Youth Violence and African Americans: Perspectives from

Emergency Medicine

Youth Violence and African Americans: Perspectives from

Emergency Medicine

Rob Gore, MDSUNY Downstate - Kings County

Department of Emergency MedicineFebruary 10, 2007

Rob Gore, MDSUNY Downstate - Kings County

Department of Emergency MedicineFebruary 10, 2007

OutlineOutline

Epidemiology, Demographics and Trends

Youth Violence Risk FactorsIntervention and Prevention

Epidemiology, Demographics and Trends

Youth Violence Risk FactorsIntervention and Prevention

Youth ViolenceYouth Violence

> 800, 000 violent acts involving youth5,570 homicides – U.S. 2003Firearm homicide rate 17 times higher

than other industrialized nations (5-14 yrs)

Homicide is the #2 cause of death for U.S. Youth (10-19 years)

#1 cause of death in African American youth

> 800, 000 violent acts involving youth5,570 homicides – U.S. 2003Firearm homicide rate 17 times higher

than other industrialized nations (5-14 yrs)

Homicide is the #2 cause of death for U.S. Youth (10-19 years)

#1 cause of death in African American youth

National Center for Injury And Prevention Control

Youth HomicideYouth Homicide

Most murder victims ages 12-17 are black

Males account for > 67% of homicides

Most murder victims ages 12-17 are black

Males account for > 67% of homicides

US Dept of Justice - OJJDPImage by Hank Willis Thomas

Violence and the Emergency Department

Violence and the Emergency Department

3 million ED visits/year related to violence

Traumatic assault is recurrentHospital readmission rates

Subsequent assault – 44%Subsequent homicides – 20%

3 million ED visits/year related to violence

Traumatic assault is recurrentHospital readmission rates

Subsequent assault – 44%Subsequent homicides – 20%

Denninghoff, et al.

Recent Observed and Projected Firearm- and Motor Vehicle Related

Injury and Deaths

Recent Observed and Projected Firearm- and Motor Vehicle Related

Injury and Deaths

Nonfatal Violent InjuryNonfatal Violent Injury

Increased rates across U.S. Major cause of disability94 nonfatal injuries for every

homicidal deathRecurrent rates between 5% and

45% over the 5 years subsequent to the initial injury

Increased rates across U.S. Major cause of disability94 nonfatal injuries for every

homicidal deathRecurrent rates between 5% and

45% over the 5 years subsequent to the initial injury

Rich, et al.

Economic Costs of Gun Violence

Economic Costs of Gun Violence

> $18,000 for gun assault injuries

Indirect costs:$800 million –

1997$100 – 126 billion

per year (Cook et al.)

> $18,000 for gun assault injuries

Indirect costs:$800 million –

1997$100 – 126 billion

per year (Cook et al.)

http://www.bradycampaign.org/

Re-injury Risk FactorsRe-injury Risk Factors

Substance abuse School failure Weapon possession Poverty Male gender Black race Gang involvement Exposure to

television violence

Substance abuse School failure Weapon possession Poverty Male gender Black race Gang involvement Exposure to

television violence

Rich, et al.

Urban Youth Perspectives on Violence and the Necessity of

Fighting

Urban Youth Perspectives on Violence and the Necessity of

FightingJohnson et al.

13 focus groups120 Urban youth

Causes of Violence – Multi-factorialStressSubstance abuseWitnessing violenceDisrespectStanding up for friendsNeighborhood “Beef”

Johnson et al.13 focus groups

120 Urban youth

Causes of Violence – Multi-factorialStressSubstance abuseWitnessing violenceDisrespectStanding up for friendsNeighborhood “Beef”

Pathways to Recurrent Trauma Among Young Black

Men

Pathways to Recurrent Trauma Among Young Black

MenRich et al.

Qualitative analysis49 Black male violence victim narratives

Factors Related to safety after violent InjuryLoss of Respect

Code of the Street

Lack of Faith in PoliceTrauma Stress

Rich et al.Qualitative analysis49 Black male violence victim narratives

Factors Related to safety after violent InjuryLoss of Respect

Code of the Street

Lack of Faith in PoliceTrauma Stress

Rich, et al.

“Code of the Street”“Code of the Street”

“Informal rules governing interpersonal public behavior, particularly violence”

Lack of aggressive response associated as “tolerating victimization”

“Informal rules governing interpersonal public behavior, particularly violence”

Lack of aggressive response associated as “tolerating victimization”

Pathways to RecurrencePathways to Recurrence

Rich, et al.

