Factors Associated With Recurrent Pediatric Firearm Injury : A 10-Year Retrospective Cohort Analysis.

BACKGROUND: Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. OBJECTIVE: To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region. DESIGN: Multicenter, observational, cohort study. SETTING: 2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri. PARTICIPANTS: Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019. MEASUREMENTS: From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury. RESULTS: During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury. LIMITATION: Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals. CONCLUSION: Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children. PRIMARY FUNDING SOURCE: National Institutes of Health.

Assessing the acute effects of exposure to community violence among adolescents: A strategic comparison approach.

This paper examines whether exposure to spatially proximate homicide affects norms, attitudes, and the adaptive strategies adolescents take to insulate themselves from violent victimization. Drawing on survey data from a large sample of urban youth (n = 3195), we assess the impact of homicides occurring within a one-mile radius of respondents' homes on a variety of psychosocial outcomes. We exploit random variation in the timing of survey administration to compare the survey responses of youths who were exposed to a homicide in the immediate vicinity of their homes in the one-month period leading up the administration of the survey with students who did not experience a homicide near their homes during that period but would the following month. This strategic comparison approach minimizes the confounding influence of endogenous processes that funnel children and families into places where homicides tend to concentrate.

Personal goals of young survivors of violent injury: implications for practice.

INTRODUCTION: Firearm injuries are the leading cause of death among young people in the USA and disproportionately impact communities of colour and those experiencing socioeconomic distress. Understanding the personal goals of violently injured patients is essential to identifying protective factors and developing interventions that promote them. However, limited research characterising these personal goals exists. OBJECTIVE: The objective of this study was to use qualitative thematic analysis to analyse and describe the personal goals of young people who enrolled in a region-wide hospital-based violence intervention programme after surviving a violent injury. METHODS: A qualitative coding framework was developed, evaluated, and implemented using data from Life Outside of Violence, the St. Louis Area Hospital-Based Violence Intervention Programme. Chart abstraction procedures were used to compile qualitative data on Life Outside of Violence participants' personal goals documented by clinical case managers during individual treatment planning sessions with participants (n=168). Descriptive analyses are reported and implications for practice are discussed. RESULTS: Key findings reveal that (1) violent injury survivors have unmet therapeutic and resource needs, indicating the importance of having service providers with both clinical and case management skills, (2) anger management is a common clinical goal, and (3) employment opportunities are a common resource need. CONCLUSIONS: Findings from this study inform the implementation of the Life Outside of Violence programme and offer a roadmap to other hospital-based violence intervention programmes operating nation-wide. Our results provide insight into participants' needs, desires, and motivations, allowing unique opportunities for improved participant engagement and service delivery.

Policing Pot: State-Level Cannabis Arrests Increase Perceived Risks and Costs but Not Use.

Legal sanctions are purported to play a role in cannabis use and related consequences. General models of deterrence suggest that increases in arrests should decrease consumption by heightening perceptions of the negative consequences of use as well as the likelihood and severity of penalties. The present study examined if arrests resulting from cannabis possession relate to cannabis consumption, perceptions of use, and likelihood and severity of related penalties. Combining data from the National Survey on Drug Use and Health with the FBI Uniform Crime Report (2002-2013) allowed for the estimation of a series of fixed- effects models that compare rates of arrests and perceived risks of aggregate rates of self-reported use at the state-level over time. Forty-nine states reported data (N = 592 state-years). Cannabis-related arrest rates (ratio of possession arrests for state/state population times 1,000) ranged from 0.04 - 5.63. Increases in cannabis-related arrests were associated with heightened perceptions of risk from use (b = .80 [-.16, 1.8], p < .05); but this association was non-significant in the model omitting states that legalized recreational cannabis in 2012. Arrests related to greater perceptions of the severity of potential penalties, including community service (b = .54 [.24, .85], p < .05), probation (b = .85 [.44, 1.3], p < .001), and prison sentences (b = .25 [.02, .5], p < .05). Arrest rates were not associated with cannabis use (b = -.25 [-.52, .05], p > .05) or the proportion of new initiates (b = -.02 [-.08, .05], p > .05). We conclude that increased arrests are associated with perceptions of negative consequences and penalty but appear unrelated to actual use. This study highlights the need to re-examine the utility of punitive approaches to reduce the public health burden posed by substance use.

School Cohesion Perception Discrepancy and Student Delinquency.

Research suggests that positive school environments contribute to lower levels of school disorder. Studies have also documented stark differences between how students and personnel perceive their schools. The current study examines such "perception discrepancies" as a meaningful dimension of the school environment, investigating the hypothesis that when students perceive their schools as less cohesive than their teachers, they are more likely to engage in delinquent conduct. The University of Missouri-St. Louis Comprehensive School Safety Initiative (UMSL CSSI) study allows comparisons between student and personnel perceptions of school climate among an analytic sample of 2741 students nested in 12 American middle schools (average age = 13.6; 54% female; 39% black; 39% white). The results of a series of hierarchical regression models demonstrate that students engage in higher levels of delinquency when they perceive their school environments as less cohesive, on average, than do school personnel. This suggests that discrepancies among students and personnel concerning aspects of the school climate represent a deficiency in the school's ability to protect against student delinquency.

