Gun Violence Exposure and Suicide Among Black Adults.

Importance: Black individuals are disproportionately exposed to gun violence in the US. Suicide rates among Black US individuals have increased in recent years. Objective: To evaluate whether gun violence exposures (GVEs) are associated with suicidal ideation and behaviors among Black adults. Design, Setting, and Participants: This cross-sectional study used survey data collected from a nationally representative sample of self-identified Black or African American (hereafter, Black) adults in the US from April 12, 2023, through May 4, 2023. Exposures: Ever being shot, being threatened with a gun, knowing someone who has been shot, and witnessing or hearing about a shooting. Main Outcomes and Measures: Outcome variables were derived from the Self-Injurious Thoughts and Behaviors Interview, including suicidal ideation, suicide attempt preparation, and suicide attempt. A subsample of those exhibiting suicidal ideation was used to assess for suicidal behaviors. Results: The study sample included 3015 Black adults (1646 [55%] female; mean [SD] age, 46.34 [0.44] years [range, 18-94 years]). Most respondents were exposed to at least 1 type of gun violence (1693 [56%]), and 300 (12%) were exposed to at least 3 types of gun violence. Being threatened with a gun (odds ratio [OR], 1.44; 95% CI, 1.01-2.05) or knowing someone who has been shot (OR, 1.44; 95% CI, 1.05-1.97) was associated with reporting lifetime suicidal ideation. Being shot was associated with reporting ever planning a suicide (OR, 3.73; 95% CI, 1.10-12.64). Being threatened (OR, 2.41; 95% CI, 2.41-5.09) or knowing someone who has been shot (OR, 2.86; 95% CI, 1.42-5.74) was associated with reporting lifetime suicide attempts. Cumulative GVE was associated with reporting lifetime suicidal ideation (1 type: OR, 1.69 [95% CI, 1.19-2.39]; 2 types: OR, 1.69 [95% CI, 1.17-2.44]; ≥3 types: OR, 2.27 [95% CI, 1.48-3.48]), suicide attempt preparation (≥3 types; OR, 2.37; 95% CI, 2.37-5.63), and attempting suicide (2 types: OR, 4.78 [95% CI, 1.80-12.71]; ≥3 types: OR, 4.01 [95% CI, 1.41-11.44]). Conclusions and Relevance: In this cross-sectional study, GVE among Black adults in the US was significantly associated with lifetime suicidal ideation and behavior. Public health efforts to substantially reduce interpersonal gun violence may yield additional benefits by decreasing suicide among Black individuals in the US.

Differences in Perceptions of Gun-Related Safety by Race and Gun Ownership in the United States.

Motivated by disparities in gun violence, sharp increases in gun ownership, and a changing gun policy landscape, we conducted a nationally representative survey of U.S. adults (n=2,778) in 2021 to compare safety-related views of white, Black, and Hispanic gun owners and non-owners. Black gun owners were most aware of homicide disparities and least expecting of personal safety improvements from gun ownership or more permissive gun carrying. Non-owner views differed. Health equity and policy opportunities are discussed.

Assessment of Reasons for Ownership and Attitudes About Policies Among Firearm Owners With and Without Children.

Importance: Given the dangers that firearms in the home pose to children, it is critical to engage parents in effective firearm safety counseling. This requires a broader understanding of how the presence of children in the home is associated with motivations surrounding gun ownership. Objective: To examine the association of having children in the home and gun owners' attitudes and beliefs. Design, Setting, and Participants: This cross-sectional survey study analyzed data from the National Lawful Use of Guns Survey conducted in 2019. A representative sample of 3698 adult gun owners nationwide were randomly invited to participate, with a 56.5% survey response rate. Survey responses were weighted to account for survey nonresponse and selection bias, and comparison groups were matched by age. Statistical analysis was performed in 2020. Main Outcomes and Measures: Reasons for gun ownership, symbolic meaning of guns, and attitudes toward gun policies. Results: Of the 2086 respondents, 383 (18.4%) had children in the home, 68.7% (95% CI, 66.4%-71.0%) were male, 8.2% (95% CI, 6.8%-9.7%) were Black, 76.3% (95% CI, 73.8%-78.6%) were White, 79.4% (95% CI, 77.5%-81.2%) were living in metropolitan areas, 51.3% (95% CI, 48.9%-53.8%) identified as Republican; 34.7% (95% CI, 32.6%-36.9%) were aged 60 years or older. Despite the majority of respondents feeling safe in their local communities (respondents with children: 93.4% [95% CI,: 89.3%-96.0%]; without children: 88.9% [95% CI, 87.0%- 90.6%]), 92.3% (95% CI, 87.0%-95.6%) of respondents with children stated the primary reason for gun ownership was to protect their family, compared with 68.6% (95% CI, 65.2%-71.8%) of respondents without children. On logistic regression analysis, having children in the home remained an independent factor associated with reasons for gun ownership. Gun owners with children were more likely than those without children to feel that guns make them feel more valuable to their family (23.5% [95% CI, 18.9%-28.8%] vs 17.0% [95% CI, 15.0%-19.2%]). Among those with children, 35.2% (95% CI, 30.0%-40.8%) believed gun laws should be more strict compared with 40.7% (95% CI, 38.1%- 43.3%) of those without children. Conclusions and Relevance: These findings suggest that acknowledging parental motivations for gun ownership is a pivotal component of educational efforts toward firearm injury prevention. These findings can guide clinicians to engage in effective individual counseling and community level efforts to reduce pediatric gun injuries.

