Community-level factors and incidence of gun violence in the United States, 2014-2017

Pediatric Homicides: Not Just a Teenage Problem

INTRODUCTION

Homicide is a leading cause of death for American children. We hypothesized demographics and homicide circumstances would differ by victim age.

METHODS

We performed a retrospective analysis of the 2003-2020 National Violent Death Reporting System. The National Violent Death Reporting System collects data from nearly all 50 states, the District of Columbia, and Puerto Rico. Demographics (age, sex, race, and ethnicity), homicide year, and weapon type were abstracted. Inclusion criteria were pediatric victims (age < 18). Two groups: 0-4 y old (young cohort [YC]) and 13-17 y old (teen cohort [TC]) were compared. Chi-squared tests, p-test, and t-tests with significance P < 0.05 were used to determine the association between victim demographics, cohort, and homicide mechanism.

RESULTS

10,569 pediatric (male: 70.2% [n = 7424], median age: 12 y old [interquartile range 1-16], black: 52.7% [n = 5573]) homicides met inclusion. Homicides demonstrated a bimodal age distribution (YC: 40.9% [n = 4320] versus TC: 48.9% [n = 5164]). Gender and race were both associated with homicide victimhood (P < 0.001). TC homicides were more likely to be male (YC: 57.8% [n = 2496] versus TC: 83.7% [n = 4320], P < 0.001) and black (YC: 40.1% [n = 1730] versus TC: 65.0% [n = 3357], P < 0.001). Pediatric homicides increased from 2018 (n = 1049) to 2020 (n = 1597), with only TC demonstrating a significant increase (2018: n = 522 versus 2020: n = 971, P < 0.001). Homicide mechanism was significantly associated with age (Blunt: YC: 57.5% [n = 2484] versus TC: 2.9% [n = 148], P < 0.001; Penetrating: YC: 7.9% [n = 340] versus TC: 92.8% [n = 4794], P < 0.001).

CONCLUSIONS

Pediatric homicides demonstrate distinct demographic characteristics and homicide mechanisms between two at risk age cohorts. Age-based education and intervention strategies may increase injury prevention programs' efficacy.

Exploring the Role of Fear, Civic Disengagement, and Economic Disenfranchisement Within Communities that Experience Gun Violence

A growing body of research has documented how gun violence can affect mental and physical health outcomes among adults. Likewise, the literature is also beginning to reveal negative psychological effects related to distress and hypervigilance and sociological implications around diminished community engagement and economic opportunity. However, there remains a need to fully explore the role of fear related to the experience of gun violence. Through a qualitative inquiry consisting of community resident focus groups and community leader interviews, this study examined how participants' perceptions of fear related to their exposures to and experiences of gun violence. The findings highlight the pervasive emotional experience of existing in a fearful, distressed, and/or anxious state within certain communities, and how civic disengagement, neighborhood disconnection, and economic disenfranchisement exist in communities that disproportionately experience violence.

Detect, Dispatch, Drive: A Study of ShotSpotter Acoustic Technology and Transport of Gunshot Victims

INTRODUCTION

Our previous work demonstrated that use of ShotSpotter (SS), a gunfire detection system, and use of police department (PD) transport decreased response and transport time for gunshot wound (GSW) victims versus events with non-ShotSpotter (NSS). The purpose of this study was to evaluate transport trends and how they are linked to SS in the period of 2016-2021 in Camden, NJ.

METHODS

This was a single-center, retrospective observational study. Demographics, response time, transport time, and clinical data were collected. Independent t-test, Mann-Whitney U test, chi-squared test, and linear regression to correct for transport time and method of transport were used to compare outcomes (P < 0.05).

RESULTS

A total of 267 GSWs were included: 77 emergency medical technicians (EMS)-SS, 41 EMS-NSS, 116 PD-SS, and 33 PD-NSS. When comparing response from 2016 to 2021, PD improved from 4 to 2 min (P = 0.001). EMS improved from 6.4 min (EMS-NSS) and 4.5 min (EMS-SS) to 5 min (EMS- NSS) and 4 min (EMS-SS) (P = 0.281). In addition, PD transport times, 5 min (SS) and 4 min (NSS), were faster than EMS, 9 min (SS and NSS) (P < 0.001). Overall PD transport volume increased with a peak in 2020 (68.3%). There was also an increase in PD-NSS transport 4% to 37.9% (P < 0.001). EMS-SS transport decreased from 54.7% to 6.9% (P < 0.001).

