[Homicides in southern South American cities: educational inequalities and economic fluctuations]. / Homicidios en ciudades del sur de Sudamérica: desigualdades educativas y fluctuaciones económicas.

Information on how economic fluctuations affect educational inequalities in homicides in Latin America is scarce. This study aimed to: (a) analyze the temporal variations of educational inequalities related to homicide mortality and (b) compare these inequalities between years of economic growth and recession in southern South America cities from 2000 to 2019. Data from seven urban areas in three countries in the Southern Cone of South America were used: Mendoza and Rosario (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro, and São Paulo (Brazil); and Santiago (Chile). Poisson models were estimated by using age, sex, city of residence, year of economic growth or recession, and schooling level as explanatory variables. Results showed significant differences in the temporal evolution of homicide rates in the seven cities, although populations with a low schooling level always showed the most vulnerability. The four Brazilian cities, analyzed together, showed greater educational inequalities related to homicides in years of economic recession when compared to those of economic growth. On the one hand, the indiscriminate use of force by the State against criminal groups seems to increase social inequality in homicide mortality. On the other hand, criminal fragmentation and economic crisis can exacerbate these inequalities by increasing territorial disputes between criminal groups.

Se sabe poco sobre cómo las fluctuaciones económicas afectan las desigualdades educativas en homicidios en países latinoamericanos. Los objetivos de este estudio fueron (a) analizar las variaciones temporales de las desigualdades relativas educacionales de la mortalidad por homicidio, y (b) comparar estas desigualdades entre años de crecimiento económico y años de recesión en ciudades del sur sudamericano durante el período 2000-2019. Se utilizaron datos de siete áreas urbanas, en tres países del Cono Sur Sudamericano: Mendoza y Rosario (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro y São Paulo (Brasil); y Santiago (Chile). Se estimaron modelos de Poisson, utilizando como variables explicativas la edad, sexo, año, ciudad de residencia, año de expansión o recesión económica y nivel educativo. Encontramos diferencias marcadas en la evolución temporal de las tasas de homicidio entre las siete ciudades, aunque siempre las poblaciones de nivel educativo bajo fueron las más vulnerables. Las cuatro ciudades de Brasil, analizadas en conjunto, tuvieron desigualdades educativas relativas de homicidios mayores en años de recesión económica, con respecto a años de crecimiento económico. Por un lado, el uso de la fuerza indiscriminado por parte del Estado enfocado hacia grupos criminales parece haber llevado a una creciente desigualdad social de la mortalidad por homicidio. Por el otro, en un contexto de fragmentación criminal y crisis económica se podrían agravar estas desigualdades a través de mayores disputas territoriales entre grupos criminales.

São escassas as informações sobre como as flutuações econômicas afetam as desigualdades educacionais em homicídios na América Latina. Os objetivos deste estudo foram: (a) analisar as variações temporais das desigualdades educacionais relacionadas à mortalidade por homicídio, e (b) comparar essas desigualdades entre os anos de crescimento econômico e os anos de recessão nas cidades do sul da América do Sul no período de 2000 a 2019. Foram utilizados dados de sete áreas urbanas, em três países do Cone Sul da América do Sul: Mendoza e Rosário (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro e São Paulo (Brasil); e Santiago (Chile). Os modelos de Poisson foram estimados utilizando como variáveis explicativas a idade, sexo, ano, cidade de residência, ano de expansão ou recessão econômica e nível de escolaridade. Os resultados mostraram diferenças significativas na evolução temporal das taxas de homicídio entre as sete cidades, apesar de que as populações com baixo nível de escolaridade sempre foram as mais vulneráveis. As quatro cidades brasileiras, analisadas em conjunto, apresentaram maiores desigualdades educacionais relacionadas a homicídios em anos de recessão econômica em relação aos anos de crescimento econômico. Por um lado, o uso indiscriminado da força pelo Estado contra grupos criminosos parece ter levado ao aumento da desigualdade social na mortalidade por homicídio. Por outro lado, em um contexto de fragmentação criminal e crise econômica, essas desigualdades podem ser exacerbadas pelo aumento das disputas territoriais entre grupos criminosos.

States' Abortion Laws Associated With Intimate Partner Violence-Related Homicide Of Women And Girls In The US, 2014-20.

Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages 10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4 percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages 10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.

Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth.

Importance: Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. Objective: To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. Design, Setting, and Participants: This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Main Outcomes and Measures: Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Results: Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. Conclusions and Relevance: In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.

Evaluating Firearm Violence After New Jersey's Cash Bail Reform.

Importance: Reducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence. Objective: To evaluate changes in firearm violence after New Jersey's 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention. Design, Setting, and Participants: This case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024. Exposure: Implementation of New Jersey's cash bail reform law in 2017. Main Outcomes and Measures: Quarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people. Results: Although New Jersey's pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, -0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, -0.24 deaths per 100 000), or within racialized groups during the postpolicy period. Conclusions and Relevance: Incarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.

Reporting and Description of Research Methodology in Studies Estimating Effects of Firearm Policies.

BACKGROUND: Evidence about which firearm policies work, to what extent, and for whom is hotly debated, perhaps partly because variation in research methodology has produced mixed and inconclusive effect estimates. We conducted a scoping review of firearm policy research in the health sciences in the United States, focusing on methodological considerations for causal inference. METHODS: We identified original, empirical articles indexed in PubMed from 1 January 2000 to 1 September 2021 that examined any of 18 prespecified firearm policies. We extracted key study components, including policy type(s) examined, policy operationalization, outcomes, study setting and population, study approach and design, causal language, and whether and how authors acknowledged potential sources of bias. RESULTS: We screened 7733 articles and included 124. A plurality of studies used a legislative score as their primary exposure (n = 39; 32%) and did not examine change in policies over time (n = 47; 38%). Most examined firearm homicide (n = 51; 41%) or firearm suicide (n = 40; 32%) as outcomes. One-third adjusted for other firearm policies (n = 41; 33%). Three studies (2%) explicitly mentioned that their goal was to estimate causal effects, but over half used language implying causality (n = 72; 58%). Most acknowledged causal identification assumptions of temporality (n = 91; 73%) and exchangeability (n = 111; 90%); other assumptions were less often acknowledged. One-third of studies included bias analyses (n = 42; 34%). CONCLUSIONS: We identified a range of methodologic approaches in firearm policy research in the health sciences. Acknowledging the imitations of data availability and quality, we identify opportunities to improve causal inferences about and reporting on the effects of firearm policies on population health.

The Characterization of Violent Deaths Among Asian and Pacific Islander Americans.

INTRODUCTION: Health disparities in the Asian and Pacific Islander Americans (APIAs) community have not been well described, unlike non-Hispanic Black and Hispanic communities. However, there has been a rise in violence against the APIA community. This study explores and characterizes violent death by incident (e.g., homicide, suicide), weapon (e.g., firearm, strangulation), and location types among APIAs as they compare with other racial or ethnic groups. METHODS: We used the National Violent Death Reporting System from 2003 to 2018 to characterize violent deaths among APIA and compared them to all other races. We compared these racial categories in two ways. First, we compared all races as a categorical variable that included six non-Hispanic racial categories including "Other or unspecified" and "two or more races. We then created a binary variable of APIA versus All Other Races for analysis. We explored the incident type of death, substance abuse disorders, mental health history, and gang involvement among other variables. We used Chi-square tests for categorical variables and Mann-Whitney U-tests for continuous variables. RESULTS: Overall, APIAs had a unique pattern of violent death. APIAs were more likely to commit suicide (71.74%-62.21%, P<0.001) and less likely to die of homicide than other races (17.56%-24.31%, P<0.001). In the cases of homicide, APIAs were more likely to have their deaths precipitated by another crime (40.87% versus 27.87%, P < 0.001). APIAs were more than twice as likely to die of strangulation than other races (39.93%-18.06%, P<0.001). Conversely, APIAs were less likely to die by firearm than other races (29.69-51.51, P<0.001). CONCLUSIONS: APIAs have a unique pattern of violence based on analysis of data from the National Violent Death Reporting System. Our data reveal a significant difference in the incident, weapon and location type as compared to Americans of other races, which begs further inquiry into the patterns of change in time and factors that contribute to inter-racial differences in death patterns.

Police shootings, violent crime, race and socio-economic factors in municipalities in the United States of America.

