Article

Changes in Attitudes toward Guns and Shootings following Implementation of the Baltimore Safe Streets Intervention

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Abstract

Among youth 15 to 24 years of age, homicide and nonfatal shootings are the leading causes of mortality and morbidity. Urban youth's attitudes and perceptions about the use of gun violence to resolve conflict present a major barrier to efforts to reduce gun homicides and nonfatal shootings. The current investigation extends the existing literature on attitudes toward guns and shootings among high-risk youth ages 18 to 24 by measuring perceived norms and viewpoints regarding gun violence in two analogous Baltimore City neighborhoods pre-implementation and 1-year post-implementation of the Safe Streets intervention (adapted from the CeaseFire/Cure Violence intervention). The Safe Streets intervention is designed for communities with high rates of gun violence and utilizes outreach workers to identify and build trusting relationships with youth ages 15 to 24 who are at greatest risk of being involved in gun violence. The outreach workers also position themselves in the community so that they can rapidly intervene in disputes that have the potential to lead to gun violence. Chi-squared tests and exploratory structural equation modeling (ESEM) were used to examine changes in attitudes toward gun violence 1 year after the implementation of the Safe Streets intervention. There was a statistically significantly improvement in 43 % of the attitudes assessed in the intervention community post-intervention compared to 13 % of the attitudes in the control community. There was a statistically significant improvement in the violent attitudes toward personal conflict resolution scale after implementation of the intervention in both the intervention (b = -0.522, p < 0.001) and control community (b = -0.204, p < 0.032). Exposure to the intervention (e.g., seeing stop shooting signs in your neighborhood) was also associated with the nonviolent attitudes toward conflict scale. Overall, the study found greater improvement in attitudes toward violence in the intervention community following the implementation of the Safe Streets program. These findings offer promising insights into future community violence prevention efforts.

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... targeted residents of the area(s) in which the PBA was implemented, while two publications (2.9%) did not. These two were non-CTC publications, one of which targeted young people frequenting a particular area, regardless of whether they lived there or not (Milam et al., 2016), and the other which, aside from residents, also targeted people who worked in or were involved with community organisations in the target neighbourhoods (Hausman, Siddons, & Becker, 2000). It should also be noted that most CTC PBAs, while initially targeting students who remained in the intervention or control communities for at least one semester, continued to track and survey all participants annually, including those who had left the PBA communities (see, for example, M. R. Kuklinski, Briney, Hawkins, & Catalano, 2012; M. R. Kuklinski, Fagan, Hawkins, Briney, & Catalano, 2015;Rhew, Oesterle, Coffman, & Hawkins, 2018). ...
... • Cultural and contextual relevance of programmes: selecting programmes that are compatible with local culture and values or that are adapted for the type of violence in the community (e.g. Knox et al., 2011;Milam et al., 2016). For example, Steketee et al. (2013) • Programme novelty: e.g. Kelly et al. (2010) , however no further information is provided in the text to explain how novelty was conceptualised. ...
... • Capacity to deliver interventions at multiple levels: for instance, the Safe Streets Program was chosen in part due to its tenets and multi-layered approach to intervention (Milam et al., 2016). ...
Technical Report
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This report sets out the findings of a series of linked studies drawing together evidence about place based approaches (PBAs) to reduce youth violence. The project was commissioned by the Youth Endowment Fund (YEF) to support its key strategic work using PBAs and undertaken by a research consortium consisting of the Centre for Evidence and Implementation, Monash University and the Violence Research Centre (University of Cambridge).
... These recommendations included direct interventions such as improved building security, resident patrol, and a willingness for residents to intervene when they see someone in distress. Recommendations for bystander intervention build upon past literature highlighting how addressing community-based social norms can reduce violence (Milam et al., 2016;Webster et al., 2012). Additionally, participant recommendations to reduce community violence consisted of indirect intervention targeting institutions for more longterm results. ...
... Community programs using this approach employ trained violence intervention workers who have strong and trusted relationships within the community and can engage in outreach and direct interruption or mediation of neighborhood conflicts. Research capturing the efficacy of such programs in reducing gun violence have produced promising results (Milam et al., 2016;Webster et al., 2012) but more studies are needed. ...
Article
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This study provides insight into New York City residents' perceptions about violence after the outbreak of Coronavirus disease (COVID-19) based on information from communities in New York City Housing Authority (NYCHA) buildings. In this novel analysis, we used focus group and social media data to confirm or reject findings from qualitative interviews. We first used data from 69 in-depth, semi-structured interviews with low-income residents and community stakeholders to further explore how violence impacts New York City's low-income residents of color, as well as the role of city government in providing tangible support for violence prevention during co-occurring health (COVID-19) and social (anti-Black racism) pandemics. Residents described how COVID-19 and the Black Lives Matter movement impacted safety in their communities while offering direct recommendations to improve safety. Residents also shared recommendations that indirectly improve community safety by addressing long term systemic issues. As the recruitment of interviewees was concluding, researchers facilitated two focus groups with 38 interviewees to discuss similar topics. In order to assess the degree to which the themes discovered in our qualitative interviews were shared by the broader community, we developed an integrative community data science study which leveraged natural language processing and computer vision techniques to study text and images on public social media data of 12 million tweets generated by residents. We joined computational methods with qualitative analysis through a social work lens and design justice principles to most accurately and holistically analyze the community perceptions of gun violence issues and potential prevention strategies. Findings indicate valuable community-based insights that elucidate how the co-occurring pandemics impact residents' experiences of gun violence and provide important implications for gun violence prevention in a digital era.
... 34,35 Furthermore, street outreach programs, which train staff to mediate conflicts and promote social norms that protect against violence, may reduce violence and youths' acceptability of violence when implemented well. 36 These findings support previous research showing that increased collective efficacy (e.g., neighborhood contexts of trust and solidarity that facilitate residents' willingness to intervene to prevent violence) is inversely related to community violence, 37 and suggest that community approaches can benefit youth living in urban neighborhoods. ...