Significados y experiencias personales de perdón y reconciliación en mujeres víctimas y mujeres excombatientes de las FARC / Meanings and personal experiences of forgiveness and reconciliation in women who are victims and ex-combatents of the FARC

Este trabajo pretende comprender la experiencia subjetiva de mujeres víctimas y excombatientes de las FARC en torno al perdón y la reconciliación. Para ello, se realizó una investigación de corte cualitativo con enfoque fenomenológico-hermenéutico, basada en postulados de la psicología social crítica latinoamericana. Las técnicas para recolectar información fueron la observación participante, la entrevista en profundidad y los grupos de conversación, en donde participaron 8 víctimas y 4 excombatientes. Se realizó un análisis hermenéutico de contenido, identificando concepciones que las participantes tienen sobre perdón y reconciliación, identificando experiencias vividas. Uno de los principales hallazgos es que en el proceso para perdonar y reconciliarse, las participantes transforman su subjetividad, asumiendo reivindicar sus derechos ante el Estado y redescubriendo su humanidad después de la guerra; finalmente, las excombatientes cam-bian las armas por palabras

This work aims to understand the subjective experience of women victims and women ex-combatants of the FARC, around forgiveness and reconciliation. For this purpose, a qualitative research was conducted with a phenomenological-hermeneutic approach, based on postulates of Latin American critical social psychology. The techniques to collect information were participant observation, in-depth interview and conversation groups, in which 8 victims and 4 ex-combatants participated. a hermeneutical analysis of content was carried out, identifying conceptions that the participants have about forgiveness and reconciliation, identifying lived experiences. One of the main findings is that, in the process of forgiving and reconciling, the participants transform their subjectivity, assuming to restore their rights before the State and rediscovering their humanity after the war. Finally, ex-combatants change weapons for words

Nature and determinants of social actions during a mass shooting.

Reactions to danger have been depicted as antisocial but research has shown that supportive behaviors (e.g., helping injured others, giving information or reassuring others) prevail in life-threatening circumstances. Why is it so? Previous accounts have put the emphasis on the role of psychosocial factors, such as the maintenance of social norms or the degree of identification between hostages. Other determinants, such as the possibility to escape and distance to danger may also greatly contribute to shaping people's reactions to deadly danger. To examine the role of those specific physical constraints, we interviewed 32 survivors of the attacks at 'Le Bataclan' (on the evening of 13-11-2015 in Paris, France). Consistent with previous findings, supportive behaviors were frequently reported. We also found that impossibility to egress, minimal protection from danger and interpersonal closeness with other crowd members were associated with higher report of supportive behaviors. As we delved into the motives behind reported supportive behaviors, we found that they were mostly described as manifesting cooperative (benefits for both interactants) or altruistic (benefits for other(s) at cost for oneself) tendencies, rather than individualistic (benefits for oneself at cost for other(s)) ones. Our results show that supportive behaviors occur during mass shootings, particularly if people cannot escape, are under minimal protection from the danger, and feel interpersonal closeness with others. Crucially, supportive behaviors underpin a diversity of motives. This last finding calls for a clear-cut distinction between the social strategies people use when exposed to deadly danger, and the psychological motivations underlying them.

Community violence and academic achievement: High-crime neighborhoods, hotspot streets, and the geographic scale of "community".

