Income support policies and firearm violence prevention: A scoping review

Does state-level supplemental nutrition assistance program access reduce firearm mortality among black youth? A two-way fixed effects analysis of age-stratified and cause-specific outcomes across 22 states, 2000-2020

BACKGROUND

Firearm-related injuries represent a growing public health crisis disproportionately affecting Black youth in the United States. While research has established strong associations between poverty and community violence, the potential for poverty-alleviation policies to reduce firearm mortality remains understudied. This study examines the relationship between state-level Supplemental Nutrition Assistance Program (SNAP) access for Black individuals and firearm mortality rates among Black youth aged 10-34, analyzing variations by cause of death and age group.

METHODS

Using a two-way fixed effects design, we analyzed state-level data from 2000 to 2022, examining how SNAP access affected firearm mortality rates. SNAP access was calculated as the ratio of Black SNAP households to eligible Black households below 125% of the federal poverty line. Outcomes included firearm-related deaths (homicide, suicide, accidental, undetermined) among Black youth aged 10-34, identified through National Vital Statistics System data. We used generalized linear models with Poisson distribution, adjusting for state and year-fixed effects, demographic characteristics, and policy covariates.

RESULTS

SNAP access for Black individuals showed the strongest protective association with firearm homicides among youth aged 10-18 (adjusted RR = 0.93; 95% CI: 0.89-0.97). Increased SNAP access among this age group was also associated with significant reductions in total firearm mortality adjusted for state and year fixed effects (RR = 0.93; 95% CI: 0.88-0.98), and further adjustment resulted in similar estimates. Firearm suicide estimates suggest a potential protective association, particularly for youth aged 19-25 (adjusted RR = 0.90; 95% CI: 0.85-0.96). No associations were found with accidental firearm deaths across age groups.

CONCLUSION

State-level SNAP access for Black individuals demonstrates protective associations with firearm mortality among Black youth, particularly for homicides affecting adolescents aged 10-18 years and suicides for young adults aged 19-25. These findings suggest that expanding receipt of SNAP benefits among families living near or below the federal poverty line could serve as an upstream intervention for reducing firearm violence, especially during critical developmental periods. Future research examining mechanisms linking economic support to violence prevention is warranted to explore integration with other protective interventions.

A Qualitative Scoping Review of Community Firearm Violence in Low-Income Settings

Firearm violence is a public health crisis in the United States that disproportionately impacts community members in low-income areas who witness and experience violence and violent victimization at elevated rates compared to other socioeconomic groups, often as result of community disinvestment and systemic racism (Smith et al., Soc Sci Med 246:112587, 2020). While quantitative reviews of firearm violence and related factors exist, a review of qualitative methods and findings regarding exposure to firearm violence has not yet been conducted. This scoping review sought to address a gap in the literature by summarizing the findings of qualitative studies on community firearm violence in low-income settings in the U.S. EBSCO databases, Criminal Justice Abstracts, National Criminal Justice Reference Service Abstracts, ProQuest, and PsycINFO were searched for studies that described the firearm related experiences of individuals and families in low-income communities. Thirty studies met the criteria for review. Findings were situated within the Centers for Disease Control and Prevention's (CDC) Social-Ecological Model as a framework for prevention (CDC, The social-ecological model: a framework for prevention, https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html , 2018; Dahlberg and Krug, World Report on violence and health, World Health Organization, Geneva, 2002). A critique of the literature, as well as implications and future directions of findings, are discussed. This study may inform future research questions and programs that center the voices of those most impacted by firearm violence.

Gun violence exposure and population health inequality: a conceptual framework

This essay establishes a conceptual framework to understand how direct, secondar and community exposures to gun violence converge to influence population health. Our framework asserts that persistent gun violence in structurally disadvantaged communities enacts broad consequences for mental, physical and behavioural health, operating as a key driver of racial and socioeconomic health disparities. We discuss the applications of this framework for research and improved data collection with a focus on establishing timely and accurate measures of gun violence alongside individual and community health measures. We then address the policy implications of the framework, emphasising the need for long-term, institutional investment in gun violence prevention and intervention, survivor service provision and evidence-based policies at all levels of government.