... 21 A cost-benefit analysis in the state of Washington showed that connecting youth to caring adults through school-based mentoring yielded between $15 and $24 in return for every $1 of cost. 28,36 A well-developed body of research shows nurturing and supportive relationships between caregivers and children significantly lowers risk of violence. 21,32 Parenting skill and family relationship programs promote caregivers' knowledge about age-appropriate child development, strategies for enhancing communication and behavioral monitoring, and management in childhood and adolescence. ...
Article
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Introduction: The purpose of this study is to characterize violence-related disparities experienced by young blacks in the U.S. Reducing violence experienced by blacks, particularly youth, who are at substantially higher risk, is essential to improving the health of blacks in the U.S. Methods: Data from four independent data sets for youth and adults were analyzed to examine rates of homicide, assault, injury from a physical fight, bullying victimization, and missing school because of safety concerns for non-Hispanic blacks and whites aged 10-34 years between 2010 and 2015. Disparities in adverse childhood experiences (e.g., exposure to violence and household challenges) and physical/mental health outcomes in adulthood were examined. Data were analyzed in 2017. Results: Black adolescents and young adults are at higher risk for the most physically harmful forms of violence (e.g., homicides, fights with injuries, aggravated assaults) compared with whites. In addition, black adults reported exposure to a higher number of adverse childhood experiences than whites. These adverse childhood experiences were positively associated with increased odds of self-reported coronary heart disease, fair or poor physical health, experiencing frequent mental distress, heavy drinking, and current smoking. Conclusions: Disproportionate exposure to violence for blacks may contribute to disparities in physical injury and long-term mental and physical health. Understanding the violence experiences of this age group and the social contexts surrounding these experiences can help improve health for blacks in the U.S. Communities can benefit from the existing evidence about policies and programs that effectively reduce violence and its health and social consequences.
... Milam and colleagues, for example, examined changes in attitudes toward violence in two Baltimore neighborhoods and found similar results. There were significant improvements (43%) in attitudes among residents of a community after the introduction of Cure Violence compared with a control community (13%) (Milam et al. 2016). ...
Technical Report
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New York City launched its first Cure Violence program— which uses community outreach to interrupt violence—in 2010 with funding from the U.S. Department of Justice. Today, there are 18 programs around the city. This report examines two of them: Man Up! Inc. in East New York, Brooklyn; and Save Our Streets South Bronx. Each of the two neighborhoods was compared with another neighborhood that had similar demographics and crime trends but no Cure Violence program. As detailed in this report, the comparisons provide promising evidence that the public health approach to violence reduction championed by Cure Violence may be capable of creating safe and healthy communities.
... For example, the Cure Violence intervention, which has been replicated in dozens of cities around the United States, has been found to reduce youths' willingness to turn to violence to resolve conflict and increase confidence in the community in its collective ability to reduce gun violence. 28,29 Researchers have also found that the program increased preferences for nonviolent responses to interpersonal conflicts. 30 However, studies of Cure Violence's impact on gun violence outcomes, while generally positive, have produced varied estimates of program effect across sites-sometimes within the same city-with some studies reporting null or negative results. ...
... For example, research shows that deploying teams of trained mental health professionals paired with medics in place of law enforcement officers substantially decreases the likelihood that people experiencing nonviolent crises will enter criminal legal systems (Dholakia & Gilbert, 2021). Community interventions involving "violence interrupters" and outreach workers also appear to be an effective means of reducing violent crime through conflict mediation without reliance on police or criminal legal intervention (Cerdá et al., 2018;Milam et al., 2016;Webster et al., 2013). ...
Article
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Objectives: In October 2021, the American Psychological Association (APA) passed a resolution addressing ways psychologists could work to dismantle systemic racism in criminal legal systems. In the present report, developed to inform APA's policy resolution, we detail the scope of the problem and offer recommendations for policy makers and psychologists to address the issue by advancing related science and practice. Specifically, we acknowledge the roots of modern-day racial and ethnic disparities in rates of criminalization and punishment for people of color compared with White people. Next, we review existing theory and research that helps explain the underlying psychological mechanisms driving racial and ethnic disparities in criminal legal systems (e.g., endorsement of negative stereotypes, explicit and implicit bias). We also elucidate how racially disparate treatment generates downstream negative mental health consequences for people of color. Conclusions: Evidence-based recommendations to work toward eliminating systemic racism in the criminal legal systems include (a) rigorous measurement and analysis of disparities; (b) targeted changes in policy, practice, and law; (c) increased access to culturally aware and competent services and interventions; (d) design and promotion of education and training programs regarding racial bias; (e) increased attention to issues of intersectionality; and (f) promotion of diversity and fair-mindedness among criminal legal actors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Then, they make contact with the involved parties' social ties to steer them toward peaceful resolutions, social services, and material and health resources (Cheng 2017;Moore and Stuart 2022). Studies find that the Cure Violence program reduces shootings in targeted communities by 41-73%, with program participants reporting significant reductions in disposition to use violence in both petty and serious disputes (Delgado et al. 2017;Milam et al. 2016;Slutkin et al. 2015). Although this approach recognizes the importance of third-party influence, it is similarly limited in its capacity to systematically identify and account for the de-escalating influence of the expansive network of informal and intimate neighborhood social ties, which may play out beyond the purview of outreach workers. ...
Article
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There is growing alarm among the media and public that digital social media amplify the frequency and severity of urban violence. Contrary to popular imagination, however, emerging research suggests that social media may just as readily offer novel tools for informal social control and de-escalation. Toward building an empirically grounded theory of urban violence in the digital age, we examine a key mechanism by which social media afford communities newfound capacities to mitigate conflicts. Drawing on digital, urban, ethnographic fieldwork in Harlem and Chicago’s South Side, we argue that social media afford a historic level of what new media scholars refer to as “communication visibility.” Specifically, social media allow onlookers to observe others’ online behavior and, in turn, exert influence over subsequent relationships, exchanges, and actions in ways that can prevent and reduce violence. First, we examine how young women protectors and a street pastor exert direct third-party influence by monitoring and manipulating social media communication to extricate potential combatants from risky situations. Second, we examine indirect third-party influence whereby potential combatants, in anticipation of onlookers’ intervention, proactively alter their own behavior in ways that encourage peaceful conflict resolution. These findings not only improve contemporary theories of violence, but also provide actionable lessons for enhancing the life-saving work of violence intervention and street outreach programs.