Numerous studies have demonstrated a negative relationship between community violence and youth academic achievement, but they have varied in their geographic definition of "community," especially as it relates to proximity to students' residences. We extend this by considering the independent relationships between academic achievement and violent events (from 911 dispatches; e.g., gun shots) at the neighborhood (i.e., census tract) and street-block levels. We use data from standardized Math and English Language Arts (ELA) tests from Boston, MA for 2011-2013. Exposure to community violence was partially independent between streets and tracts, with some students living on low-crime streets in high-crime neighborhoods or high-crime streets in low-crime neighborhoods. Initial regression models found that differences in a neighborhood's violent crime predicted up to a 3% difference in test scores on both Math and ELA tests. Students living on high-crime streets scored an additional 1% lower than neighbors on safer streets. Subsequent models with student-level fixed effects, however, eliminated these relationships, except for the effect of neighborhood-level violence on Math scores. These findings suggest that future work should consider community violence at both geographic scales, but that in this case the impacts were only consistent at the neighborhood level and associations at the street level were seemingly due to spatial segregation of households.

Association of Neighborhood Gun Violence With Mental Health-Related Pediatric Emergency Department Utilization.

Importance: Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood. Objective: To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization. Design, Setting, and Participants: This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021. Exposure: Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence. Main Outcomes and Measures: ED encounters for a mental health-related chief complaint or primary diagnosis. Results: A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]). Conclusions and Relevance: Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.

Patient Characteristics and Perspectives of Firearm Safety Discussions in the Emergency Department.

INTRODUCTION: Firearm injury prevention discussions with emergency department (ED) patients provide a unique opportunity to prevent death and injury in high-risk patient groups. Building mutual understanding of safe firearm practices between patients and providers will aid the development of effective interventions. Examining ED patient baseline characteristics, perspectives on healthcare-based safety discussions, and experience with and access to firearms, will allow practitioners to craft more effective messaging and interventions. METHODS: Using an institutional review board-approved cross-sectional survey modified from a validated national instrument, we recruited 625 patients from three large, urban, academically affiliated EDs in the South to assess patient baseline characteristics, perspectives regarding firearms and firearm safety discussions, and prior violence history, as well as firearm access and safety habits. We compared the degree to which patients were open to discussions regarding firearms across a variety of provider types and clinical scenarios between those with and without gun access. RESULTS: Of the 625 patients consented and eligible for the study, 306 had access to firearms. The patients with firearm access were predominantly male, were more likely to have military experience, live in an urban or suburban region, and have experienced prior violence when compared to those without firearm access. Patients with and without gun access view firearm safety discussions with their healthcare provider as acceptable and analogous to other behavioral health interventions (i.e., helmet/seat belt use, alcohol/cigarette use). Patients were also accepting of these firearm safety discussions in many clinical contexts and led by multiple provider types. Of the patients with gun access, storage of each type of firearm was reviewed and the primary reason for ownership was for personal protection across all firearm types. CONCLUSION: Patients in the ED indicate openness to firearm safety discussions delivered by a variety of providers and in diverse clinical scenarios. Healthcare providers engaging firearm owners in appropriate risk-benefit discussions using a trauma-informed approach is a critical next step in research and intervention.

The Power of an Active Shooter Simulation: Changing Ethical Beliefs.

INTRODUCTION: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk. METHODS: Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test. RESULTS: Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively. CONCLUSION: Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.

Empowering the affected: Informing community-based solutions through interviews with survivors of interpersonal firearm violence-Perspectives of survivors of firearm injuries.

BACKGROUND: Firearm violence remains epidemic in the United States, with interpersonal gun violence leading to significant morbidity and mortality. Interpersonal violence has strong associations with social determinants of health, and community-specific solutions are needed to address root causes. We hypothesized that open-ended interviews with survivors of interpersonal firearm violence would identify themes in individual and community-level factors that contribute to ongoing violence. METHODS: Between July 2017 and November 2019, we performed a mixed-methods study in which qualitative and quantitative data were obtained from survivors of interpersonal firearm violence admitted to our urban level I trauma center. Qualitative data were obtained through semistructured, open-ended interviews with survivors. Quantitative data were obtained via survey responses provided to these same individuals. Qualitative and quantitative data were then used to triangulate and strengthen results. RESULTS: During the study period, 51 survivors were enrolled in the study. The most common cause of firearm violence reported by survivors was increased gang and drug activity (n = 40, 78%). The most common solution expressed was to reduce drug and gang lifestyle by offering jobs and educational opportunities to afflicted communities to improve opportunities (n = 35, 69%). Nearly half of the survivors (n = 23, 45%) believe that firearm violence should be dealt with by the affected community itself, and another group of survivors believe that it should be through partnership between the community and trauma centers (n = 19, 37%). CONCLUSION: Interviews with survivors of firearm violence at our urban level I trauma center suggest that drug and gang lifestyle perpetuate ongoing violence and that this would best be overcome by improving access to quality education and job opportunities. To address endemic firearm violence in their communities, trauma centers should identify opportunities to partner in developing programs that provide improved education, job access, and conflict mediation. LEVEL OF EVIDENCE: Prognostic and epidemiological, level I.