BACKGROUND: Both police shootings and violent crime remain high in the United States of America compared to other developed nations but debates continue about whether race, mental health or other social factors are related to them. AIMS: Our aim was to test relationships between community factors indicative of socio-economic status, racial demographics, police shootings, and violent crime. METHODS: Data on police shootings, violent crime and community sociodemographic factors were drawn from two publicly accessible datasets: health and police records of 100 US municipalities and relationships between them explored using regression analyses. RESULTS: Data were from the 100 largest US municipalities as designated by the mapping police violence database. The median per capital violent crime rate was 5.94 and median killings by police per 10 thousand arrests was 13.7. Violent crime was found to be related mainly to income inequality and lower academic achievement in the community. Race was unrelated to violent crime after controlling for other factors. Police shootings were found to be related to community level mental health concerns, food insecurity and the municipality's violent crime rate. CONCLUSION: The evidence suggests that socio-economic factors are the primary drivers of both violent crime perpetration and police shootings. Policy approaches aimed at improving education and reducing poverty are likely to mitigate both violent crime and police shootings. However, it is important to recognise that being Black is an indicator of particular disadvantage within this context. This underscores the need for comprehensive strategies that address the systemic issues of racial disparities and socio-economic inequality, while also acknowledging the complex interplay of race, poverty and policing in the context of violent crime and police shootings.

Racial inequities in homicide rates and homicide methods among Black and White women aged 25-44 years in the USA, 1999-2020: a cross-sectional time series study.

BACKGROUND: In the USA, Black women aged 25-44 years are disproportionately murdered compared with their White counterparts. Despite ongoing efforts to reduce racial and structural inequities, the result of these efforts remains unclear, particularly in light of the COVID-19 pandemic. METHODS: This study examined a cross-sectional time series of homicide death rates, by race, from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research system. We included data for women aged 25-44 years between 1999 and 2020 among 30 states in the USA. Homicide death was classified using underlying cause and multiple cause of death codes; mortality rates were calculated per 100 000 based on US Census Bureau population sizes. Homicide methods were classified as firearm, cutting or piercing, and other. Firearm homicides were compared with other homicides with logistic regression including covariates of race, time, and their interaction. We report odds ratios and 95% CIs. FINDINGS: In 2020, the homicide rate among Black women was 11·6 per 100 000, compared with 3 per 100 000 among White women. This inequity has persisted over time and is virtually unchanged since 1999. Homicide inequities vary across US states; in 11 states, racial inequities have increased since 1999. The racial inequity was greatest in Wisconsin, where in 2019-20, Black women aged 25-44 years were 20 times more likely to die by homicide than White women. Homicide by firearm is increasing in frequency; women in the USA had 2·44 (95% CI 2·14-2·78) times the odds of homicide involving firearms in 2019-20 compared with 1999-2003. Firearm homicide deaths are disproportionately concentrated among Black women in every region in the USA. INTERPRETATION: Our findings suggest that there is an urgent need to address homicide inequities among Black and White women in the USA. Enacting federal legislation that reduces gun access is a crucial step. Policy makers must address long-standing structural factors that underpin elevated gun violence by implementing sustainable wealth-building opportunities; developing desegregated, mixed income and affordable housing; and increasing green spaces in communities where Black women largely reside. FUNDING: National Institute of Mental Health of the National Institutes of Health.

The Association Between State Minimum Wage and Firearm Homicides, 2000-2020.

INTRODUCTION: Recent research has indicated an association between both poverty and income inequality and firearm homicides. Increased minimum wages may serve as a strategy for reducing firearm violence by increasing economic security among workers earning low wages and reducing the number of families living in poverty. This study aimed to examine the association between state minimum wage and firearm homicides in the U.S. between 2000 and 2020. METHODS: State minimum wage, obtained from Temple's Law Atlas and augmented by legal research, was conceptualized using the Kaitz Index. State-level homicide counts were obtained from 2000 to 2020 multiple-cause-of death mortality data from the National Vital Statistics System. Log-linear regressions were conducted to model the associations between state minimum wage and firearm homicides, stratifying by demographic groups. Analyses were conducted in 2023. RESULTS: A 1% point increase in a state's Kaitz Index was associated with a 1.3% (95% CI: -2.1% to -0.5%) decrease in a state's firearm homicide rate. When interacted with quartile of firearm ownership, the Kaitz Index was associated with decreases in firearm homicide in all except the lowest quartile. These findings were largely consistent across stratifications. CONCLUSIONS: Changing a state's minimum wage, whereby a full-time minimum wage worker's salary is closer to a state's median income, may be an option for reducing firearm homicides.