... For example, Baltimore currently has two community-based violence prevention programs in place: Safe Streets, a violence interruption and community outreach program based on the Cure Violence model, and Roca which uses outreach, supportive services, mentorship, and cognitive behavioral theory to change the trajectory of those at high risk of violence involvement. Evaluations of Safe Streets have found program effects on violence to be mixed (Buggs, Webster, & Crifasi, 2021;Webster, Whitehill, Vernick, & Curriero, 2013); however, it is associated with improvements in community attitudes toward violence (Milam et al., 2016) and evaluators have noted that with increased resources, oversight, training, and support, program impact on violence outcomes could be improved. Roca has shown promising reductions in incarceration among men who completed the program (Roca, 2022). ...
Article
Introduction Gun violence plagues many communities that simultaneous experience other threats to their health and safety. Policing strategies to address illegal gun carrying may exacerbate or even contribute to gun violence. Methods We conducted a mixed-methods study to understand community perspectives on gun violence, safety, and the Baltimore Police Department (BPD)’s approaches to gun violence reduction. Using an explanatory-exploratory approach – we conducted household surveys (n = 200) and then explored key survey findings with focus groups. Descriptive statistics were generated from the surveys and key themes were identified from the focus groups. Results One-quarter of survey respondents reported having been a victim of a gun crime, one-third reported not feeling safe in their neighborhood, and slightly less than one-half thought police would respond quickly if shots were fired. Many participants expressed distrust in police as a result of their strategies to reduce gun carrying and address violence. Discussion Residents in Baltimore's neighborhoods besieged by gun violence perceive the police to be ineffective in their gun violence prevention efforts. Several strategies were identified that could improve trust and reduce violence, including improving officer accountability and training, and developing tools for officers to address their own mental health and trauma.
... In two cities, there was a 15-42% decrease in the number of African American men under 35 years old that were victims of a gun homicide in 2021 compared to 2018. We also found that the gun violence program operating in these cities called Advance Peace interrupted This article aims to contribute to a decades-long engagement by this journal in both understanding the drivers behind urban firearm violence and how a public health approach might help reduce urban gun crime [6][7][8][9][10]. ...
Article
The years 2020-2021 during the COVID-19 pandemic witnessed increases in firearm violence in many cities across the USA. We present data from Sacramento, Stockton, and Richmond, California that suggests firearm homicides during the pandemic did not increase in all communities or disproportionately burden the African American community. More specifically, we found that in these cities, there was a 5-52% decrease in gun homicides during the 2020/2021 period compared to the 2018/2019 period for neighborhoods with a gun violence prevention program operating there. We also found a 24-83% reduction in gun homicides in census tracts with > 20% Black populations in Sacramento and Stockton during the 2020/2021 period compared to the 2018/2019 period. In two cities, there was a 15-42% decrease in the number of African American men under 35 years old that were victims of a gun homicide in 2021 compared to 2018. We also found that the gun violence program operating in these cities called Advance Peace interrupted 202 street-level conflicts where guns were present across the three cities in 2020/2021 compared to 178 of the same conflicts in 2018/2019. These interruptions likely saved hundreds of lives and we estimate contributed to between US $65 and $494 million in savings. Advance Peace is a program that engages those at the center of gun violence, frequently young, Black men under 35 years old, and offers them the Peacemaker Fellowship, an intensive, 18-month program of 24/7 mentorship, social services, and life opportunities. The program is delivered by community resident "credible messengers," who conduct the mentorship and interrupt conflicts in the streets. While these findings are descriptive and preliminary, we know of no other program that was in operation before and during the pandemic in each of these cities that engaged the hard-to-reach but highly influential population at the center of gun violence.
... Participants in the program were less likely to be arrested or have any criminal involvement (Becker, Hall, Ursic, Jain, & Calhoun, 2004). Programs like Cure Violence also attempt to shift local norms related to using firearms in retaliation or as a means to resolve interpersonal conflict, which recent studies have shown can be effective (Milam et al., 2016;Milam, Furr-Holden, Leaf, & Webster, 2018). These models aim to have a community-wide impact on firearm violence, which may both directly and indirectly impact youths' exposure to violence as well; however, these programs need to be tested more specifically with children and adolescents (Ngo et al., 2019). ...
Article
Objective: Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them. Method: Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities. Results: The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15-24) was at outlier levels - many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors. Conclusions: More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.
... Taken in aggregate, the evaluations of Safe Streets suggest that the initial potentially positive effects of the program attenuated over time. Prior studies found that Safe Streets increased youth's preferences for nonviolent conflict resolution [32] and was associated with increases in preferences for nonviolent responses to interpersonal conflicts. [33] Additionally, the Cure Violence model has been associated with reductions in youths' willingness to use violence to settle conflict, [34] improved confidence in police, [35] and increased confidence in a community's ability to reduce firearm violence. ...
Article
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Objective To estimate the long-term impact of Safe Streets Baltimore, which is based on the Cure Violence outreach and violence interruption model, on firearm violence. Methods We used synthetic control methods to estimate programme effects on homicides and incidents of non-fatal penetrating firearm injury (non-fatal shootings) in neighbourhoods that had Safe Streets’ sites and model-generated counterfactuals. Synthetic control analyses were conducted for each firearm violence outcome in each of the seven areas where Safe Streets was implemented. The study also investigated variation in programme impact over time by generating effect estimates of varying durations for the longest-running programme sites. Results Synthetic control models reduced prediction error relative to regression analyses. Estimates of Safe Streets’ effects on firearm violence varied across intervention sites: some positive, some negative and no effect. Beneficial programme effects on firearm violence reported in prior research were found to have attenuated over time. Conclusions For highly targeted interventions, synthetic control methods may provide more valid estimates of programme impact than panel regression with data from all city neighbourhoods. This research offers new understanding about the effectiveness of the Cure Violence intervention over extended periods of time in seven neighbourhoods. Combined with existing Cure Violence evaluation literature, it also raises questions about contextual and implementation factors that might influence programme outcomes.