CONCLUSION

The presence of SS technology in a small urban setting continues to be associated with a higher rate of PD transport of GSW victims. The critical time of dispatch and transport for both PD and EMS has shown durable improvement.

Neighborhood disorder as a predictor of perceptions of firearm access: Examining peers effects

OBJECTIVE

This study sought to examine the relationship between neighborhood disorder and perceptions of gun access. Further, this study focused on determining whether or not antisocial peer affiliation mediates this relationship.

METHODS

The Pathways to Desistance data were analyzed. This is an 11-wave longitudinal study following 1,354 justice-involved youth across seven years post-adjudication. Generalized structural equation modeling was used to assess direct and indirect relationships of interest.

RESULTS

Greater levels of neighborhood disorder were associated with increased perceptions of access to guns in the community. Affiliation with antisocial peers significantly mediated this relationship, accounting for about 15 % of this relationship.

CONCLUSIONS

Affiliation with antisocial peers may be greater in disordered neighborhoods and they may facilitate access to guns for adolescents living in such communities. Mentoring programs for adolescents living in disordered communities may have some capacity for attenuating this relationship.

Firearm-Related Juvenile Death Rates Correlate With Gun Ownership Rates, Measures of Guns in Circulation, and Leniency of Existing Firearm Laws Among U.S. States

INTRODUCTION

Firearms now represent the leading cause of death in U.S. children. Therefore, this study aimed to determine if state-level rates of gun ownership, guns in circulation, and strictness of firearm-related laws are related to firearm-related mortality among both juveniles and overall populations.

MATERIALS AND METHODS

State firearm mortality rates among the juvenile and overall populations were obtained from 2010 to 2020. The number of weapons registered with the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF) and federal firearms licensees for each state were also recorded. Giffords Law Center Scorecard Rankings, a relative measure of the restrictiveness of each state's gun laws, were also collected. Unadjusted linear regressions modeled the relationships between firearm-associated mortality and ATF-registered weapons, federal firearm licensees, Giffords Center rankings, and gun ownership rates. Multivariable (adjusted) analyses were performed to control for poverty, unemployment, and poor mental health.

RESULTS

Unadjusted analyses demonstrated that higher gun ownership rates and more lenient gun laws were associated with increased firearm-associated mortality among juveniles. Similarly, these measures as well as increased ATF-registered weapons and ATF federal firearm licensees were associated with increased firearm mortality in the overall population. In the adjusted analyses, more ATF-registered weapons, more ATF federal firearm licensees, higher gun ownership rates, and more lenient firearm laws were associated with increased firearm-related mortality in the overall population, while increased gun ownership and higher Giffords Center rankings were associated with increased firearm-associated mortality in the pediatric population.

CONCLUSIONS

To reduce the toll of gun violence in the United States, policymakers should focus on implementing more restrictive firearm laws and reducing the prevalence of guns in their communities.

Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle-Related Injuries

Importance

Motor vehicle crash (MVC) and firearm injuries are 2 of the top 3 mechanisms of adult injury-related deaths in the US.

Objective

To understand the differing associations between community-level disadvantage and firearm vs MVC injuries to inform mechanism-specific prevention strategies and appropriate postdischarge resource allocation.

Design, Setting, and Participants

This multicenter cross-sectional study analyzed prospectively collected data from the American College of Surgeons (ACS) Firearm Study. Included patients were treated either for firearm injury between March 1, 2021, and February 28, 2022, or for MVC-related injuries between January 1 and December 31, 2021, at 1 of 128 participating ACS trauma centers.

Exposures

Community distress.

Main outcome and Measure

Odds of presenting with a firearm as compared with MVC injury based on levels of community distress, as measured by the Distressed Communities Index (DCI) and categorized in quintiles.