Exposure to Gun Violence: Associations with Anxiety, Depressive Symptoms, and Aggression among Male Juvenile Offenders.

Objective: To examine whether at-risk male youth experience increases in anxiety, depressive symptoms, and aggression during years when they are exposed to gun violence, adjusting for relevant covariates.Method: Participants were 1,216 male, justice-involved adolescents who were recently arrested for the first time for a moderate offense. They were interviewed 9 times over 5 years. Fixed effects (within-individual) regression models were used to estimate concurrent associations between exposure to gun violence and three outcomes: depressive symptoms, anxiety symptoms, and aggression (both overall and separately for proactive and reactive aggression). The reverse direction (anxiety, depressive symptoms, and aggression predicting gun violence exposure) was also modeled.Results: After controlling for covariates, exposure to gun violence was significantly associated with increases in reactive aggression and, to a lesser extent, increases in proactive aggression. In addition, gun violence exposure was associated with increased anxiety but not depressive symptoms. We found no support for the reverse direction.Conclusions: At-risk males experienced significant increases in anxiety and aggression (particularly reactive aggression) during years when they are exposed to gun violence, even after accounting for several potential confounding factors. The greater impact on reactive aggression suggests that exposure to gun violence may affect self-regulation and/or social information processing. The analyses shed light on the less-visible damage wrought by gun violence and underscore the importance of mental health screening and treatment for youth who have been exposed to violence - especially gun violence - both to assist individual youths and to disrupt cycles of violence.

K-12 School Shootings: Implications for Policy, Prevention, and Child Well-Being.

Schools should be considered safe spaces for children; children need to feel secure in order to grow and learn. This article argues that when a school shooting occurs, the harm goes beyond those who are injured or killed, because the presumption of security is shattered, and the mental and emotional health of the students is threatened. There are many interventions for preventing these attacks at the school, state, and federal levels. This article explores evidence behind some of these interventions and describes the delicate balance in implementing interventions without introducing undue stress and anxiety into a child's everyday life.

The echo chamber effect on social media.

Social media may limit the exposure to diverse perspectives and favor the formation of groups of like-minded users framing and reinforcing a shared narrative, that is, echo chambers. However, the interaction paradigms among users and feed algorithms greatly vary across social media platforms. This paper explores the key differences between the main social media platforms and how they are likely to influence information spreading and echo chambers' formation. We perform a comparative analysis of more than 100 million pieces of content concerning several controversial topics (e.g., gun control, vaccination, abortion) from Gab, Facebook, Reddit, and Twitter. We quantify echo chambers over social media by two main ingredients: 1) homophily in the interaction networks and 2) bias in the information diffusion toward like-minded peers. Our results show that the aggregation of users in homophilic clusters dominate online interactions on Facebook and Twitter. We conclude the paper by directly comparing news consumption on Facebook and Reddit, finding higher segregation on Facebook.

Mental Illness, Mass Shootings, and the Future of Psychiatric Research into American Gun Violence.

ABSTRACT: This article outlines a four-part strategy for future research in mental health and complementary disciplines that will broaden understanding of mass shootings and multi-victim gun homicides. First, researchers must abandon the starting assumption that acts of mass violence are driven primarily by diagnosable psychopathology in isolated "lone wolf" individuals. The destructive motivations must be situated, instead, within larger social structures and cultural scripts. Second, mental health professionals and scholars must carefully scrutinize any apparent correlation of violence with mental illness for evidence of racial bias in the official systems that define, measure, and record psychiatric diagnoses, as well as those that enforce laws and impose criminal justice sanctions. Third, to better understand the role of firearm access in the occurrence and lethality of mass shootings, research should be guided by an overarching framework that incorporates social, cultural, legal, and political, but also psychological, aspects of private gun ownership in the United States. Fourth, effective policies and interventions to reduce the incidence of mass shootings over time-and to prevent serious acts of violence more generally-will require an expanded body of well-funded interdisciplinary research that is informed and implemented through the sustained engagement of researchers with affected communities and other stakeholders in gun violence prevention. Emerging evidence that the coronavirus pandemic has produced a sharp increase both in civilian gun sales and in the social and psychological determinants of injurious behavior adds special urgency to this agenda.

