years and non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White persons. The most common method of injury for suicide was a firearm among males and hanging, strangulation, or suffocation among females. Suicide was most often preceded by a mental health, intimate partner, or physical health problem, or a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was highest among persons aged 20–24 years and was higher among males than females. Non-Hispanic Black males experienced the highest homicide rate of any racial or ethnic group. The most common method of injury for homicide was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicides most often were precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, were related to intimate partner violence. Homicide suspects were primarily male and the highest proportion were aged 25–44 years. When race and ethnicity information was known, non-Hispanic Black persons comprised the largest group of suspects overall and among those aged ≤44 years, and non-Hispanic White persons comprised the largest group of suspects among those aged ≥45 years. Almost all legal intervention deaths were experienced by males, and the legal intervention death rate was highest among males aged 30–34 years. Non-Hispanic AI/AN males had the highest legal intervention death rate, followed by non-Hispanic Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. The most frequent circumstances reported for legal intervention deaths were use of a weapon by the victim in the incident and a mental health or perceived substance use problem (other than alcohol use). Law enforcement officers who inflicted fatal injuries in the context of legal intervention deaths were primarily males aged 25–44 years. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White persons, and persons aged 15–24 years. These deaths most often occurred while the shooter was playing with a firearm and most frequently were precipitated by a person unintentionally pulling the trigger or mistakenly thinking that the firearm was unloaded. The rate of deaths of undetermined intent was highest among males, particularly among non-Hispanic Black and non-Hispanic AI/AN males, and among persons aged 45–54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in approximately 80% of decedents tested for those substances. Interpretation This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2018. The suicide rate was highest among non-Hispanic AI/AN and non-Hispanic White males, and the homicide rate was highest among non-Hispanic Black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Circumstances for suspects of homicide varied by age group and included having prior contact with law enforcement and involvement in incidents that were precipitated by another crime, intimate partner violence, and drug dealing or substance use. Public Health Action NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, Arizona and Wisconsin used their state-level VDRS data to support suicide prevention efforts within their respective states. Wisconsin VDRS used multiple years of data (2013–2017) to identify important risk and protective factors and subsequently develop a comprehensive suicide prevention plan. Arizona VDRS partners with the Arizona Be Connected Initiative to provide customized community-level data on veteran suicide deaths in Arizona. Similarly, states participating in NVDRS have used their VDRS data to examine intimate partner violence–related deaths to support prevention efforts. For example, data from the South Carolina VDRS were used to examine intimate partner homicides that occurred in South Carolina during 2017. South Carolina VDRS found that 12% of all homicides that occurred in 2017 were intimate partner violence–related, with females accounting for 52% of intimate partner homicide–related victims. These data were shared with domestic violence prevention collaborators in South Carolina to bolster their efforts in reducing intimate partner violence–related deaths. In 2018, NVDRS data included four additional states compared with 2017, providing more comprehensive and actionable violent death information for public health efforts to reduce violent deaths.