Results

A total of 62 981 patients were included (mean [SD] age, 42.9 [17.7] years; 42 388 male [67.3%]; 17 737 Black [28.2%], 9052 Hispanic [14.4%], 36 425 White [57.8%]) from 104 trauma centers. By type, there were 53 474 patients treated for MVC injuries and 9507 treated for firearm injuries. Patients with firearm injuries were younger (median [IQR] age, 31.0 [24.0-40.0] years vs 41.0 [29.0-58.0] years); more likely to be male (7892 of 9507 [83.0%] vs 34 496 of 53 474 [64.5%]), identified as Black (5486 of 9507 [57.7%] vs 12 251 of 53 474 [22.9%]), and Medicaid insured or uninsured (6819 of 9507 [71.7%] vs 21 310 of 53 474 [39.9%]); and had a higher DCI score (median [IQR] score, 74.0 [53.2-94.8] vs 58.0 [33.0-83.0]) than MVC injured patients. Among admitted patients, the odds of presenting with a firearm injury compared with MVC injury were 1.50 (95% CI, 1.35-1.66) times higher for patients living in the most distressed vs least distressed ZIP codes. After controlling for age, sex, race, ethnicity, and payer type, the DCI components associated with the highest adjusted odds of presenting with a firearm injury were a high housing vacancy rate (OR, 1.11; 95% CI, 1.04-1.19) and high poverty rate (OR, 1.17; 95% CI, 1.10-1.24). Among patients sustaining firearm injuries patients, 4333 (54.3%) received no referrals for postdischarge rehabilitation, home health, or psychosocial services.

Conclusions and Relevance

In this cross-sectional study of adults with firearm- and motor vehicle-related injuries, we found that patients from highly distressed communities had higher odds of presenting to a trauma center with a firearm injury as opposed to an MVC injury. With two-thirds of firearm injury survivors treated at trauma centers being discharged without psychosocial services, community-level measures of disadvantage may be useful for allocating postdischarge care resources to patients with the greatest need.

Society for Maternal-Fetal Medicine Position Statement: Gun violence and pregnancy

Position: The Society for Maternal-Fetal Medicine acknowledges gun violence as a public health crisis in the United States, with a substantial impact on pregnant and postpartum people. We recognize the urgent need for a robust, equitable, data-driven approach to mitigate the impact of access to firearms and accompanying violence on pregnant and postpartum individuals and communities. As such, the Society for Maternal-Fetal Medicine endorses the following policy principles.

Local gun violence, mental health, and sleep: A neighborhood analysis in one hundred US Cities

RATIONALE

Community gun violence significantly shapes public health and collective well-being. Understanding how gun violence is associated with community health outcomes like mental health and sleep is crucial for developing interventions to mitigate disparities exacerbated by violence exposure.

OBJECTIVE

This study examines the associations between community gun violence , insufficient sleep, and poor mental health across neighborhoods in the United States.

METHODS

We utilized a novel database covering nearly 16,000 neighborhoods in 100 US cities from 2014 through 2019. Correlated trait fixed-effects models were employed to conduct all analyses while considering various neighborhood covariates such as concentrated disadvantage, demographic composition, population density, and proximity to trauma centers.

RESULTS

Our analysis revealed that greater gun violence is associated with both insufficient sleep and poor mental health in subsequent years. There is a reciprocal relationship between poor mental health and insufficient sleep, with each partially mediating the other's association with community gun violence. Notably, gun violence exhibits the strongest direct association with poor sleep rather than with poor mental health. We found a consistent reciprocal relationship between sleep and mental health at the community level.

CONCLUSIONS

The findings highlight a complex interplay between community violence, sleep, and mental health, underlining the importance of reducing community violence through numerous long-term interventions to address health disparities across the US.

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

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

Distress about social problems and tobacco and cannabis use outcomes among young adults in Los Angeles County

OBJECTIVE

To examine associations of concern, worry, and stress about discrimination, shootings/violence, and police brutality and exclusive and dual tobacco and cannabis use among young adults.