Investing in family-centered early childhood education: A conceptual model for preventing firearm homicide among Black male youth in the United States.

INTRODUCTION: Firearms are now the number one killer of children and adolescents in the United States. Firearm homicides among Black male youth are the driver of this increase. Prevention requires a multi-faceted life course approach. Academic achievement has been identified as a protective factor. Early childhood education, which is linked to later achievement, is thus an intervention area of interest. Conceptualizing the potential links between early childhood education and reduced risk for youth firearm homicide is important for guiding policy advocacy and informing future research. METHODS: This paper presents a conceptual model linking early childhood education to reduced risk for firearm homicide. Each link in the model is discussed, and a corresponding review of the literature is presented. The need for anti-racist policies to strengthen the impact of early childhood education is highlighted. RESULTS: Early education and firearm homicide research are each well-established but largely disconnected. There are clear immediate benefits of early childhood education; however, these effects wane with time, particularly for youth of color. At the same time, juvenile delinquency-a major risk factor for firearm homicide-is influenced by educational inequities. CONCLUSIONS: Effective interventions to reduce firearm homicides among Black male youth in the United States are needed. Early childhood education shows promise as an intervention. However, to have an impact, this education needs to be accessible and affordable for all, particularly families of color and low income. Societal structures and policies must also better support the positive gains seen through early childhood education to avoid dissipation.

Childhood Factors Associated With Unnatural Death Through Midadulthood.

Importance: Life expectancy is decreasing in the US. Without national efforts to address factors that support policies and programs directed at children living in areas of concentrated poverty, life expectancy will likely continue to decline while costs and suffering associated with unnatural deaths will increase. Objective: To identify which childhood factors are associated with death from unnatural causes through midadulthood. Design, Setting, and Participants: For this cohort study, longitudinal data on childhood characteristics came from a group-randomized intervention trial implemented in Baltimore City Public Schools, Baltimore, Maryland (baseline 1985-1986; all students entering first grade were selected to participate at age 6 years). Participants were followed up to midadulthood with a National Death Index search through December 31, 2020. Data analysis was performed from February to May 2023. Exposures: Exposures included individual factors (ie, sociodemographic characteristics, teacher-reported aggressive behavior, self-reported depression, anxiety, early alcohol and cannabis use, and assaultive violence exposure), family and peer factors (ie, household structure and education level, deviant peer affiliation, and parental monitoring), and neighborhood factors (ie, rates of neighborhood assault and public assistance). Main Outcomes and Measures: The main outcome was unnatural death, defined as death due to unintentional injury, suicide, and homicide. A National Death Index search ascertained participants who died by age 41 to 42 years and cause of death. Multivariable Cox proportional hazards models were used to identify whether the exposures were independently associated with future mortality by unnatural causes. Results: The initial trial included 2311 children, and longitudinal data were available for 2180 participants (median [IQR] age in first grade, 6.3 [6.0-6.5] years; 1090 female [50.0%]; 1461 Black [67.0%]; 1168 received free or reduced lunch in first grade [53.6%]). A total of 111 male participants (10.2%) and 29 female participants (2.7%) died; among those who died, 96 male participants (86.5%) and 14 female participants (48.3%) died of unnatural causes. Two factors remained significantly associated with mortality from unnatural causes: female sex was associated with reduced risk (hazard ratio, 0.13; 95% CI, 0.08-0.22), and neighborhood public assistance was associated with increased risk (hazard ratio, 1.89; 95% CI, 1.09-3.30). Conclusions and Relevance: In this urban population-based cohort study, no modifiable risk factors of mortality at the level of the individual (eg, depression or anxiety and substance use) or the family (eg, household education level) were identified. However, the degree of neighborhood poverty in early childhood was significantly associated with death by unnatural causes in early adulthood, suggesting that economic policies are needed to advance health equity in relation to premature mortality.

Disproportionate burden of violence: Explaining racial and ethnic disparities in potential years of life lost among homicide victims, suicide decedents, and homicide-suicide perpetrators.