... The results from the present study suggest trauma-related differences in attitudes about guns may be potential foci for prevention and intervention efforts regarding gun-related behavior. Although we were not able to determine whether trauma exposure and/or PTSS were tied to unsafe gun behaviors, it is possible that assessing for trauma exposure, particularly violent forms of trauma, as well as PTSS may help clinicians better understand and perhaps target problematic attitudes related to guns and risky gun-related behaviors (Milam et al., 2016;Nanney et al., 2018;Wamser-Nanney, Nanney, Conrad, & Constans 2019;. Namely, the results indicate that exposure to a gun assault may increase the likelihood that the individual will believe that firearms can deter crime. ...
Article
Full-text available
Objective: Although gun violence is a significant public health concern, many aspects of gun violence remain grossly understudied, including factors that shape firearm perceptions and beliefs. Trauma exposure and levels of posttraumatic stress symptoms (PTSSs) may play a role in understanding gun attitudes; however, these putative associations have not been empirically determined. The aim of the study was to investigate if cumulative trauma, specific violent trauma types (i.e., violent death, and physical, weapon, and sexual assault), and PTSS are related to more positive gun attitudes. Method: A total of 495 adults from Amazon Mechanical Turk (18.5%) or a midwestern university (81.4%; Mage = 25.81 SD = 9.88, 59.5% female, 71.2% White) participated in the study. Results: Cumulative trauma was associated with more progun rights beliefs but not with perceptions that guns provide protection from victimization or deter crime. Despite expectations, PTSSs were not tied to gun attitudes. In the model with the specific types of violent trauma, weapon assault was related to a stronger endorsement that guns offer protection, whereas physical assault was inversely associated with this belief. None of the four types of violent trauma nor PTSS were related to beliefs regarding gun rights or guns and crime. Conclusion: Although PTSS was consistently unrelated to gun attitudes, cumulative trauma exposure may correspond with gun rights beliefs. There also appears to be distinctions in type of violent trauma exposure and discrete gun attitudes.
... A recent study from the University of California San Francisco reported long-term recidivism reduction among trauma victims, most of who were from high-risk communities [42]. And as a final point, community-based programs, such as the Safe Streets program based on the Cure Violence model in Baltimore, has reported an improvement in attitudes toward violence intervention programs in the community, as well as a reduction in nonfatal firearm injuries among high-risk adolescents and young adults [43][44][45]. Therefore, given the findings herein and the emerging data supporting the ability of community-based programs to mitigate firearm violence risk, targeted approaches toward the highest-risk groups and communities may result in significant risk reduction in vulnerable populations. ...
Article
Background/purpose: The U.S. has an alarming rate of firearm injuries. Racial disparities among victims and predictors of outcomes are not well established. Our objective was to assess costs, length of stay (LOS), and inpatient mortality among nonfatal and fatal pediatric firearm injuries that required hospitalization. Methods: Pediatric (≤18 years of age) hospitalizations with a firearm injury discharge diagnosis were identified from the national Kids' Inpatient Databases (KID) for 2006 through 2012. Firearm injury intent, weapon type, and hospitalization rates by racial groups were examined. Inpatient mortality, costs, and length of stay were examined using regression models. Results: Of 15,211 hospitalizations, the majority of injuries were due to assault (60%) and the intentions of firearm injury differed by race (p < 0.001). The median cost per hospitalization was $10,159 (interquartile range: $5071 to $20,565), totaling more than a quarter of a billion dollars. On regression analysis, Black (OR: 0.41; CI: 0.30-0.55) and Hispanic (OR: 0.47; CI: 0.34-0.66) patients were less likely to die than White patients. Conclusion: Pediatric firearm injury circumstances and survival vary by race with Whites being more likely to experience unintentional injury and suicide, while Blacks and Hispanics are more likely to experience inflicted injury. Level of evidence: Level II. Type of study: Clinical Research Study.
... Youth often have exaggerated perceptions of the Effects are constrained across states so that the HR for transitions out of No-FA is equal to the inverse of the HR out of FA, corresponding to forcing risk factors for FA to have equivalent effects regardless of whether the transition is from No-FA or FA. The choice to enforce this constraint was based on prior tests displayed in Table 2 and described in the text norms surrounding delinquent behaviors such as substance use, (Borsari & Carey, 2001;Suls & Green, 2003) and firearm carrying (Hemenway et al., 2011), and norms are modifiable through intervention, (Paluck et al., 2016;Prince & Carey, 2010;Suls & Green, 2003), including attitudes toward firearm violence (Milam et al., 2016). Thus, normative resetting may be a promising route for universal prevention, particularly, when combined with other individual-focused evidenced-based violence prevention strategies, such as motivational interviewing, mentoring, and/or collaborative care models (e.g. ...
Article
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Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals’ transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.
... Moreover, a recent study demonstrated that implementation of primary violence prevention efforts across the social ecology in a community (e.g., individual intervention, mentoring, vacant lot clean up) reduced assault injuries; however, firearm-related outcomes (e.g., carriage, use, injuries) were not assessed (Heinze et al., 2016). Finally, several community-level interventions focused primarily on gang members, and/or older samples (e.g., adults over 18 years; Cease Fire: (Skogan et al., 2009); Safe Streets: (Duncan et al., 2014;Milam et al., 2016;Whitehill et al., 2013), show promise for reducing firearm injury. Altogether, these studies underscore the potential impact of multi-sector community wide interventions. ...