METHODS

A prospective, racially/ethnically diverse cohort of young adults (n = 1960) living in Los Angeles, California completed a baseline survey in 2020 (age range: 19-23) and a follow-up survey in 2021. Exploratory factor analysis (EFA) was employed on nine variables assessing levels of concern, worry, and stress about societal discrimination, societal shootings/violence, and community police brutality at baseline. Past 30-day tobacco and cannabis use at follow-up was categorized as current exclusive tobacco, exclusive cannabis, and dual tobacco and cannabis (vs never/former) use based on eleven use variables. Multinomial logistic regressions estimated adjusted associations between each factor score (translated to standard deviation units) with exclusive and dual tobacco and cannabis use.

RESULTS

The EFA produced four factor scores representing concern/worry/stress (i.e., distress) about community police brutality (F1), distress about societal shootings/violence (F2), and distress about societal discrimination (F3), as well as generalized stress about police brutality, shootings/violence, and discrimination (F4). F1, F2, and F3 were associated with subsequent exclusive current cannabis use, with F1 having the strongest association (OR: 1.35, 95% CI: 1.18-1.55), while only F1 (OR: 1.51, 95% CI: 1.27-1.78) was associated with dual tobacco and cannabis use. None of the factors were associated with exclusive tobacco use.

CONCLUSIONS

Young adult concern, worry, and/or stress about social problems may increase risk of cannabis use with or without concurrent tobacco use 6-12 months later.

Modification of Firearm Law-Firearm Injury Association by Economic Disadvantage

INTRODUCTION

Firearm-related injuries in the U.S. have risen 37% since 2015. Understanding how the association between firearm incidents and state-level firearm restrictiveness is modified by community-level distress and economic connectedness (EC) may inform upstream injury prevention efforts.

METHODS

A national cross-sectional study of firearm incidents (interpersonal and unintentional firearm events) occurring between 1/2015 and 12/2021 was performed using the Gun Violence Archive. The exposures were community distress (Distressed Communities Index, DCI), EC, and year-state-level firearm restrictiveness. The primary outcome was mean annual urban firearm incidence rate per ZIP Code Tabulation Area. Generalized linear mixed models were fit to evaluate the modification of the firearm law-firearm incident association by DCI and EC. Data analyses took place in 2022.

RESULTS

About 266,020 firearm incidents were included. The mean rate was higher with each DCI tertile, with a RR of 3.18 (95% CI: 3.06, 3.30) in high versus low distress communities. Low EC was associated with over 1.8 times greater rate of firearm-related injury. The least restrictive firearm laws were associated with 1.20 times higher risk of firearm incidents (95% CI: 1.12, 1.28). The association between restrictive laws and lower incidence rates was strongest in low and medium distress and high EC communities.

CONCLUSIONS

Stricter firearm laws are associated with lower rate of firearm incidents. The magnitude of this association is smallest for communities experiencing the greatest economic disadvantage.

Characterizing Gun Violence by Time, Day of the Week, Holidays, and Month in 6 US Cities, 2015-2021

Developing interventions to prevent firearm-related violence and to address its consequences requires an improved understanding of when these violent events are most likely to occur. We explored gunshot events in 6 of the most populated cities in the United States by time of day, day of week, holiday/non-holiday, and month using publicly available datasets. In some of these cities, gunshot events occurred most often at nighttime, on holidays and weekends, and during summer months, with significant interaction effects. There were also time-related changes in characteristics of the victims. Primary prevention efforts aimed at curbing firearm-related violence should consider these differential risks.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Reciprocal Neighborhood Dynamics in Gun Violence Exposure, Community Health, and Concentrated Disadvantage in One Hundred US Cities

Gun violence imparts a tremendous human and financial toll on local communities. Researchers have documented extensive mental and physical health consequences of generalized violence exposure but few studies have analyzed the particular impacts of gun violence on community well-being using nationally comprehensive data. We leverage a unique database of almost 16,000 neighborhoods in 100 US cities (2014-2019) to examine how year-over-year rates of gun violence correspond to overall neighborhood well-being and three aspects of community health: (1) health behaviors, (2) physical and mental health status, and (3) health prevention efforts. We simultaneously consider the reciprocal influence of neighborhood well-being on subsequent gun violence while accounting for concentrated disadvantage in communities. The results demonstrate that gun violence is associated with poorer community health in subsequent years, particularly health behaviors and mental/physical health status. Furthermore, we find substantial reciprocal effects for both gun violence and community health in their relationship to neighborhood concentrated disadvantage. These findings highlight the consequential role of gun violence in perpetuating cycles of harm in local communities.

