The Impact of Firearm Legislation on Firearm Deaths, 1991-2017.

Firearm violence is a major public health concern in the USA with firearm suicide and homicide accounting for the majority of gun deaths. The present work seeks to explore the role of firearm legislation in reducing suicide and homicide rates. Using the State Firearm Law Database (www.statefirearmlaws.org), suicide and homicide rates were compared across the 50 US states from 1991 to 2017. A firearm regulations index was computed to represent the total number of state firearm laws. Generalized estimating equations were used to explore population-level increases or decreases in firearm regulations and their association with state suicide and homicide rates after controlling for several state-level covariates. Even after accounting for several key covariates (US region; time; gun ownership; percent of the state population that was White, Black, below the poverty line and 25 years or older with a bachelor's degree; incarceration rate, unemployment rate and divorce rate), we found that firearm laws significantly predicted state firearm suicide and homicide rates. States with greater numbers of laws had reduced suicide and homicide rates compared with those with fewer laws. The present findings point to the role of firearm legislation in curbing rates of gun violence across the USA.

Using police data to measure children's exposure to neighborhood violence: a new method for evaluating relations between exposure and mental health.

Studies have identified a robust association between children's exposure to violence and their mental health. Yet, most of this research has been based on self-reported exposure and self-reported mental health. In this study, we used a new, map-based method via police data for measuring children's exposure to violent crime and compared it to child self-reports and parent reports of exposure. Results suggest that child self-reports of violence exposure may not be valid except for exposure to murder, but police and parent reports of violent crime can reveal interesting relations between violence and mental health. Children showed higher levels of internalizing problems in the absence of police-reported murder and parent-reported robbery. Discussion emphasizes implications for measurement as well as theory building.

Identifying participants for inclusion in hospital-based violence intervention: An analysis of 18 years of urban firearm recidivism.

BACKGROUND: Identifying individuals at highest risk maximizes efficacy of prevention programs in decreasing recidivist gunshot wound (GSW) injury. Characteristics of GSW recidivists may identify this population. Hospital-based violence intervention programs (HVIPs) are one effective strategy; however, programs are expensive, therefore, when possible, epidemiologic data should guide inclusion criteria. METHODS: Seventeen years of all GSW patients presenting to an urban Level I trauma center were reviewed. Countywide murders were reviewed from the same timeframe. Recidivists were any patient presenting twice, either to the hospital or once to the hospital and subsequently dying by firearm. Demographics and characteristics of future recidivists were compared with nonfuture recidivists. RESULTS: There were 9,699 unique intentional, GSW cases reviewed and 1,426 died, leaving 8,273 at risk of recidivism. Five hundred fourteen (6.2%) became recidivists. Most recidivists were African-American men and were younger at first GSW. Median time between incidents was 2.5 years, with a range of 0 days to 16 years. Nearly half were treated and released from the emergency department at their first episode of GSW. For recidivists who died, 128 died at the second incident, 29 at later incidents. Mortality from a second incident of firearm injury is 10% higher than first injuries, second hospitalizations are US $5,000 more expensive, and loss of life has a societal cost of US $167 billion in this community alone. CONCLUSION: The most appropriate population for inclusion in HVIPs at our hospital are young black men. The HVIP services are needed in the emergency department to address those treated and released at first GSW. Recidivists have higher mortality, and hospitalizations are significantly more expensive at the second injury. The investment in prevention is justified and may lead to a decrease in recidivism. LEVEL OF EVIDENCE: Therapeutic/Care Management level III.

Coping with violence: a comprehensive framework and implications for understanding resilience.

Interpersonal violence is present at all levels of influence in the social ecology and can have comprehensive and devastating effects on child and adolescent development through multiple simultaneous channels of exposure. Children's experiences with violence have been linked with a range of behavioral and mental health difficulties including posttraumatic stress disorder and aggressive behavior. In this article, we offer a conceptual framework delineating the ways in which children and adolescents might encounter violence, and a theoretical integration describing how violence might impact mental and behavioral health outcomes through short- and long-term processes. We propose that coping reactions are fundamental to the enduring effects of violence exposure on their psychosocial development and functioning. Finally, we discuss the manner in which coping efforts can support resilience among children exposed to violence and suggest new directions for research and preventive intervention aimed at optimizing outcomes for children at risk of exposure.

Coping zone construction and mapping: an exploratory study of contextual coping, PTSD, and childhood violence exposure in urban areas.

This mixed-method study explored how urban children aged 11 to 14 cope with multicontextual violence exposures simultaneously and analyzed the immediate action steps these children took when faced with such violence over time. Participants' (N = 12) narratives were initially analyzed utilizing a grounded theory framework as 68 violent incidents were coded for perceived threat and coping levels. Coping strategies were examined from a Transactional Model of Stress and Coping perspective taking into account the context and severity of each violent exposure itself. A comprehensive assessment map was developed to plot and visually reveal participants (N = 12) overall contextualized coping responses. Overall "coping zone" scores were generated to index perceived threat and coping responses associated with each violent incident described. These scores were then correlated with indicators of post-traumatic stress disorder (PTSD). Results indicated that urban children with less optimal coping zone scores across context have a greater likelihood of PTSD than do children who do not.

Coping with stress, coping with violence: Links to mental health outcomes among at-risk youth.

Coping reactions to stressful events are important links between difficult experiences and the emergence of psychopathology. In this study we compared youths' negative coping with stress in general to their negative coping with violence in particular, and utilized a person-centered analytic approach to examine how patterns of coping relate to various mental health outcomes. We utilized survey interview measures to collect data from a sample of 131 youth (ages 11-14, 100% ethnic minority) residing in an economically distressed metropolitan area of the northeast. We observed significant relations between youths' tendencies to cope with stress and violence via externalized-internalized strategies (e.g., yelling to let off steam, crying) and their mental health symptoms. However, we generally did not observe relations between engagement in distancing coping strategies (e.g., making believe nothing happened) and any problematic outcomes. Negative coping does not appear be a monolithic construct uniformly associated with negative outcomes for youth. Distancing coping might represent an especially useful short-term coping response for youth living in socioeconomically distressed conditions from the standpoint of inhibiting symptom development.