Article
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Intentional and unintentional firearm injury is the second leading cause of death for youth, underscoring the need for effective primary prevention approaches that focus on increasing safe storage by caregivers and decreasing handling/carriage among youth. This article describes the state of the science for prevention of firearm injuries among children and adolescents. We applied PRISMA guidelines to present results from a scoping review using PubMed, Scopus, CINAHL, and CJ Abstracts for original research articles published between January 1, 1985 and March 1, 2018 in the U.S. focusing on primary screening or interventions for primary prevention of pediatric firearm injuries. In total, 46 articles met inclusion criteria: safe storage (23), screening (2), firearm handling/carriage/use (21). Across school, healthcare, and community settings, few evidenced-based programs exist, and data on firearm safety technologies are lacking. Programs have generally not employed rigorous designs, and/or assessed behavioral (e.g., carriage) or injury-related firearm outcomes. Evidenced-based prevention programs are needed to mitigate firearm morbidity and mortality among youth.
... (Arp et al., 2017;Fowler, Dahlberg, Haileyesus, & Annest, 2015;Institute of Medicine and National Research Council, 2013;Milam, Buggs et al., 2016;Patton, Sodhi, Affinati, Lee, & Crandall, 2019).According to Dr. Georges Benjamin, executive director of the American Public Health Association (APHA), "Health epidemics don't end unless we intervene taking the best science approach about what does and does not work and using it. The epidemic of gun violence can be reversed with a public health approach" (Triosi & Williams, 2016). ...
Article
Efforts to reduce gun violence have moved away from models that rely solely on law enforcement approaches, toward public health-focused models of intervention. This paper discusses urban gun violence from a public health and social work perspective, examining a method to interrupt, reduce and prevent gun violence at the community level. A qualitative research design was utilized to evaluate perceptions held by thirty-seven community members regarding the impact of a gun and related violence prevention program, Albany SNUG. Five key findings emerged from the data analysis: 1) Violence was viewed as significant, widespread and a source of despair and hopelessness; 2) Residents perceived a lack of resources and opportunities within the community; 3) There was general consensus regarding the program’s importance to the community; 4) There were several obstacles and challenges to program implementation as identified by participants; and 5) Community involvement and shared responsibility were viewed as central to the reduction of gun and related violence. Recommendations for practice and policy changes and the potential role for social work in future collective efficacy and social change initiatives are also discussed.
... The program appears to have reduced gun violence in most neighborhoods where it has been implemented, [71][72][73][74] and evidence suggests that it may promote norms that eschew the use of guns to settle disputes. 120,121 Community mobilization has been a longstanding approach to addressing the social norms that tolerate and perpetuate intimate partner violence and sexual violence; emergent evidence shows that this approach can be powerful in changing norms, 100 as well as violence victimization. 101 Firearm policy. ...
Article
Violence is a leading source of morbidity and mortality in the United States. In this article, we suggest a public health framework for preventing community violence, intimate partner violence and sexual violence, and suicide as key forms of interpersonal and self-directed violence. These types of violence often co-occur and share common risk and protective factors. The gender, racial/ethnic, and age-related disparities in violence risk can be understood through an intersectionality framework that considers the multiple simultaneous identities of people at risk. Important opportunities for cross-cutting interventions exist, and intervention strategies should be examined for potential effectiveness on multiple forms of violence through rigorous evaluation. Existing evidence-based approaches should be taken to scale for maximum impact. By seeking to influence the policy and normative context of violence as much as individual behavior, public health can work with the education system, criminal justice system, and other sectors to address the public health burden of interpersonal violence and suicide.
... Violence perpetration has multiple roots, including men's past experiences with violence perpetration and victimization through community and family-based exposure and stress [11][12][13][14][15][16][17]. Urban environments like Baltimore, MD, house a myriad of socio-structural factors that increase the risk of violence [16], including homicides and other forms of street violence that are often a priority of prevention [15,[18][19][20]. Given the complexity of violence, identified risk factors have emerged at multiple levels of the socio-ecological framework [21], with violence among men associated with use of violence in intimate relationships [15,[22][23][24][25][26]. ...
Article
Intimate partner violence (IPV) is a significant health concern rooted in community experiences and other social determinants. The purpose of this study is to understand community-based risk and protective factors of IPV perpetration through participatory research that engages men who use IPV. Secondarily, we assess the relative influence, as measured by ranking, of these factors regarding risk of IPV perpetration and stress. We conducted concept mapping with Baltimore men (n = 28), ages 18 and older, enrolled in an abuse intervention program (AIP), through partnership with a domestic violence agency. Concept mapping, a three-phase participatory process, generates ideas around an issue then visually presents impactful domains via multi-dimensional scaling and hierarchical clustering. Most participants were Black (87.5%) and 20-39 years old (75%). Seven key domains, or clusters, were established. "No hope for the future" was the greatest contributor to IPV perpetration. "Socioeconomic struggles" (i.e., lack of employment) and "life in Baltimore" (i.e., homicide) were most likely to result in stress. Emergent domains related to IPV perpetration and stress were ranked similarly, but with some nuance. Having good support systems (i.e., family, community centers) were felt to prevent IPV and reduce stress. This participant-driven process among a primarily young, Black sample of Baltimore men speaks to the influence of perceived social disempowerment and underlying trauma on intimate relationships and the potential for mitigation. Few studies have engaged men who use IPV through participatory research to understand the comprehensive dynamics of an impoverished, urban environment. Results provide direction for community-based intervention and prevention programming to increase self-efficacy, particularly among younger men, and to enact trauma-informed violence prevention policy from the perspectives of male IPV perpetrators.
Article
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The Supreme Court's decision in New York State Rifle & Pistol Association Inc. v. Bruen undermines the ability of cities and states to regulate firearms safety. Nonetheless, we remain hopeful that firearm violence can decline even after the Bruen decision. Several promising public health approaches have gained broader adoption in recent years. This essay examines the key drivers of community firearm violence and reviews promising strategies to reverse those conditions, including community violence intervention (CVI) programs and place-based and structural interventions.