Risk Factors in School Shootings

Risk Factors in School Shootings

Verlinden et al. – 2000

9 incidents of multiple homicides in Secondary schools

Risk Factors identified

Verlinden et al. – 2000

9 incidents of multiple homicides in Secondary schools

Risk Factors identified

Columbine, Oregon, Conyers -Risk Factors for School

Shootings

Columbine, Oregon, Conyers -Risk Factors for School

ShootingsSchool FailureFrequent fightingWeapon

possessionAlcohol abuseExposure to

violenceGang involvementFamily problems

School FailureFrequent fightingWeapon

possessionAlcohol abuseExposure to

violenceGang involvementFamily problems

Verlinden et al

Where we (EM Physicians) Fail

Where we (EM Physicians) Fail

Inadequately prepared to conduct interventions

Lack of available resources for appropriate referral

Lack of established intervention protocols

Focus on consequences of violence

Inadequately prepared to conduct interventions

Lack of available resources for appropriate referral

Lack of established intervention protocols

Focus on consequences of violence

Denninghoff, et al.

Ideal Place for Intervention – Emergency Department

Ideal Place for Intervention – Emergency Department

First to encounter individuals after violence

Parental/guardian availability when treating underage youth

# of high risk groups receive majority of care in the ED

First to encounter individuals after violence

Parental/guardian availability when treating underage youth

# of high risk groups receive majority of care in the ED

Denninghoff, et al.

Competencies for Effective Practice

Competencies for Effective Practice

Three Levels of Competence in Youth ViolenceLevel 1 – Generalist Level 2 – Specialist Level 3 – Scholars / Leaders

Three Levels of Competence in Youth ViolenceLevel 1 – Generalist Level 2 – Specialist Level 3 – Scholars / Leaders

Denninghoff, et al.

Level 1 - GeneralistLevel 1 - Generalist

Basic knowledge of youth violenceUnderstanding of risk and

protective factorsSelf knowledge - personal

experience

Basic knowledge of youth violenceUnderstanding of risk and

protective factorsSelf knowledge - personal

experience

Level 2 - SpecialistLevel 2 - Specialist

Specific clinical interventionsInitiation of violence related injury

referralsScreening persons at risk for

violence related injuryAware of community programs and

advocacy groups

Specific clinical interventionsInitiation of violence related injury

referralsScreening persons at risk for

violence related injuryAware of community programs and

advocacy groups

Level 3 - Scholars and Leaders

Level 3 - Scholars and Leaders

Training other health professionals in violence prevention

Training other health professionals in violence prevention

Strategies to Reduce Youth Violence

Strategies to Reduce Youth Violence

Kellerman et al. 1998Types of Programs Studied

Early Childhood Family InterventionsYouth and Adolescent InterventionsCommunity Level Interaction

Kellerman et al. 1998Types of Programs Studied

Early Childhood Family InterventionsYouth and Adolescent InterventionsCommunity Level Interaction

Take HomeTake Home

Youth violence is a public health issue

Screen for risk factorsEducate those at riskGet Involved!!!!

Youth violence is a public health issue

Screen for risk factorsEducate those at riskGet Involved!!!!

Youth Violence OrganizationsYouth Violence Organizations

Doctors Against Murder (New York)(917) 440-9526

Project Brotherhood (Chicago)(773) 753 – 5508

Omega Boys Club (San Francisco)(800) 765 - 3437

Violence Prevention Institute (New Jersey)(973) 395 - 0311

Doctors Against Murder (New York)(917) 440-9526

Project Brotherhood (Chicago)(773) 753 – 5508

Omega Boys Club (San Francisco)(800) 765 - 3437

Violence Prevention Institute (New Jersey)(973) 395 - 0311

Questions?Questions?

“Priceless” by Hank Willis Thomas

BibliographyBibliography Denninghoff, K.R., Knox, L., Cunningham, R., Paratain, S. (2002). “Emergency

Medicine: Competencies for youth violence prevention and control.” Academic Emergency Medicine (9): 9, p.947.