Association of Gun Violence With Emergency Department Visits for Stress-Responsive Complaints.

STUDY OBJECTIVE: We evaluate the association between living near a neighborhood shooting and emergency department (ED) utilization for stress-responsive complaints. METHODS: In this location-based before-and-after neighborhood study, we examined variability in ED encounter volume for stress-responsive complaints after neighborhood shooting incidents around 2 academic hospitals. We included patients residing within 1/8- and 1/2-mile-diameter buffers around a shooting (place) if their ED encounter occurred 7, 30, or 60 days before or after the shooting (time). Prespecified outcomes were stress-responsive complaints (chest pain, lightheadedness, syncope, hypertension, shortness of breath, asthma, anxiety, depression, and substance use) based on prior literature for stress-responsive diseases. Conditional logistic regression was used to calculate the odds of presentation to the ED with a stress-responsive complaint after, compared with before, a neighborhood shooting incident. RESULTS: Between January 2013 and December 2014, 513 shooting incidents and 19,906 encounters for stress-responsive complaints were included in the analysis. Mean age was 50.3 years (SD 22.3 years), 61.5% were women, and 91% were black. We found increased odds of presenting with syncope in 2 place-time buffers: 30 days in the 1/8-mile buffer (odds ratio 2.61; 99% confidence interval 1.2 to 5.67) and 60 days in 1/8-mile buffer (odds ratio 1.56; 99% confidence interval 0.99 to 2.46). No other chief complaints met our statistical threshold for significance. CONCLUSION: This study evaluated the relationship between objectively measured gun violence exposure and short-term health effect at a microspatial scale. Overall, this was a study with largely negative results, and we did not find any consistent dose-response pattern in time or space regarding neighborhood shootings and stress-responsive presentations to the ED. Theoretic links make this relationship plausible, however, and further investigation is needed to understand the short-term health consequences of violence exposure, and whether those vary based on the circumstances that are experienced inherently by residents of a given neighborhood.

How Health Care Workers Wield Influence Through Twitter Hashtags: Retrospective Cross-sectional Study of the Gun Violence and COVID-19 Public Health Crises.

BACKGROUND: Twitter has emerged as a novel way for physicians to share ideas and advocate for policy change. #ThisIsOurLane (firearm injury) and #GetUsPPE (COVID-19) are examples of nationwide health care-led Twitter campaigns that went viral. Health care-initiated Twitter hashtags regarding major public health topics have gained national attention, but their content has not been systematically examined. OBJECTIVE: We hypothesized that Twitter discourse on two epidemics (firearm injury and COVID-19) would differ between tweets with health care-initiated hashtags (#ThisIsOurLane and #GetUsPPE) versus those with non-health care-initiated hashtags (#GunViolence and #COVID19). METHODS: Using natural language processing, we compared content, affect, and authorship of a random 1% of tweets using #ThisIsOurLane (Nov 2018-Oct 2019) and #GetUsPPE (March-May 2020), compared to #GunViolence and #COVID19 tweets, respectively. We extracted the relative frequency of single words and phrases and created two sets of features: (1) an open-vocabulary feature set to create 50 data-driven-determined word clusters to evaluate the content of tweets; and (2) a closed-vocabulary feature for psycholinguistic categorization among case and comparator tweets. In accordance with conventional linguistic analysis, we used a P<.001, after adjusting for multiple comparisons using the Bonferroni correction, to identify potentially meaningful correlations between language features and outcomes. RESULTS: In total, 67% (n=4828) of #ThisIsOurLane tweets and 36.6% (n=7907) of #GetUsPPE tweets were authored by health care professionals, compared to 16% (n=1152) of #GunViolence and 9.8% (n=2117) of #COVID19 tweets. Tweets using #ThisIsOurLane and #GetUsPPE were more likely to contain health care-specific language; more language denoting positive emotions, affiliation, and group identity; and more action-oriented content compared to tweets with #GunViolence or #COVID19, respectively. CONCLUSIONS: Tweets with health care-led hashtags expressed more positivity and more action-oriented language than the comparison hashtags. As social media is increasingly used for news discourse, public education, and grassroots organizing, the public health community can take advantage of social media's broad reach to amplify truthful, actionable messages around public health issues.