Research indicates that the burden of violent death in the United States is disproportionate across racial and ethnic groups. Yet documented disparities in rates of violent death do not capture the full extent of this inequity. Recent studies examining race-specific rates of potential years of life lost-a summary measure of premature mortality-indicate that persons of color may die at younger ages than their counterparts, leading to increased trauma among surviving family members, friends, and communities. This study examines racial and ethnic disparities in potential years of life lost among people who died by homicide and suicide. We calculated potential years of life lost using life expectancy values specific to each racial and ethnic group, thereby isolating racial differences in potential years of life lost due to violence. Findings indicated that persons of color were disproportionately impacted by violence. Non-Hispanic African American homicide victims, suicide decedents, and homicide-suicide perpetrators died eleven or more years earlier than their non-Hispanic White counterparts. Similar disparities were observed for non-Hispanic Asian or Pacific Islander decedents. Less pronounced differences were observed for Hispanic and non-Hispanic American Indian or Alaska Native decedents. These racial and ethnic disparities were partly accounted for by a broad array of individual differences, incident characteristics, and contextual factors. The results suggest that homicide and suicide exact a high societal cost, and the burden of that cost is disproportionately high among persons of color.

Modeling the Relationship Between Firearm Restrictions, Medicaid Expansion, and Political Partisanship with Pediatric Firearm Mortality Costs.

INTRODUCTION: Firearms are now the leading cause of pediatric mortality in the U.S., but few studies have investigated the economic impact of these deaths. Thus, this study determined whether multiple different gun-related measures, political partisanship and Medicaid expansion were related to the costs of pediatric gun deaths. METHODS: Each states' medical costs, years of potential life lost (YPLL), and value of statistical life (VSL) lost due to pediatric gun deaths were extracted from the WISQARS database from 2015 to 2020. Seven firearm laws or restrictiveness measures (assault weapons bans, child access prevention laws, firearm registration and permit to purchase requirements, safe storage laws, Giffords Law Center ranking, and the number of firearm provisions), the Cook Partisan Voting Index (PVI), and Medicaid expansion status were determined across states. Unadjusted analyses compared each measure and (1) medical costs, (2) VSL, and (3) YPLL for each state. These were repeated using adjusted analyses, controlling for poverty, educational attainment, poor mental health, and race. RESULTS: Of the 9 variables assessed, unadjusted analyses revealed that 8 variables were significantly associated with increased medical costs, all 9 were associated with higher VSL and 8 were associated with higher YPLL due to pediatric firearm-related mortality. Multivariable analyses revealed that 7 variables were associated with medical costs, 7 were associated with VSL and 6 were associated with YPLL. CONCLUSION: States with fewer gun laws and those which have not adopted Medicaid expansion were more likely to experience a higher economic burden due to pediatric gun deaths. Quantifying the costs of these deaths can demonstrate the social toll of gun violence to policymakers and the general public. LEVEL OF EVIDENCE: III.

Modification of Firearm Law-Firearm Injury Association by Economic Disadvantage.

INTRODUCTION: Firearm-related injuries in the U.S. have risen 37% since 2015. Understanding how the association between firearm incidents and state-level firearm restrictiveness is modified by community-level distress and economic connectedness (EC) may inform upstream injury prevention efforts. METHODS: A national cross-sectional study of firearm incidents (interpersonal and unintentional firearm events) occurring between 1/2015 and 12/2021 was performed using the Gun Violence Archive. The exposures were community distress (Distressed Communities Index, DCI), EC, and year-state-level firearm restrictiveness. The primary outcome was mean annual urban firearm incidence rate per ZIP Code Tabulation Area. Generalized linear mixed models were fit to evaluate the modification of the firearm law-firearm incident association by DCI and EC. Data analyses took place in 2022. RESULTS: About 266,020 firearm incidents were included. The mean rate was higher with each DCI tertile, with a RR of 3.18 (95% CI: 3.06, 3.30) in high versus low distress communities. Low EC was associated with over 1.8 times greater rate of firearm-related injury. The least restrictive firearm laws were associated with 1.20 times higher risk of firearm incidents (95% CI: 1.12, 1.28). The association between restrictive laws and lower incidence rates was strongest in low and medium distress and high EC communities. CONCLUSIONS: Stricter firearm laws are associated with lower rate of firearm incidents. The magnitude of this association is smallest for communities experiencing the greatest economic disadvantage.

