Structural vulnerability to narcotics-driven firearm violence: An ethnographic and epidemiological study of Philadelphia's Puerto Rican inner-city.

BACKGROUND: The United States is experiencing a continuing crisis of gun violence, and economically marginalized and racially segregated inner-city areas are among the most affected. To decrease this violence, public health interventions must engage with the complex social factors and structural drivers-especially with regard to the clandestine sale of narcotics-that have turned the neighborhood streets of specific vulnerable subgroups into concrete killing fields. Here we present a mixed-methods ethnographic and epidemiological assessment of narcotics-driven firearm violence in Philadelphia's impoverished, majority Puerto Rican neighborhoods. METHODS: Using an exploratory sequential study design, we formulated hypotheses about ethnic/racial vulnerability to violence, based on half a dozen years of intensive participant-observation ethnographic fieldwork. We subsequently tested them statistically, by combining geo-referenced incidents of narcotics- and firearm-related crime from the Philadelphia police department with census information representing race and poverty levels. We explored the racialized relationships between poverty, narcotics, and violence, melding ethnography, graphing, and Poisson regression. FINDINGS: Even controlling for poverty levels, impoverished majority-Puerto Rican areas in Philadelphia are exposed to significantly higher levels of gun violence than majority-white or black neighborhoods. Our mixed methods data suggest that this reflects the unique social position of these neighborhoods as a racial meeting ground in deeply segregated Philadelphia, which has converted them into a retail endpoint for the sale of astronomical levels of narcotics. IMPLICATIONS: We document racial/ethnic and economic disparities in exposure to firearm violence and contextualize them ethnographically in the lived experience of community members. The exceptionally concentrated and high-volume retail narcotics trade, and the violence it generates in Philadelphia's poor Puerto Rican neighborhoods, reflect unique structural vulnerability and cultural factors. For most young people in these areas, the narcotics economy is the most readily accessible form of employment and social mobility. The performance of violence is an implicit part of survival in these lucrative, illegal narcotics markets, as well as in the overcrowded jails and prisons through which entry-level sellers cycle chronically. To address the structural drivers of violence, an inner-city Marshall Plan is needed that should include well-funded formal employment programs, gun control, re-training police officers to curb the routinization of brutality, reform of criminal justice to prioritize rehabilitation over punishment, and decriminalization of narcotics possession and low-level sales.

Relationships between sexual violence and chronic disease: a cross-sectional study.

BACKGROUND: Sexual assault is a traumatic event with potentially devastating lifelong effects on physical and mental health. Research has demonstrated that individuals who experience sexual assault during childhood are more likely to engage in risky behaviors later in life, such as smoking, alcohol and drug use, and disordered eating habits, which may increase the risk of developing a chronic disease. Despite the high prevalence and economic burden of sexual assault, few studies have investigated the associations between sexual violence and chronic health conditions in the US. The purpose of this study is to identify associations between sexual violence and health risk behaviors, chronic health conditions and mental health conditions utilizing population based data in Kansas. METHODS: Secondary analysis was done using data from the 2011 Kansas Behavioral Risk Factor Surveillance System sexual violence module (N = 4,886). Crude and adjusted prevalence rate ratios were computed to examine associations between sexual assault and health risk behaviors, chronic health conditions and mental health conditions, overall and after adjusting for social demographic characteristics. Additional logistic regression models were implemented to examine the association between sexual assault and health risk behaviors with further adjustment for history of anxiety or depression. RESULTS: There was a significantly higher prevalence of health risk behaviors (heavy drinking, binge drinking and current smoking), chronic health conditions (disability, and current asthma) and mental health conditions (depression, anxiety, and suicidal ideation) among women who ever experienced sexual assault compared to women who did not, even after adjustment for potential confounders. CONCLUSIONS: Study findings highlight the need for chronic disease prevention services for victims of sexual violence. There are important implications for policies and practices related to primary, secondary, and tertiary prevention, as well as collaborations between sexual violence, chronic disease, and health risk behavior programs.

The Moral Economy of Violence in the US Inner City.

In an 8-week period, there were 16 shootings with three fatalities, three stabbings, and 14 additional "aggravated assaults" in the four square blocks surrounding our field site in the Puerto Rican corner of North Philadelphia. In the aftermath of the shoot-outs, the drug sellers operating on our block were forced to close down their operations by several mothers who repeatedly called the police. Drawing on the concept of moral economy (Thompson, Scott, Taussig), Mauss's interpretation of gift exchange, and a political economy critique of hypercarceralization in the United States, we understand the high levels of US inner-city violence as operating within a moral logic framed by economic scarcity and hostile state relations. Residents seek security, self-respect, and profit in social networks that compel them to participate in solidary exchanges of assistive violence dynamized by kinship and gender obligations. A hierarchical, extractive drug economy fills the void left by deindustrialization, resulting in a dynamic of embodied primitive accumulation at the expense of addicted customers and chronically incarcerated just-in-time street sellers at high risk of assault. Nevertheless, the mobilization of violence organizing the illegal drug economy also follows ethical norms and obligations that are recognized as legitimate by many local residents.