Assessing the Gun Violence Archive as an Epidemiologic Data Source for Community Firearm Violence in 4 US Cities

Importance

Firearm injury is a major public health burden in the US, and yet there is no single, validated national data source to study community firearm violence, including firearm homicide and nonfatal shootings that result from interpersonal violence.

Objective

To assess the validity of the Gun Violence Archive as a source of data on events of community firearm violence and to examine the characteristics of individuals injured in shootings.

Design, Setting, and Participants

This cross-sectional observational study compared data on community firearm violence from the Gun Violence Archive with publicly available police department data, which were assumed to be the reference standard, between January 1, 2015, and December 31, 2020. Cities included in the study (Philadelphia, Pennsylvania; New York, New York; Chicago, Illinois; and Cincinnati, Ohio) had a population of greater than 300 000 people according to the 2020 US Census and had publicly available shooting data from the city police department. A large city was defined as having a population greater than or equal to 500 000 (ie, Philadelphia, New York City, and Chicago). Data analysis was performed in December 2022.

Main Outcomes and Measures

Events of community firearm violence from the Gun Violence Archive were matched to police department shootings by date and location. The sensitivity and positive predictive value of the data were calculated (0.9-1.0, excellent; 0.8-0.9, good; 0.7-0.8, fair; 0.6-0.7, poor; and <0.6, failed).

Results

A total of 26 679 and 32 588 shooting events were documented in the Gun Violence Archive and the police department databases, respectively, during the study period. The overall sensitivity of the Gun Violence Archive over the 6-year period was 81.1%, and the positive predictive value was 99.0%. The sensitivity steadily improved over time. Shootings involving multiple individuals and those involving women and children were less likely to be missing from the Gun Violence Archive, suggesting a systematic missingness.

Conclusions and Relevance

These findings support the use of the Gun Violence Archive in large cities for research requiring its unique advantages (ie, spatial resolution, timeliness, and geographic coverage), albeit with caution regarding a more granular examination of epidemiology given its apparent bias toward shootings involving multiple persons and those involving women and children.

Individual- and Peer-Level Risk and Protective Factors for Gun Carriage Among Adolescents Living in Low-Income Urban Communities

Carrying a handgun is an established risk factor for firearm violence, with detrimental and too often irreversible consequences for adolescents including injury and mortality. Although researchers identified a number of risk factors for adolescent handgun carriage, little is known regarding the role of strengths or developmental assets in buffering against risk. The goal of this study was to identify both risk and protective factors for handgun carriage among a predominantly African American (88%) community-based sample of adolescents (Mage = 14.3) who resided in urban communities with high rates of poverty and exposure to violence. Consistent with prior work, we found that adolescents with access to a handgun or with friends who had carried a handgun had higher odds of carrying a handgun themselves in the past 3 months. Handgun access, friends' handgun carriage, and beliefs supporting reactive aggression were identified as risk factors for handgun carriage. Although personal and social assets and positive outlook moderated these relations, the direction was contrary to our hypotheses. We believe that these findings are in part due to structural inequities and social norms impacting adolescents in urban communities characterized by concentrated poverty and high rates of violence. Our findings highlight the value of moving beyond a deficit-oriented framework to gain a more nuanced understanding of the dynamics among both positive and negative factors that alter risk for handgun carriage among African American youth living in low-income urban areas.