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Affiliation(s)
- Kameron J. Sheats
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Rebecca F. Wilson
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Bridget H. Lyons
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Shane P.D. Jack
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Carter J. Betz
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Katherine A. Fowler
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
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Liasidis PK, Lewis M, Jakob DA, Inaba K, Demetriades D. Firearm injuries during legal interventions Nationwide analysis. J Trauma Acute Care Surg 2021; 91:465-472. [PMID: 34432753 DOI: 10.1097/ta.0000000000003146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There is limited literature on firearm injuries during legal interventions. The purpose of this study was to examine the epidemiology, injury characteristics, and outcomes of both civilians and law enforcement officials (LEOs) who sustained firearm injuries over the course of legal action. METHODS Retrospective observational study using data from the National Trauma Data Bank (2015-2017) was performed. All patients who were injured by firearms during legal interventions were identified using the International Classification of Disease, Tenth Revision, external cause of injury codes. The study groups were injured civilian suspects and police officers. Demographics, injury characteristics, and outcomes were analyzed and compared between the groups. Primary outcomes were the clinical and injury characteristics among the victims. RESULTS A total of 1,411 patients were included in the study, of which 1,091 (77.3%) were civilians, 289 officers (20.5%), and 31 bystanders (2.2%). Overall, 95.2% of patients were male. Compared with LEOs, civilians were younger (31 vs. 34 years, p = 0.007) and more severely injured (median Injury Severity Score, 13 vs. 10 [p = 0.005]; Injury Severity Score >15, 44.4% vs. 37.1% [p = 0.025]). Civilians were more likely to sustain severe (Abbreviated Injury Scale, ≥3) intra-abdominal injuries (26.8% vs. 16.1%, p < 0.001) and spinal fractures (13.0% vs. 6.9%, p = 0.004). In-hospital mortality and overall complication rate were similar between the groups (mortality: civilians, 24.7% vs. LEOs, 27.3% [p = 0.360]; overall complications: civilians, 10.3% vs. LEOs, 8.4% [p = 0.338]). CONCLUSION Firearm injuries during legal interventions are associated with significant injury burden and a higher mortality than the reported mortality in gunshot wounds among civilians. The mortality and overall complication rate were similar between civilian suspects and law enforcement officials. LEVEL OF EVIDENCE Epidemiologic, level IV.
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Affiliation(s)
- Panagiotis K Liasidis
- From the Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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Boxer P, Brunson RK, Gaylord‐Harden N, Kahn K, Patton DU, Richardson J, Rivera LM, Smith Lee JR, Staller MS, Krahé B, Dubow EF, Parrott D, Algrim K. Addressing the inappropriate use of force by police in the United States and beyond: A behavioral and social science perspective. Aggress Behav 2021; 47:502-512. [PMID: 33948965 DOI: 10.1002/ab.21970] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/05/2022]
Abstract
Recent high-profile incidents involving the deadly application of force in the United States sparked worldwide protests and renewed scrutiny of police practices as well as scrutiny of relations between police officers and minoritized communities. In this report, we consider the inappropriate use of force by police from the perspective of behavioral and social science inquiry related to aggression, violence, and intergroup relations. We examine the inappropriate use of force by police in the context of research on modern policing as well as critical race theory and offer five recommendations suggested by contemporary theory and research. Our recommendations are aimed at policymakers, law enforcement administrators, and scholars and are as follows: (1) Implement public policies that can reduce inappropriate use of force directly and through the reduction of broader burdens on the routine activities of police officers. (2) For officers frequently engaged in use-of-force incidents, ensure that best practice, evidence-based treatments are available and required. (3) Improve and increase the quality and delivery of noncoercive conflict resolution training for all officers, along with police administrative policies and supervision that support alternatives to the use of force, both while scaling back the militarization of police departments. (4) Continue the development and evaluation of multicomponent interventions for police departments, but ensure they incorporate evidence-based, field-tested components. (5) Expand research in the behavioral and social sciences aimed at understanding and managing use-of-force by police and reducing its disproportionate impact on minoritized communities, and expand funding for these lines of inquiry.