[The Habit of Rage in a United States Ghetto.] / Habitus furibundo en el gueto estadounidense.

For five years, the open air drug sales block where the authors resided and conducted participant-observation fieldwork in the Puerto Rican corner of inner-city Philadelphia was subject to a routinized whirlwind of shootings, stabbings and assaults. The narcotics industry filled the void left by deindustrialization, turning the city's former factory district into an open-air narcotics supermarket staffed at the entry level by young Puerto Ricans serving primarily poor white injectors. A capacity to mobilize rage ensures success in the drug economy, protection in prison, and minimal income for the no-longer-worthy poor who are diagnosed as cognitively disabled. Many residents seek alliances in social networks that oblige them to participate in solidary exchanges of assistive violence. A dynamic of embodied, primitive accumulation kills, maims, disables or incarcerates most of this industry's entry-level employees and customers. Artificially high profit margins depend on violence and coercion. A rage-filled habitus propels street-level sellers into violently defending the micro-monopoly power of their bosses in the underground economy as if it were fun. They rush to enforce commercial transactions in the absence of protective legal sanctions in an environment of scarcity that is flooded by streams of cash, addictive drugs and automatic weapons. With the end of welfare entitlements, the left hand of the state, in the form of social services, attempts to continue subsidies for vulnerable individuals by diagnosing scarred bodies and brains as proof of permanent cognitive disability in need of heavy pharmaceutical medication. Periodic outbursts of interpersonal or of self-inflicted rage-filled violence emerge as the best way to ensure the continuity of that fragile public subsidy. Simultaneously, within the bowels of the right hand of the state, in overcrowded, hostilely-supervised violent prisons, rage becomes a valuable physical self-protection strategy for inmates. In short, expressive violence becomes a practical basis for economic sustenance and masculine and feminine self respect.

Structural vulnerability and health: Latino migrant laborers in the United States.

Latino immigrants in the United States constitute a paradigmatic case of a population group subject to structural violence. Their subordinated location in the global economy and their culturally depreciated status in the United States are exacerbated by legal persecution. Medical Anthropology, Volume 30, Numbers 4 and 5, include a series of ethnographic analyses of the processes that render undocumented Latino immigrants structurally vulnerable to ill health. We hope to extend the social science concept of "structural vulnerability" to make it a useful concept for health care. Defined as a positionality that imposes physical/emotional suffering on specific population groups and individuals in patterned ways, structural vulnerability is a product of class-based economic exploitation and cultural, gender/sexual, and racialized discrimination, as well as complementary processes of depreciated subjectivity formation. A good-enough medicalized recognition of the condition of structural vulnerability offers a tool for developing practical therapeutic resources. It also facilitates political alternatives to the punitive neoliberal policies and discourses of individual unworthiness that have become increasingly dominant in the United States since the 1980s.

Factors contributing to the effectiveness of four school-based sexual violence interventions.

This study extends past research by examining factors associated with changes in attitudes, knowledge, and intended behaviors related to sexual assault. This study included 1,182 participants from four unique multiple-session school-based sexual violence interventions. Implementation and participant factors examined include single- versus mixed-gender groups, group setting versus classroom lecture setting, and participant gender. Participants completed self-administered, paper-and-pencil pre- and postsurveys. A significant desired overall effect was found on participants' reports of positive attitudes, beliefs, and behavior regarding sexual harassment and personal boundaries and positive dating relationship norms (from pretest to posttest). There were steeper increases over time in both measures, with larger mixed-gender/single-gender differences among boys than among girls. Differences in the impact of participating in mixed- versus single-gender groups depended on classroom versus small group settings. The implications of these findings are discussed for sexual assault prevention programs.

Logic models as a tool for sexual violence prevention program development.

Sexual violence is a growing public health problem, and there is an urgent need to develop sexual violence prevention programs. Logic models have emerged as a vital tool in program development. The Centers for Disease Control and Prevention funded an empowerment evaluation designed to work with programs focused on the prevention of first-time male perpetration of sexual violence, and it included as one of its goals, the development of program logic models. Two case studies are presented that describe how significant positive changes can be made to programs as a result of their developing logic models that accurately describe desired outcomes. The first case study describes how the logic model development process made an organization aware of the importance of a program's environmental context for program success; the second case study demonstrates how developing a program logic model can elucidate gaps in organizational programming and suggest ways to close those gaps.