Interpersonal Firearm Injury and Death in Portland, Oregon: 2018 Through 2021

The annual number of firearm injuries in Portland, Oregon has been higher in the years since 2020 than in any prior year in the city's history. This descriptive study analyzed data from Gun Violence Archives (GVA) from January 1, 2018, to December 31, 2021. All incidents in GVA of interpersonal firearm injury that occurred in Portland during this period were analyzed for location, number of people injured or killed, and demographic information for those injured or killed. Comparisons in firearm injury rates were made with Seattle and San Francisco. Interpersonal firearm injuries began to rise after the first COVID-19 case in Oregon; July 2020 had the most injuries in the four-year period. Black men suffered the highest rate of interpersonal fatalities, with more than 11-fold higher rate per 100,000 than White men in every year studied. Portland had a higher rate of total interpersonal firearm injuries and a higher rate of firearm fatalities from 2018 through 2021 compared to Seattle and San Francisco. Neighborhoods near Downtown and those on the Eastside of the city had the highest rates of interpersonal injuries and deaths from firearms, whereas those in the Southwest had the lowest. Defining the burden of disease from interpersonal firearm injuries is a fundamental step in designing future public health research and implementing interventions to curb the trauma brought by interpersonal firearm injury.

Mental Health Care Utilization Among Children and Adolescents With a Firearm Injury

Importance

Firearm injuries are a leading cause of morbidity and mortality among US children and adolescents. Despite evidence demonstrating mental health sequelae for children and adolescents who have experienced a firearm injury, little is known about mental health care utilization after a firearm injury.

Objective

To evaluate mental health care utilization in the 12 months after a firearm injury among Medicaid-insured and commercially insured children and adolescents compared with propensity score-matched controls.

Design, Setting, and Participants

This propensity score-matched retrospective cohort analysis assessed 2127 children and adolescents, aged 0 to 17 years, with a firearm injury that occurred between January 1, 2016, and December 31, 2017, compared with 2127 matched controls using MarketScan Medicaid and commercial claims data. Claims data were analyzed 12 months before and after injury, with the total study period spanning from January 1, 2015, to December 31, 2018.

Exposure

Nonfatal firearm injury.

Main Outcomes and Measures

The primary outcome of interest was a dichotomous variable representing any mental health care utilization in the 12 months after injury. Secondary outcomes included psychotherapy utilization, substance use-related utilization, and a psychotropic medication prescription. Logistic regression modeling was used to estimate relative risks with adjusted analyses of dichotomous outcomes.

Results

The overall cohort consisted of 4254 children and adolescents, of whom 2127 (mean [SD] age, 13.5 [4.1] years; 1722 [81.0%] male) had an initial encounter for a firearm injury and an equal number of matched controls (mean [SD] age, 13.5 [4.1] years; 1720 [80.9%] male). Children and adolescents with a firearm injury had a 1.40 times greater risk (95% CI, 1.25-1.56; P < .001) of utilizing mental health services in the 12 months after their injury compared with children and adolescents without a firearm injury, after controlling for potential confounders. Children and adolescents with a firearm injury had a 1.23 times greater risk (95% CI, 1.06-1.43; P = .007) of utilizing psychotherapy and a 1.40 times greater risk (95% CI, 1.19-1.64; P < .001) of substance use-related utilization. Among those who experienced a firearm injury, Black children and adolescents were 1.64 times more likely (95% CI, 1.23-2.19; P < .001) to utilize mental health care compared with White children and adolescents.

Conclusions and Relevance

This propensity score-matched cohort study found that children and adolescents with a firearm injury had a greater risk of utilizing mental health services in the 12 months after their injury compared with those without an injury, and significant racial disparities were associated with use of mental health services. The findings suggest that health care practitioners should be aware of this increased risk and ensure adequate mental health follow-up for these patients.

Racial Disparities in Child Exposure to Firearm Violence Before and During COVID-19

INTRODUCTION

Childhood exposure to neighborhood firearm violence adversely affects mental and physical health across the life course. Study objectives were to (1) quantify racial disparities in these exposures across the U.S. and (2) assess changes during the COVID-19 pandemic, when firearm violence increased.

METHODS

The study used counts of children aged 5-17 years, disaggregated by U.S. Census racial category, for every census tract (N=73,056). Neighborhood firearm violence was the number of fatal shootings per census tract, based on 2015-2021 Gun Violence Archive data. Quasi-Poisson regressions were used to estimate baseline disparities and COVID-19‒related changes and examined differences across geographic regions.