Johnson, S.B., Frattaroli, S., Wright, J.L., Pearson-Fields, C.B. and Cheny, T.L. (2004). Urban Youths Perspective on Violence and the Necessity of Fighting. Injury Prevention (10): 287-291

Miller M, Azrael D, Hemenway D (2002) Firearm Availability and Unintentional Firearm Deaths, Suicide and Homicide among 5-14 Year Olds. J Trauma 52(2):267-275

Rich JA, Grey CM, (2005). Pathways to Recurrent Trauma Among young Black Men: Traumatic Stress, Substance Use and the “Code of the Street”. Am J Public Health 95(5): 816-824

Twemlow, S.W., Sacco, F.C. (1998). The Application of Traditional Martial Arts Practice and Theory to the Treatment of Violent Adolescents. Adolescence 30(131): 505-518

Verlinden, S., Hersen, M., Thomas, J. (2000). Risk Factors in School Shootings. Clinical Psych Review (20): 3-56

Wintemute, G. (2002) Where the Guns Come From: The Gun Industry and Gun Commerce. Future of the Children (12): 55-71

Yonas, MA (2004). Addressing Youth Violence. J Public Health Management Practice 10(6):567-568

Child and Adolescent Injury in Chicago, 1999-2001. Children’s Memorial Research Center June 2005

National Center for Injury Prevention and Control [Website]. Available at http://www.cdc.gov/ncipc/factsheets/yvfacts.htm

Almighty Latin King and Queen Nation [Website]. Available at http://www.gripe4rkids.org/Lkhis.html

The Brady Law: Preventing Crime and Saving Lives [Website]. Available at http://www.bradycampaign.org/facts/research/?page=bradyprev&menu=gvr

Denninghoff, K.R., Knox, L., Cunningham, R., Paratain, S. (2002). “Emergency Medicine: Competencies for youth violence prevention and control.” Academic Emergency Medicine (9): 9, p.947.

Johnson, S.B., Frattaroli, S., Wright, J.L., Pearson-Fields, C.B. and Cheny, T.L. (2004). Urban Youths Perspective on Violence and the Necessity of Fighting. Injury Prevention (10): 287-291

Miller M, Azrael D, Hemenway D (2002) Firearm Availability and Unintentional Firearm Deaths, Suicide and Homicide among 5-14 Year Olds. J Trauma 52(2):267-275

Rich JA, Grey CM, (2005). Pathways to Recurrent Trauma Among young Black Men: Traumatic Stress, Substance Use and the “Code of the Street”. Am J Public Health 95(5): 816-824

Twemlow, S.W., Sacco, F.C. (1998). The Application of Traditional Martial Arts Practice and Theory to the Treatment of Violent Adolescents. Adolescence 30(131): 505-518

Verlinden, S., Hersen, M., Thomas, J. (2000). Risk Factors in School Shootings. Clinical Psych Review (20): 3-56

Wintemute, G. (2002) Where the Guns Come From: The Gun Industry and Gun Commerce. Future of the Children (12): 55-71

Yonas, MA (2004). Addressing Youth Violence. J Public Health Management Practice 10(6):567-568

Child and Adolescent Injury in Chicago, 1999-2001. Children’s Memorial Research Center June 2005

National Center for Injury Prevention and Control [Website]. Available at http://www.cdc.gov/ncipc/factsheets/yvfacts.htm

Almighty Latin King and Queen Nation [Website]. Available at http://www.gripe4rkids.org/Lkhis.html

The Brady Law: Preventing Crime and Saving Lives [Website]. Available at http://www.bradycampaign.org/facts/research/?page=bradyprev&menu=gvr

Bibliography cntd.Bibliography cntd. The Brady Law: Preventing Crime and Saving Lives [Website].

Available at http://www.bradycampaign.org/facts/research/?page=bradyprev&menu=gvr

National Rifle Association Institute for Legislative Action. http://www.nraila.org/News/Read/InTheNews.aspx?ID=6371

New Yorkers Against Gun Violence: http://www.nyagv.org/facts.htm U.S. Department of Justice - Bureau of Justice Statistics: Homicide

Trends in the U.S. http://www.ojp.usdoj.gov/bjs/homicide/teens.htm#vage

House Research Organization: Texas House of Representatives Focus Report. April 2002. http://www.hro.house.state.tx.us/focus/gunshow.pdf

The Coalition to Stop Gun Violence. http://www.csgv.org/issues/illegalmarkets/gunshowloop/

The Brady Law: Preventing Crime and Saving Lives [Website]. Available at http://www.bradycampaign.org/facts/research/?page=bradyprev&menu=gvr

National Rifle Association Institute for Legislative Action. http://www.nraila.org/News/Read/InTheNews.aspx?ID=6371

New Yorkers Against Gun Violence: http://www.nyagv.org/facts.htm U.S. Department of Justice - Bureau of Justice Statistics: Homicide

Trends in the U.S. http://www.ojp.usdoj.gov/bjs/homicide/teens.htm#vage

House Research Organization: Texas House of Representatives Focus Report. April 2002. http://www.hro.house.state.tx.us/focus/gunshow.pdf

The Coalition to Stop Gun Violence. http://www.csgv.org/issues/illegalmarkets/gunshowloop/