Racial Disparity among Youth Decedents of Legal Intervention Trauma.

BACKGROUND: Legal intervention trauma (LIT) is defined as injury due to any encounter with law enforcement. This study investigates associations between demographics, violent status, and law enforcement tactics among youth decedents of LIT. STUDY DESIGN: Decedents of LIT age 26 years or younger were identified using the CDC's National Violent Death Reporting System from 2003 to 2018. Decedents were classified as "violent" if they possessed a weapon, were committing a violent crime, or if law enforcement reported justified use of force. All others were classified as "nonviolent." Law enforcement tactics were stratified into "lethal" (firearm with standard ammunition) or "less lethal" (any other) force. Differences in the racial distribution across these classifications were assessed using chi-square tests of proportions. RESULTS: We identified 1,281 youth decedents of LIT; of which, 92.5% met violent criteria. Black youths were less likely than White youths to possess a weapon (71.6% vs 77.4%, p = 0.02) and were not more likely to be committing a violent crime (63.6% vs 60.4%, p = 0.27). They were, however, more likely than White youths to experience force reported as justified by law enforcement (89.9% vs 82.4%, p = 0.002) and to experience exclusively lethal force not preceded by less-lethal tactics (94.0% vs 88.7%, p = 0.001). Among the subset of 85 cases where law enforcement reported justified use of force despite the decedent not possessing a weapon or committing a violent crime, the precipitating event was more often a traffic stop for Black youths than for White youths (28.5% vs 6.66%, p = 0.02). CONCLUSIONS: These findings indicate a racial disparity among youth decedents of LIT.

Systematic Review of Per Person Violence Costs.

INTRODUCTION: Data on the long-term and comprehensive cost of violence are essential for informed decision making regarding the future benefits of resources directed toward violence prevention. This review aimed to summarize original per-person estimates of the attributable cost of interpersonal violence to support public health economic research and decision making. METHODS: In 2023, English-language peer-reviewed journal articles published in 2000-2022 with a focus on high-income countries reporting original per-person average cost of violence estimates were identified using index terms in multiple databases. Study contents, including violence type (e.g., adverse childhood experiences), timeline and payer cost perspective (e.g., hospitalization event-only healthcare payer cost), and associated per-person cost estimates, were summarized. Costs were in 2022 U.S. dollars. RESULTS: Per-person cost estimates related to adverse childhood experiences, community violence, sexual violence, intimate partner violence, homicide, firearm violence, youth violence, workplace violence, and bullying from 73 studies (majority focusing on the U.S.) were summarized. For example, among 23 studies with a focus on adverse childhood experiences, monetary estimates ranged from $390 for adverse childhood experience-related annual healthcare out-of-pocket costs per U.S. adult with ≥3 adverse childhood experiences to $20.2 million for the lifetime societal economic burden of a U.S. child maltreatment fatality. CONCLUSIONS: This review provides a descriptive summary of available per-person cost of violence estimates. Results can help public health professionals to describe the economic burden of violence, identify the best available estimate for a particular public health question, and address data gaps. Ultimately, understanding the long-term and comprehensive cost of violence is necessary to anticipate the economic benefits of prevention.

Contemporary slave labor and subjectivity: psychosocial perspectives on the enslaved's narratives / Trabalho escravo contemporâneo e subjetividade: considerações psicossociais sobre narrativas de escravizado(a)s / Trabajo esclavo contemporáneo y subjetividad: consideraciones psicosociales sobre narrativas de personas esclavizadas

This study addresses the relation between subjectivity and contemporary enslaved labor from the enslaved workers' narratives in Brazil. A qualitative social research was carried out based on a constructionist perspective. We sought interaction with rescued workers and used (a) participant observation of workers' routine in an institutional project that supports them and a field diary, (b) semi-structured and open individual interviews with workers and a member of the team project. The fieldwork lasted a year and a half and the analysis followed Content Analysis. Freudian theory and Foucault's thought were used for interpretation, which managed to understand aspects of workers' experiences, exploitation characteristics, parental abandonment, as well as the tensions in self-classification as enslaved. The narratives pointed to a dramatic reality manifested in body exploitation, authoritarian abuses, violence, and negligence. At the same time, these narratives showed forms of worker resistance that calls for further investigations to increase knowledge on the subjective experiences of those who were enslaved.(AU)