Incorporating Neighborhood Choice in a Model of Neighborhood Effects on Income.

Studies of neighborhood effects often attempt to identify causal effects of neighborhood characteristics on individual outcomes, such as income, education, employment, and health. However, selection looms large in this line of research, and it has been argued that estimates of neighborhood effects are biased because people nonrandomly select into neighborhoods based on their preferences, income, and the availability of alternative housing. We propose a two-step framework to disentangle selection processes in the relationship between neighborhood deprivation and earnings. We model neighborhood selection using a conditional logit model, from which we derive correction terms. Driven by the recognition that most households prefer certain types of neighborhoods rather than specific areas, we employ a principle components analysis to reduce these terms into eight correction components. We use these to adjust parameter estimates from a model of subsequent neighborhood effects on individual income for the unequal probability that a household chooses to live in a particular type of neighborhood. We apply this technique to administrative data from the Netherlands. After we adjust for the differential sorting of households into certain types of neighborhoods, the effect of neighborhood income on individual income diminishes but remains significant. These results further emphasize that researchers need to be attuned to the role of selection bias when assessing the role of neighborhood effects on individual outcomes. Perhaps more importantly, the persistent effect of neighborhood deprivation on subsequent earnings suggests that neighborhood effects reflect more than the shared characteristics of neighborhood residents: place of residence partially determines economic well-being.

Unpacking the Relationships between Impulsivity, Neighborhood Disadvantage, and Adolescent Violence: An Application of a Neighborhood-Based Group Decomposition.

Scholars have become increasingly interested in how social environments condition the relationships between individual risk-factors and adolescent behavior. An appreciable portion of this literature is concerned with the relationship between impulsivity and delinquency across neighborhood settings. The present article builds upon this growing body of research by considering the more nuanced pathways through which neighborhood disadvantage shapes the development of impulsivity and provides a situational context for impulsive tendencies to manifest in violent and aggressive behaviors. Using a sample of 12,935 adolescent from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (mean age = 15.3, 51% female; 20% Black, 17% Hispanic), we demonstrate the extent to which variation in the association between impulsivity and delinquency across neighborhoods can be attributed to (1) differences in mean-levels of impulsivity and violence and (2) differences in coefficients across neighborhoods. The results of a series of multivariate regression models indicate that impulsivity is positively associated with self-reported violence, and that this relationship is strongest among youth living in disadvantaged neighborhoods. The moderating effect of neighborhood disadvantage can be attributed primarily to the stronger effect of impulsivity on violence in these areas, while differences in average levels of violence and impulsivity account for a smaller, yet nontrivial portion of the observed relationship. These results indicate that the differential effect of impulsivity on violence can be attributed to both developmental processes that lead to the greater concentration of violent and impulsive adolescents in economically deprived neighborhoods as well as the greater likelihood of impulsive adolescents engaging in violence when they reside in economically disadvantaged communities.

Toward a Demographic Understanding of Incarceration Disparities: Race, Ethnicity, and Age Structure.

OBJECTIVES: Non-Hispanic blacks and Hispanics in the United States are more likely to be incarcerated than non-Hispanic whites. The risk of incarceration also varies with age, and there are striking differences in age distributions across racial/ethnic groups. Guided by these trends, the present study examines the extent to which differences in age structure account for incarceration disparities across racial and ethnic groups. METHODS: We apply two techniques commonly employed in the field of demography, age-standardization and decomposition, to data provided by the Bureau of Justice Statistics and the 2010 decennial census to assess the contribution of age structure to racial and ethnic disparities in incarceration. FINDINGS: The non-Hispanic black and Hispanic incarceration rates in 2010 would have been 13-20 % lower if these groups had age structures identical to that of the non-Hispanic white population. Moreover, age structure accounts for 20 % of the Hispanic/white disparity and 8 % of the black/white disparity. CONCLUSION: The comparison of crude incarceration rates across racial/ethnic groups may not be ideal because these groups boast strikingly different age structures. Since the risk of imprisonment is tied to age, criminologists should consider adjusting for age structure when comparing rates of incarceration across groups.

The highs that bind: school context, social status and marijuana use.

Substance use has been closely linked with the structural characteristics of adolescent social networks. Those who drink, smoke, and use drugs typically enjoy an elevated status among their peers. Rates of substance use vary substantially across schools, and indicators of school structure and climate account for at least part of this variation. Emerging research suggests peer-group processes are contingent on school context, but questions remain regarding the school-level mechanisms which condition the influence of network characteristics on substance use. The present study uses multilevel logistic regression models to examine the moderating influence of school connectedness, school drug culture, and global network density on the association between peer network status and marijuana use. The analyses draw on self, peer, and parental data from a sample of 7,548 high-school aged youth nested within 106 schools participating in the National Longitudinal Study of Adolescent to Adult Health (mean age = 15.2; % white = 59 %; male = 45 %). The results indicate that school connectedness significantly reduces the effect of social status on marijuana use. This provides evidence that school-level mechanisms can reduce the instrumentality of marijuana consumption in the status attainment process in adolescence.