State expansion of Supplemental Nutrition Assistance Program eligibility and rates of firearm-involved deaths in the United States

INTRODUCTION

Poverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination of the asset test and increases in the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility with rates of firearm-involved suicide and homicide deaths in the United States.

METHODS

This ecological repeated cross-sectional study used 2015-2019 data from the SNAP Policy Database and death certificate data from the National Vital Statistics System. The exposures were (1) state elimination of the asset test for SNAP eligibility and (2) state elimination of the asset test and increases in the income limit for SNAP eligibility, compared with (3) state adoption of neither policy. The outcomes were firearm-involved suicide deaths and firearm-involved homicide deaths. The research team conducted mixed-effects regressions to estimate associations.

RESULTS

State elimination of the asset test for SNAP eligibility (incidence rate ratio (IRR), 0.67; 95% CI, 0.48 to 0.91) and state adoption of both eliminating the asset test and increasing the income limit for SNAP eligibility (IRR, 0.68; 95% CI, 0.49 to 0.92) were associated with decreased rates of firearm-involved suicide deaths compared with state adoption of neither policy. There were no associations with state firearm-involved homicide rates.

CONCLUSIONS

SNAP is an important social safety net programme that addresses food insecurity, and the present results suggest it may also contribute to reducing firearm-involved suicide.

Using EMS data to explore community-level factors associated with firearm violence in North Carolina

BACKGROUND

Firearm violence is a significant public health issue. However, it is unclear if there is an association between the Social Vulnerability Index (SVI) and the intent of both fatal and nonfatal firearm injuries, and if these associations are modified by community race and ethnic composition. This study examines the association between community-level social vulnerability and firearm injury incidence in North Carolina (NC) using 2021-2022 emergency medical services (EMS) data. Additionally, it investigates how these associations vary by the intent of injury (assault, self-inflicted, and unintentional), and whether they are modified by community racial/ethnic composition.

METHODS

This cross-sectional study utilized NC EMS data, capturing firearm incidents from January 1, 2021, to December 31, 2022. The SVI from the Centers for Disease Control and Prevention (CDC) was used to assess community-level vulnerability. The SVI's racial/ethnic minority status component was removed for stratification analysis. Firearm injury rates were calculated per 100,000 population, and negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) for different SVI levels and intents of firearm injuries.

RESULTS

During the study period, we identified 7,250 EMS encounters at non-healthcare locations related to firearm injuries, encompassing 2,648 NC census tracts. Assault was the leading cause of firearm injuries (n = 3,799), followed by self-inflicted (n = 1,498), and unintentional injuries (n = 722). High-SVI communities had significantly higher rates of firearm injuries compared to low-SVI communities, particularly for assault-related injuries. When the minority status component was excluded from SVI, racial/ethnic minority status emerged as a significant modifier, with higher rates of firearm injuries being observed in communities with larger racial/ethnic minority populations.

CONCLUSION

Community-level social vulnerability is significantly associated with firearm injury incidence, with the effect being more pronounced in racial/ethnic minority communities. These findings underscore the need for targeted public health interventions that address underlying social determinants of health (e.g., access to education) to reduce firearm violence. Future research should further explore the intersection of social vulnerability and racial/ethnic composition to develop effective prevention strategies.

Association of pediatric firearm injury with neighborhood social deprivation in Philadelphia

Background

Firearm-related injury is the leading cause of death among children and adolescents. There is a need to clarify the association of neighborhood environment with gun violence affecting children. We evaluated the relative contribution of specific social determinants to observed rates of firearm-related injury in children of different ages.

Methods

This was a population-based study of firearm injury in children (age <18 years) that occurred in Philadelphia census tracts (2015-2021). The exposure was neighborhood Social Deprivation Index (SDI) quintile. The outcome was the rate of pediatric firearm injury due to interpersonal violence stratified by age, sex, race, and year. Hierarchical negative binomial regression measured the risk-adjusted association between SDI quintile and pediatric firearm injury rate. The relative contribution of specific components of the SDI to neighborhood risk of pediatric firearm injury was estimated. Effect modification and the role of specific social determinants were evaluated in younger (<15 years old) versus older children.