O artigo aborda as relações entre subjetividade e trabalho escravo contemporâneo a partir da narrativa de trabalhadores(as) escravazados(as). Foi realizada uma pesquisa social qualitativa em uma perspectiva construcionista. Buscamos a interação com trabalhadores resgatados e realizamos a observação participante da rotina de trabalhadores atendidos em um projeto institucional, com diário de campo, e entrevistas individuais (semiestruturadas e abertas) com trabalhadores(as) e equipe do projeto institucional. O trabalho de campo durou um ano e meio, e a pesquisa foi realizada com o suporte da Análise de Conteúdo. Para a interpretação utilizamos aportes da teoria freudiana e do pensamento de Foucault, com os quais foi possível compreender aspectos das vivências dos trabalhadores, características da exploração, abandonos parentais e tensões em torno da autoclassificação como "escravo". As narrativas apontaram uma realidade dramática manifesta na exploração do corpo, em abusos autoritários, na violência e negligência. Ao mesmo tempo, as narrativas evidenciaram formas de resistência dos trabalhadores que convocam mais investigações para adensar o conhecimento sobre as experiências subjetivas desses que estão num lugar de escravizado(a).(AU)

Este artículo aborda la relación entre la subjetividad y el trabajo esclavo contemporáneo desde la narrativa de trabajadores esclavizados. Se realizó una investigación social cualitativa desde una perspectiva construccionista. Buscamos la interacción con los trabajadores liberados y utilizamos la observación participante de la rutina de los trabajadores atendidos en un proyecto institucional, diario de campo y entrevistas individuales (semiestructuradas y abiertas) con trabajadores y miembros del equipo del proyecto institucional. El trabajo de campo duró un año y medio, y se utilizó como apoyo el análisis de contenido. Para la interpretación se utilizaron aportes de la teoría freudiana y el pensamiento de Foucault, con lo que fue posible comprender aspectos de las vivencias de los trabajadores, características del escenario de explotación, abandono parental y las tensiones relacionadas con la autoclasificación "esclavo". Las narrativas apuntan a una realidad dramática manifestada en la explotación del cuerpo, abuso autoritario, violencia y abandono. Al mismo tiempo, evidenciaron formas de resistencia por parte de los trabajadores, que reclaman más investigaciones para profundizar en el conocimiento sobre las vivencias subjetivas de quienes se encuentran en esclavitud.(AU)

The Health and Economic Impact of Youth Violence by Injury Mechanism.

INTRODUCTION: Violence is a leading cause of morbidity and mortality among U.S. youth. More information on the health and economic burden of the most frequent assault mechanisms-or, causes (e.g., firearms, cut/pierce)-can support the development and implementation of effective public health strategies. Using nationally representative data sources, this study estimated the annual health and economic burden of U.S. youth violence by injury mechanism. METHODS: In 2023, CDC's WISQARS provided the number of homicides and nonfatal assault ED visits by injury mechanism among U.S. youth aged 10-24 years in 2020, as well as the associated average economic costs of medical care, lost work, morbidity-related reduced quality of life, and value of statistical life. The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample provided supplemental nonfatal assault incidence data for comprehensive reporting by injury mechanism. RESULTS: Of the $86B estimated annual economic burden of youth homicide, $78B was caused by firearms, $4B by cut/pierce injuries, and $1B by unspecified causes. Of the $36B billion estimated economic burden of nonfatal youth violence injuries, $19B was caused by struck by/against injuries, $3B by firearm injuries, and $365M by cut/pierce injuries. CONCLUSIONS: The lethality of assault injuries affecting youth when a weapon is explicitly or likely involved is high-firearms and cut/pierce injuries combined account for nearly all youth homicides compared to one-tenth of nonfatal assault injury ED visits. There are numerous evidence-based policies, programs, and practices to reduce the number of lives lost or negatively impacted by youth violence.

Risk and Protective Factors for Firearm Assault Injuries Among Black Men: A Scoping Review of Research.

Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.