Article
Background The COVID-19 pandemic has altered daily life on a global scale and has resulted in significant mortality with over 985,000 lives lost in the United States alone. Superimposed on the COVID-19 pandemic has been a concurrent worsening of longstanding urban gun violence. We sought to evaluate the impact attributable to these two major public health issues on the greater Louisville region as determined by years of potential life lost (YPLL). Methods Utilizing the Collaborative Jefferson County Firearm Injury Database, all firearm injuries from January 1, 2011 to December 31, 2021 were examined. COVID-19 data was compiled from the Louisville Metro Department of Public Health and Wellness. Pre-COVID (03/01/2019-02/29/2020) and COVID (03/01/2020-02/28/2021) time intervals were examined. Demographics, outcomes data, and YPLL were determined for the groups and injury locations were geocoded. Results From 2011 to 2021, there were 6,043 firearm injuries in Jefferson County, Kentucky. During the COVID time interval, there were 4,574 years of potential life lost (YPLL) due to the SARS-CoV-2 virus and 9,722 YPLL due to all-cause gun violence. In the pre-COVID time interval, there were 5,723 YPLL due to all-cause gun violence. Conclusion In Louisville, greater YPLL were attributable to firearm fatalities than the SARS-CoV-2 virus. Given the impact of COVID-19, the robust response has been proportionate and appropriate. The lack of response to firearm injury and fatality is striking in comparison. Additional resources to combat the sequelae of gun violence are needed.
Article
The Black Lives Matter movement has operated alongside a growing recognition among social scientists that policing research has been limited in its scope and outmoded in its assumptions about the nature of public safety. This essay argues that social science research on policing should reorient its conception of the field of policing, along with how the study of crime rates and police departments fit into this field. New public safety research should broaden its outcomes of interest, its objects of inquiry, and its engagement with structural racism. In this way, next-generation research on policing and public safety can respond to the deficiencies of the past and remain relevant as debates over transforming American policing continue.
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Guns have been described as a “social toxin.” Like other infectious diseases, incidents of gun violence tend to cluster and can spread throughout populations by means of social contagion. While this is most often thought of in the context of homicide, adolescent gun-related suicide can also cluster. Gun violence is a major public health issue affecting adolescents in the United States. As such, evidence-based, multidisciplinary public heath solutions are needed for the prevention of firearm-related homicides and suicides. The public health approach has been employed in the creation of violence interruption programs using community health workers to address gun violence, modeled after other community programs to interrupt the spread of infectious diseases. Further research is needed to identify and target additional elements of the pathogenicity and spread of adolescent gun violence.
Article
Guns are used in the majority of homicides in the United States, making the problem of homicide largely a problem of gun violence. This article presents three types of gun homicide (mass shootings, intimate partner homicide, and community gun violence), and briefly discusses the state of knowledge on their risk factors and promising interventions. Future directions for research are presented, focusing on examining differential implementation and impacts of interventions by racialized groups and communities, as well as interrogating conventional approaches and methodologies.
Article
For nearly a century, gang scholarship has remained foundational to criminological theory and method. Twenty-first-century scholarship continues to refine and, in some cases, supplant long-held axioms about gang formation, organization, and behavior. Recent advances can be traced to shifts in the empirical social reality and conditions within which gangs exist and act. We draw out this relationship—between the ontological and epistemological—by identifying key macrostructural shifts that have transformed gang composition and behavior and, in turn, forced scholars to revise dominant theoretical frameworks and analytical approaches. These shifts include large-scale economic transformations, the expansion of punitive state interventions, the proliferation of the Internet and social media, intensified globalization, and the increasing presence of women and LGBTQ individuals in gangs and gang research. By introducing historically unprecedented conditions and actors, these developments provide novel opportunities to reconsider previous analyses of gang structure, violence, and other related objects of inquiry. Expected final online publication date for the Annual Review of Criminology, Volume 5 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Violence is fundamentally a health issue, which is a predictable result of exposure, contagion, and trauma. Further, health and public health methods—and in particular epidemic disease control methods—have been proven effective in reducing violence without the major toxicities commonly caused by many criminal justice approaches. Violence is the only public health issue not primarily managed by the health sector. The Cure Violence approach uses standard epidemic control methods to detect and interrupt violent events, identify and change behavior among the highest-risk persons and groups, and shift the group and community norms.
Article
Objectives: Missing from the discussion of youth and gun violence are qualitative data from diverse youth regarding their perspectives on gun violence in their communities and what will help prevent or reduce such violence. The purpose of this exploratory study was therefore to gain a deeper understanding of urban teens' perceptions of gun violence in the context of their daily lives and gather their ideas for reducing or preventing gun violence through meaningful discussions with urban teens. Study design: Focus group discussions. Methods: A total of 29 urban teens aged between 14 and 18 years participated in two separate focus group discussions between August 2016 and July 2017. Participants engaged in an open-ended discussion guided by 12 semistructured questions that addressed their perceptions of community safety, the need to carry a gun, police relations, the need for community change, and their ideas to reduce gun violence and help make their communities safer. Data were analyzed using a thematic approach. Results: Teens' perceptions of racism and poor relations with the police are tied to gun violence, while they identified the need for better relations with the police and meaningful, long-term relationships with adults as factors to help prevent or reduce gun violence. Conclusions: Long-term reductions in community violence will not occur until larger social issues are addressed. While waiting for these concerns to be addressed, secondary prevention, including mentoring programs and other efforts to build meaningful relationships between adults and teens can foster teen resilience and activism in the face of gun violence.