Results

927 children were injured due to gun violence during the study period. Firearm-injured children were predominantly male (87%), of black race (89%), with a median age of 16 (IQR 15-17). Nearly one-half of all pediatric shootings (47%) occurred in the quintile of highest SDI (Q5). Younger children represented a larger proportion of children shot in neighborhoods within the highest (Q5), compared with the lowest (Q1), SDI quintile (25% vs 5%; p<0.007). After risk adjustment, pediatric firearm-related injury was strongly associated with increasing SDI (Q5 vs Q1; aRR 14; 95% CI 6 to 32). Specific measures of social deprivation (poverty, incomplete schooling, single-parent homes, and rented housing) were associated with significantly greater increases in firearm injury risk for younger, compared with older, children. Component measures of the SDI explained 58% of observed differences between neighborhoods.

Conclusions

Neighborhood measures of social deprivation are strongly associated with firearm-related injury in children. Younger children appear to be disproportionately affected by specific adverse social determinants compared with older children. Root cause evaluation is required to clarify the interaction with other factors such as the availability of firearms and interpersonal conflict that place children at risk in neighborhoods where gun violence is common.

Level of evidence

Level III - Observational Study.

Spatial co-occurrence of firearm homicides and opioid overdose deaths in Chicago by level of COVID-19 mortality, 2017-2021

BACKGROUND

Firearm homicide and opioid overdoses were already leading causes of death in the U.S. before both problems surged during the COVID-19 pandemic. Firearm violence, overdoses, and COVID-19 have all disproportionately harmed communities that are socially and economically marginalized, but the co-occurrence of these problems in the same communities has received little attention. To describe the co-occurrence of firearm homicides and opioid overdose deaths with COVID-19 mortality we used 2017-2021 medical examiner's data from Chicago, IL. Deaths were assigned to zip codes based on decedents' residence. We stratified zip codes into quartiles by COVID-19 mortality rate, then compared firearm homicide and fatal opioid overdose rates by COVID-19 quartile.

FINDINGS

Throughout the study period, firearm homicide and opioid overdose rates were highest in the highest COVID-19 mortality quartile and lowest in the lowest COVID-19 mortality quartile. Increases in firearm homicide and opioid overdose were observed across all COVID-19 mortality quartiles.

CONCLUSIONS

High co-occurrence of these deaths at the community level call for addressing the systemic forces which made them most vulnerable before the pandemic. Such strategies should consider the environments where people reside, not only where fatal injuries occur.

Trends in Suicides and Homicides in 21st Century America

BACKGROUND

Violent deaths, including suicides and homicides, pose a significant public health challenge in the United States. Understanding the trends and identifying associated risk factors is crucial for targeted intervention strategies.

AIM

To examine the trends in suicides and homicides over the past two decades and identify demographic and contextual predictors using the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System online database.

METHODS

A retrospective analysis of mortality records from 2000 to 2020 was conducted, utilizing multivariate regression analyses. Covariates included age, race, sex, education, mental health conditions, and time period. Age-adjusted rates were employed to assess trends.

RESULTS

Over the 20 years, there was an upward trajectory in suicide rates, increasing from approximately 10/100,000 to over 14/100,000 individuals, which is a notable increase among American Indians (100.8% increase) and individuals aged 25 years and younger (45.3% increase). Homicide rates, while relatively stable, exhibited a significant increase in 2019-2020, with African Americans consistently having the highest rates and a significant increase among American Indians (73.2% increase). In the multivariate regression analysis, Individuals with advanced education (OR= 1.74, 95% CI= 1.70 - 1.78), depression (OR = 13.47, 95% CI = 13.04 - 13.91), and bipolar disorder (OR = 2.65, 95% CI = 2.44 - 2.88) had higher odds of suicide. Risk factors for homicide include African Americans (OR = 4.15, 95% CI = 4.08 - 4.23), Latinx (OR = 2.31, 95% CI = 2.26 - 2.37), people aged 25 years and younger, and those with lower educational attainment.

CONCLUSION

This study highlights the changing demographic pattern in suicides and homicides in the United States and the need for targeted public health responses. Means restriction, universal suicide screening, addressing mental health stigma, and implementing broad interventions that modify societal attitudes toward suicide and homicides are essential components of a comprehensive strategy.