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Affiliation(s)
- Paul Boxer
- Department of Psychology Rutgers University Newark New Jersey USA
| | - Rod K. Brunson
- School of Criminology and Criminal Justice Northeastern University Boston Massachusetts USA
| | - Noni Gaylord‐Harden
- Department of Psychological and Brain Sciences Texas A&M University College Station Texas USA
| | - Kimberly Kahn
- Department of Psychology Portland State University Portland Oregon USA
| | | | - Joseph Richardson
- Department of African American Studies University of Maryland College Park Maryland USA
| | - Luis M. Rivera
- Department of Psychology Rutgers University Newark New Jersey USA
| | - Jocelyn R. Smith Lee
- Department of Human Development and Family Studies University of North Carolina‐Greensboro Greensboro North Carolina USA
| | - Mario S. Staller
- University of Applied Sciences for Police and Public Administration Gelsenkirchen North Rhine‐Westphalia Germany
| | - Barbara Krahé
- Department of Psychology University of Potsdam Potsdam Germany
| | - Eric F. Dubow
- Department of Psychology Bowling Green State University Bowling Green Ohio USA
| | - Dominic Parrott
- Department of Psychology Georgia State University Atlanta Georgia USA
| | - Kaylise Algrim
- Department of Psychology Rutgers University Newark New Jersey USA
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Loder RT, Young A, Atoa B. Firearm injuries associated with law enforcement activity. J Forensic Leg Med 2021; 83:102249. [PMID: 34461598 DOI: 10.1016/j.jflm.2021.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Law enforcement activity can involve firearms, and either a civilian or the law enforcement officer can be injured. It was the purpose of this study to characterize the injuries and demographics associated with law enforcement firearm activity across the entire US using a national data base. METHODS Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study data 1993-2015 was used. Law enforcement involvement and other demographic variables were ascertained. Statistical analyses were performed accounting for the weighted, stratified nature of the data. P < 0.05 was considered to be statistically significant. RESULTS There were an estimated 2,667,896 ED visits for injuries due to firearms; 1.7% (45,497) were associated with law enforcement. Those involved with law enforcement were older (33.2 vs 29.8 years), a handgun was more commonly involved (80.3 vs 71.5%), male (90.7 vs 86.8%), White (52.9 vs 37.2%), had more upper trunk injuries (25.2 vs 16.2%), fewer lower extremity (15.1% vs 25.9%) injuries, and more fatalities (10.0 vs. 6.2%). An argument, crime, fight and drug involvement were all greater in the law enforcement group. Within the law enforcement group, when the injured patient was the civilian and not the officer, the patient was more commonly Black, male, sustained more trunk injuries, fewer extremity injuries, and more frequently admitted to the hospital. The civilian group had fewer upper extremity (11.7% vs 29.7%), lower extremity (12.2% vs 23.7%) and lower trunk injuries (14.6% vs 8.0%), more upper trunk injuries (31.3% vs 7.8%, and similar proportion of head/neck injuries (31.5% vs 30.7%) compared to the officer group. More females were injured in the officer group (16.9% vs 7.5%). The fatality rate was 12.6% for the civilian group and 3.0% for the officer group. There were no differences by race in disposition from the ED (released, admitted, death) for those who sustained injuries by the officer. CONCLUSIONS Firearm injuries due to law enforcement activity occurred in 1.7% of all ED visits for injuries due to firearms. The law enforcement officer was the injured patient in 23% of the events. This study spanning nearly a quarter of a century of data for injuries due to firearm activity resulting in ED visits is baseline data for future studies, especially in the present setting of calls for police reform within the US. This will be important when analyzing the effect of new programs in law enforcement training and/or police reform.
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Affiliation(s)
- Randall T Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Allison Young
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bradley Atoa
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Arseniev-Koehler A, Foster JG, Mays VM, Chang KW, Cochran SD. Aggression, Escalation, and Other Latent Themes in Legal Intervention Deaths of Non-Hispanic Black and White Men: Results From the 2003‒2017 National Violent Death Reporting System. Am J Public Health 2021; 111:S107-S115. [PMID: 33984244 PMCID: PMC8319068 DOI: 10.2105/ajph.2021.306312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate racial/ethnic differences in legal intervention‒related deaths using state-of-the-art topic modeling of law enforcement and coroner text summaries drawn from the 2003-2017 US National Violent Death Reporting System (NVDRS). Methods. Employing advanced topic modeling, we identified 8 topics consistent with dangerousness in death incidents in the NVDRS death narratives written by public health workers (PHWs). Using logistic regression, we then evaluated racial/ethnic differences in PHW-coded variables and narrative topics among 4981 males killed by legal intervention, while adjusting for age, county-level characteristics, and year. Results. Black, as compared with White, decedents were younger and their deaths were less likely to include PHW-coded mental health or substance use histories, weapon use, or positive toxicology for alcohol or psychoactive drugs, but more likely to include "gangs-as-an-incident-precipitant" coding. Topic modeling revealed less frequent thematic representation of "physical aggression" or "escalation" but more of "gangs or criminal networks" among Black versus White decedents. Conclusions. While Black males were more likely to be victims of legal intervention deaths, PHW-coded variables in the NVDRS and death narratives suggest lower threat profiles among Black versus similar White decedents. The source of this greater risk remains undetermined.