RESULTS

Prepandemic exposure was lowest among White children and highest among Black children, who experienced 4.44 times more neighborhood firearm violence exposure (95% CI=4.33, 4.56, p<0.001) than White children. The pandemic increased exposure by 27% in the lowest risk group (i.e., White children; 95% CI=20%, 34%, p<0.001), but pandemic effects were even greater for children in nearly all non-White categories. Baseline violence levels and racial disparities varied considerably by region, with the highest levels in the South and the largest magnitude disparities observed in the Northeast and Midwest.

CONCLUSIONS

Large-scale racial disparities exist in child exposure to neighborhood firearm violence, and these disparities grew during the pandemic. Equitable access to trauma-informed programs, community-based prevention, and structural reforms are urgently needed.

Defensive gun use: What can we learn from news reports?

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).

The association between food insecurity and gun violence in a major metropolitan city

BACKGROUND

Food insecurity (FI) is an important social determinant of health that is associated with many forms of violence. We hypothesized that FI would be associated with gun violence.

METHODS

Firearm injury data was collected from 2016 to 2020 (n = 3115) at a single institution that serves as the only Level I trauma center in a major southern US city. The data were linked with Map the Meal Gap data, a publicly available data set, which estimates rates of county-level FI based on state-level FI and social determinants, including unemployment, poverty, disability, and other factors. Regression analysis was utilized to examine the relationship between FI with rates of overall gun trauma and odds of gun-related violence. Food insecurity by county of patient residence was categorized by rates less than the national average of 11.5% (low), between the national and state average (16.5%) (moderate), and greater than the state average (high). Out of state residents were excluded from the analyses.

RESULTS

Of the 3,115 patients with firearm injuries identified, 138 (4.4%) resided in counties with low FI rates, 1048 (33.6%) in moderate FI, and 1929 (62.0%) in counties with high FI. Patients in regions of high FI were more likely to be a Level I trauma activation, a victim of assault, and have Medicaid or be self-pay. There was no significant difference in mortality by levels of FI. Food insecurity was significantly associated with firearm injury, with each percent increase in FI being related to approximately 56 additional gun-related injuries per 100,000 people (95% confidence interval, 54-59) and increased odds of the injury classified as assault (odds ratio, 1.13; 95% confidence interval, 1.07-1.19).

CONCLUSION

Violence prevention initiatives targeting food insecure communities may help alleviate the US gun violence epidemic. Further, trauma center screening for household FI and in-hospital interventions addressing FI may help reduce gun violence recidivism.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level IV.

Prevalence of Adolescent Handgun Carriage: 2002-2019

OBJECTIVES

This study explores the changing prevalence of adolescent handgun carriage, with attention to differences across sociodemographic groups.

METHODS

Data were drawn from repeated cross-sectional, nationally representative surveys conducted annually from 2002 to 2019, the National Survey on Drug Use & Health. The study sample included adolescents aged 12 to 17 (N = 297 055). Logistic regression models estimated the prevalence of past year handgun carriage across cohort and sociodemographic subgroups. Interactions between 4-time cohorts and other variables explored sociodemographic variability in prevalence rates over time.

RESULTS

Handgun carriage increased significantly, particularly among rural, White, and higher-income adolescents. Carriage increased by 41% over cohorts, with predicted prevalence rates increasing from 3.3% in 2002-2006 to 4.6% in 2015-2019. Across cohorts, rural (5.1%), American Indian/Alaskan Native (5.2%), lower-income (<$20 000; 3.9%), male (5.9%), and older (16-17 years old; 4.5%) adolescents were the most likely to report carriage. However, these patterns changed significantly over time, with White and higher-income adolescents (>$75 000) most likely to carry in the most recent cohorts. Predicted carriage rates increased from 3.1% to 5.3% among White adolescents, from 2.6% to 5.1% among higher-income adolescents, and from 4.3% to 6.9% among rural adolescents between the 2002-2006 and 2015-2019 cohorts. Carriage among Black, American Indian/Alaskan Native, and lower-income adolescents decreased.

CONCLUSIONS

Adolescent handgun carriage is increasing, concentrated among particular subgroups of youth, and carriage patterns across sociodemographic groups have changed over time. Programs to address the risk of adolescent gun carriage should be tailored to the specific sociocultural and place-based concerns of diverse adolescents.