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Research conducted with violent offenders demonstrates an overwhelming tendency for individuals in this population to frame their violent acts as tuned responses to perceived slights ranging from verbal insults to ostensibly nonviolent physical actions. To date, no review has characterized and categorized specific situational cues that are associated with interpersonal violence/ideation. Here, literature addressing attitudes, attributions, and triggers around reactive forms of violence and perspectives on violence deservedness was thematically and narratively reviewed using a theoretical framework focused on shame and threatened social bonds. Of the 29 articles that met the inclusion criteria, 11 statistically assessed relationships between attributions, attitudes, or triggers and subsequent violence/ideation, with 10 (90.1%) demonstrating, in subgroup analysis, statistically greater attitudes endorsing violence when shame or a threat to a social bond manifested. Overall, three primary axes of attribution, attitudes, or triggers toward interpersonal violence emerged from the review: (1) generalized intrapersonal justifications, (2) environmental and social group triggers, and (3) jealousy and triggers in the context of romantic relationships. These dynamics, both inside and outside of the United States, are reviewed, and a conceptual intervention model is presented. Findings illustrate that behavioral interventions specifically targeting individual- and community-level pathways to shame manifestation and emotion regulation represent an underutilized yet auspicious approach to curbing violence ideation and perpetration.
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Scholars and practitioners alike in recent years have suggested that real and lasting progress in the fight against gun violence requires changing the social norms and attitudes that perpetuate violence and the use of guns. The Cure Violence model is a public health approach to gun violence reduction that seeks to change individual and community attitudes and norms about gun violence. It considers gun violence to be analogous to a communicable disease that passes from person to person when left untreated. Cure Violence operates independently of, while hopefully not undermining, law enforcement. In this article, we describe the theoretical basis for the program, review existing program evaluations, identify several challenges facing evaluators, and offer directions for future research. Expected final online publication date for the Annual Review of Public Health Volume 36 is March 18, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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This study is a methodological-substantive synergy, demonstrating the power and flexibility of exploratory structural equation modeling (ESEM) methods that integrate confirmatory and exploratory factor analyses (CFA and EFA), as applied to substantively important questions based on multidimentional students' evaluations of university teaching (SETs). For these data, there is a well established ESEM structure but typical CFA models do not fit the data and substantially inflate correlations among the nine SET factors (median rs = .34 for ESEM, .72 for CFA) in a way that undermines discriminant validity and usefulness as diagnostic feedback. A 13-model taxonomy of ESEM measurement invariance is proposed, showing complete invariance (factor loadings, factor correlations, item uniquenesses, item intercepts, latent means) over multiple groups based on the SETs collected in the first and second halves of a 13-year period. Fully latent ESEM growth models that unconfounded measurement error from communality showed almost no linear or quadratic effects over this 13-year period. Latent multiple indicators multiple causes models showed that relations with background variables (workload/difficulty, class size, prior subject interest, expected grades) were small in size and varied systematically for different ESEM SET factors, supporting their discriminant validity and a construct validity interpretation of the relations. A new approach to higher order ESEM was demonstrated, but was not fully appropriate for these data. Based on ESEM methodology, substantively important questions were addressed that could not be appropriately addressed with a traditional CFA approach.
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Residential stability matters to a young person’s educational development, and the present housing crisis has disrupted the residential stability of many families. This study uses latent growth-curve modeling to examine how changing residences affects math and reading achievement from third through eighth grade among a sample of urban elementary and middle-school students. Results show that residential moves in the early elementary years have a negative effect on math and reading achievement in third grade and a negative effect on the trajectory of reading scores thereafter. Further, there is a negative contemporaneous effect of mobility on math scores in third through eighth grade but no such contemporaneous effect on reading scores. Implications for research and practice are discussed.
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Background: Gun possession by high-risk individuals presents a serious threat to public safety. U.S. federal law establishes minimum criteria for legal purchase and possession of firearms; many states have laws disqualifying additional categories for illegal possession. Methods: We used data from a national survey of state prison inmates to calculate: 1) the proportion of offenders, incarcerated for crimes committed with firearms in 13 states with the least restrictive firearm purchase and possession laws, who would have been prohibited if their states had stricter gun laws; and 2) the source of gun acquisition for offenders who were and were not legally permitted to purchase and possess firearms. Results: Nearly three of ten gun offenders (73 of 253 or 28.9%) were legal gun possessors but would have been prohibited from purchasing or possessing firearms when committing their most recent offense if their states had stricter prohibitions. Offenders who were already prohibited under current law acquired their gun from a licensed dealer, where a background check is required, five times less often than offenders who were not prohibited (3.9% vs. 19.9%; χ(2)=13.31; p≤0.001). Nearly all (96.1%) offenders who were legally prohibited, acquired their gun from a supplier not required to conduct a background check. Conclusions: Stricter gun ownership laws would have made firearm possession illegal for many state prison inmates who used a gun to commit a crime. Requiring all gun sales to be subject to a background check would make it more difficult for these offenders to obtain guns.
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(a) To describe attitudes regarding retaliation among adolescents who have been assaulted. (b) To examine assault/event characteristics, personal, parental, and environmental factors associated with the retaliatory attitudes of adolescents who have been assaulted. African American youth aged 10-15 years presenting to two large urban hospitals with peer assault injury and a parent/caregiver completed interviews in their home after their emergency department visit. Multivariate analyses revealed that lower SES, older age, and adolescents' perceptions that their parents support fighting were related to endorsing retaliatory attitudes. Girls who were aggressive were more likely to endorse retaliatory attitudes. However, level of aggression did not impact boys' retaliatory attitudes. Affiliating with aggressive peers influenced the retaliatory attitudes of boys, but did not influence girls' retaliatory attitudes. Overall, youths' perceptions of their parents' attitudes toward fighting had the greatest impact on retaliatory attitudes. Adolescents' perceptions of their parents' attitudes toward fighting may be a factor in subsequent re-injury among youth. Violence prevention and intervention efforts need to involve components that assess parental attitudes and incorporate strategies to engage parents in violence prevention efforts. In addition, interventions for youth who have been assaulted may need to incorporate some gender-specific components in order to address the unique needs of girls and boys.