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Affiliation(s)
- Alina Arseniev-Koehler
- Alina Arseniev-Koehler and Jacob Gates Foster are with the Department of Sociology, University of California Los Angeles (UCLA). Vickie M. Mays is with the Department of Psychology, UCLA, and the Department of Health Policy and Management, UCLA Fielding School of Public Health, and the BRITE Center, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and Department of Statistics, UCLA
| | - Jacob Gates Foster
- Alina Arseniev-Koehler and Jacob Gates Foster are with the Department of Sociology, University of California Los Angeles (UCLA). Vickie M. Mays is with the Department of Psychology, UCLA, and the Department of Health Policy and Management, UCLA Fielding School of Public Health, and the BRITE Center, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and Department of Statistics, UCLA
| | - Vickie M Mays
- Alina Arseniev-Koehler and Jacob Gates Foster are with the Department of Sociology, University of California Los Angeles (UCLA). Vickie M. Mays is with the Department of Psychology, UCLA, and the Department of Health Policy and Management, UCLA Fielding School of Public Health, and the BRITE Center, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and Department of Statistics, UCLA
| | - Kai-Wei Chang
- Alina Arseniev-Koehler and Jacob Gates Foster are with the Department of Sociology, University of California Los Angeles (UCLA). Vickie M. Mays is with the Department of Psychology, UCLA, and the Department of Health Policy and Management, UCLA Fielding School of Public Health, and the BRITE Center, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and Department of Statistics, UCLA
| | - Susan D Cochran
- Alina Arseniev-Koehler and Jacob Gates Foster are with the Department of Sociology, University of California Los Angeles (UCLA). Vickie M. Mays is with the Department of Psychology, UCLA, and the Department of Health Policy and Management, UCLA Fielding School of Public Health, and the BRITE Center, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and Department of Statistics, UCLA
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Loder RT, Leiser A. Injury patterns and demographics due to legal intervention seen in US emergency departments. J Forensic Leg Med 2021; 79:102150. [PMID: 33714163 DOI: 10.1016/j.jflm.2021.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Injury and deaths inflicted by law enforcement are a topic of significant discussion in the US. The purpose of this study was to analyze injuries due to law enforcement activity that presented to emergency departments (ED) across the entire US and correlate the injury patterns with patient demographics. METHODS The National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) data was used for the years 2005 through 2015. Injuries due to legal/law enforcement activity were identified. Statistical analyses were performed with SUDAAN 11.0.01™. A p < 0.05 was considered statistically significant. RESULTS There were 939,405 ED visits for non-fatal injuries due to law enforcement. The average age was 31.9 years; 84.6% were male. The mechanism of injury was being struck in 69.7%; firearm gunshot wounds accounted for only 1.2%. The most common location of injury was the head and neck (44.0%) followed by the upper extremity (20.2%). The vast majority of the patients (94.9%) were treated and released from the ED. The seven major diagnoses were contusion/abrasion (37.8%), strain/sprain (22.7%), laceration (12.9%), fracture (7.6%), puncture (8.2%), and foreign body (2.5%). The injuries with the highest percentage of hospital admissions were foreign bodies and fractures (11.4% and 11.3% respectively. Although the number of events occurring at schools or sporting venues was 2.0%, those seen at children's hospitals demonstrated a higher percentage at 15.6%. CONCLUSIONS This data set provides another viewpoint of injuries inflicted by police. It can be used as baseline data for further studies, especially in the US recent sociopolitical environment calling for police reform and improvements in the education and training of police officers.
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Affiliation(s)
- Randall T Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Abraham Leiser
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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