Social Vulnerability and Firearm Violence: Geospatial Analysis of 5 US Cities

BACKGROUND

Firearm violence is now endemic to certain US neighborhoods. Understanding factors that impact a neighborhood's susceptibility to firearm violence is crucial for prevention. Using a nationally standardized measure to characterize community-level firearm violence risk has not been broadly studied but could enhance prevention efforts. Thus, we sought to examine the association between firearm violence and the social, structural, and geospatial determinants of health, as defined by the Social Vulnerability Index (SVI).

STUDY DESIGN

In this cross-sectional study, we merged 2018 SVI data on census tract with shooting incidents between 2015 and 2021 from Baltimore, Chicago, Los Angeles, New York City, and Philadelphia. We used negative binomial regression to associate the SVI with shooting incidents per 1,000 people in a census tract. Moran's I statistics and spatial lag models were used for geospatial analysis.

RESULTS

We evaluated 71,296 shooting incidents across 4,415 census tracts. Fifty-five percent of shootings occurred in 9.4% of census tracts. In all cities combined, a decile rise in SVI resulted in a 37% increase in shooting incidents (p < 0.001). A similar relationship existed in each city: 30% increase in Baltimore (p < 0.001), 50% in Chicago (p < 0.001), 28% in Los Angeles (p < 0.001), 34% in New York City (p < 0.001), and 41% in Philadelphia (p < 0.001). Shootings were highly clustered within the most vulnerable neighborhoods.

CONCLUSIONS

In 5 major US cities, firearm violence was concentrated in neighborhoods with high social vulnerability. A tool such as the SVI could be used to inform prevention efforts by directing resources to communities most in need and identifying factors on which to focus these programs and policies.

Neighborhood collective efficacy and environmental exposure to firearm homicide among a national sample of adolescents

BACKGROUND

Living near an incident of firearm violence can negatively impact youth, regardless of whether the violence is experienced firsthand. Inequities in household and neighborhood resources may affect the prevalence and consequences of exposure across racial/ethnic groups.

FINDINGS

Using data from the Future of Families and Child Wellbeing Study and the Gun Violence Archive, we estimate that approximately 1 in 4 adolescents in large US cities lived within 800 m (0.5 miles) of a past-year firearm homicide during 2014-17. Exposure risk decreased as household income and neighborhood collective efficacy increased, though stark racial/ethnic inequities remained. Across racial/ethnic groups, adolescents in poor households in moderate or high collective efficacy neighborhoods had a similar risk of past-year firearm homicide exposure as middle-to-high income adolescents in low collective efficacy neighborhoods.

CONCLUSIONS

Empowering communities to build and leverage social ties may be as impactful for reducing firearm violence exposure as income supports. Comprehensive violence prevention efforts should include systems-level strategies that jointly strengthen family and community resources.

Relationships, resources, and political empowerment: community violence intervention strategies that contest the logics of policing and incarceration

Community violence-defined as unsanctioned violence between unrelated individuals in public places-has devastating physical, psychological, and emotional consequences on individuals, families, and communities. Immense investments in policing and incarceration in the United States have neither prevented community violence nor systemically served those who have been impacted by it, instead often inflicting further harm. However, the logics that uphold policing and incarceration as suitable or preventative responses to community violence are deeply ingrained in societal discourse, limiting our ability to respond differently. In this perspective, we draw from interviews with leading voices in the field of outreach-based community violence intervention and prevention to consider alternative ways to address community violence. We begin by demonstrating that policing and incarceration are distinguished by practices of retribution, isolation, and counterinsurgency that are counterproductive to the prevention of community violence. Then, we identify alternative practices of outreach-based community violence intervention and prevention that include (1) fostering safety nets through relationships among individuals, families, and neighborhoods, (2) fighting poverty and increasing access to resources, and (3) building political capacity among organizations to transform the broader systems in which they are embedded. They also include accountability practices that are preventative and responsive to the needs of those who are harmed. We conclude that elevating the language, narratives, and values of outreach-based community violence intervention and prevention can transform our responses to violence, interrupt cycles of harm, and foster safer communities.