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To assess evidence for residential mobility in childhood having an adverse association with health outcomes through the life course. A systematic search of medical and social sciences literature was undertaken to identify research defining residential mobility as an independent variable and in which health outcomes were described and objectively measured. Studies were excluded that investigated international migration for asylum or were limited to educational outcomes. Two reviewers assessed each study using quality criteria with particular attention to the consideration of confounders and potential for bias. Data were extracted for analysis using a structured form. Twenty-two studies were included for this review. Outcomes identified in association with residential mobility included: higher levels of behavioural and emotional problems; increased teenage pregnancy rates; accelerated initiation of illicit drug use; adolescent depression; reduced continuity of healthcare. Studies assessed as having lower quality were less likely to demonstrate statistically significant effects. Heterogeneity precluded meta-analysis. Residential mobility interacts at neighbourhood, family and individual levels in cumulative and compounding ways with significance for the wellbeing of children. High frequency residential change is potentially a useful marker for the clinical risk of behavioural and emotional problems. The evidence supports the reorientation of health services effectively to engage these residentially mobile children for whom health and psychological needs may be identified. The impact of housing and economic policies on childhood residential mobility should be evaluated considering this evidence.
Article
Gun violence remains a pressing public health concern, especially in high-risk urban environments. Community-level violence intervention efforts are being mounted in cities across the United States to prevent and reduce the most severe forms of violence. There is growing evidence to suggest the effectiveness of theSafe StreetsProgram/Cure Violenceas a community-based intervention to reduce homicides and shootings. The mechanism underlying the reductions in community violence is theorized to be linked with changes in attitudes toward violence as well as shifts in social norms related to violence and retaliation, but there are few tools to assess these domains. This preliminary investigation sought to establish the metric properties of the Survey on Attitudes About Guns and Shootings (SAGAS) with the goal of providing an empirical measure of attitudes and community-level norms. Males aged 18 to 24 were surveyed using the SAGAS in two high-violence communities in Baltimore, Maryland, using street intercept methodology. We found acceptable reliability and validity metrics for the SAGAS. Reliability and validity of the SAGAS were assessed using internal consistency and a latent class analysis with violent behavior outcomes. The internal consistency of the total scale was in the extensive range (α = .70-.79) and the internal consistency of the factors was in the exemplary range (α ≥ .80). In addition, latent classes of attitudes were predictive of being arrested or being shot. Future studies will examine if rates of violence decrease in neighborhoods targeted by theSafe StreetsProgram and the mediating role of attitudes toward gun violence using the SAGAS.
Article
Risk factors for marijuana use in older adolescents and young adults have focused primarily on family environment and peer affiliation. A growing body of work has examined the relationship between environmental context and young adult substance use. This study builds on previous research linking neighborhood environment to young adult marijuana use by exploring two distinct features of neighborhoods, namely the physical (e.g., broken windows) and social environment (e.g., adults watching youth). Data were obtained from a longitudinal sample of 398 predominately African American young adults living in an urban environment. The data also included observational measures of physical and social order and disorder collected on the young adult's residential block. Exploratory structural equation modeling (ESEM) was utilized to test hypothesized relationships between these two features of the neighborhood environment and past year young adult marijuana use. A two-factor model of neighborhood environment with good fit indices was selected (CFI = 0.97, RMSEA = 0.037). There was a positive and significant direct effect from neighborhood physical disorder to marijuana use (0.219, p < 0.05) controlling for gender, race, and free and reduced price meal (FARPM) status. The direct effect from neighborhood social environment to marijuana use was not significant. These results converge with previous research linking vacant housing with young adult marijuana use but do not provide empirical support for the neighborhood social environment as a determinant of drug taking. Better explication of the social environment is needed to understand its relationship to drug use.
Article
The use of analytic rotation in exploratory factor analysis will be examined. Particular attention will be given to situations where there is a complex factor pattern and standard methods yield poor solutions. Some little known but interesting rotation criteria will be discussed and methods for weighting variables will be examined. Illustrations will be provided using Thurstone's 26 variable box data and other examples.
Article
Exploratory factor analysis (EFA) is a frequently used multivariate analysis technique in statistics. Jennrich and Sampson (1966)19. Jennrich , R. I. and Sampson , P. F. 1966. Rotation to simple loadings.. Psychometrika, 31: 313–323. [CrossRef], [PubMed], [Web of Science ®]View all references solved a significant EFA factor loading matrix rotation problem by deriving the direct Quartimin rotation. Jennrich was also the first to develop standard errors for rotated solutions, although these have still not made their way into most statistical software programs. This is perhaps because Jennrich's achievements were partly overshadowed by the subsequent development of confirmatory factor analysis (CFA) by Jöreskog (1969)20. Jöreskog , K. G. 1969. A general approach to confirmatory maximum-likelihood factor analysis.. Psychometrika, 34: 183–202. [CrossRef], [Web of Science ®]View all references. The strict requirement of zero cross-loadings in CFA, however, often does not fit the data well and has led to a tendency to rely on extensive model modification to find a well-fitting model. In such cases, searching for a well-fitting measurement model may be better carried out by EFA (Browne, 20017. Browne , M. W. 2001. An overview of analytic rotation in exploratory factor analysis.. Multivariate Behavioral Research, 36: 111–150. [Taylor & Francis Online], [Web of Science ®]View all references). Furthermore, misspecification of zero loadings usually leads to distorted factors with over-estimated factor correlations and subsequent distorted structural relations. This article describes an EFA-SEM (ESEM) approach, where in addition to or instead of a CFA measurement model, an EFA measurement model with rotations can be used in a structural equation model. The ESEM approach has recently been implemented in the Mplus program. ESEM gives access to all the usual SEM parameters and the loading rotation gives a transformation of structural coefficients as well. Standard errors and overall tests of model fit are obtained. Geomin and Target rotations are discussed. Examples of ESEM models include multiple-group EFA with measurement and structural invariance testing, test–retest (longitudinal) EFA, EFA with covariates and direct effects, and EFA with correlated residuals. Testing strategies with sequences of EFA and CFA models are discussed. Simulated and real data are used to illustrate the points.
Article
Chicago's CeaseFire program is an evidence-based public health approach to preventing gun violence. Baltimore is one of many US cities attempting to replicate the program. We compared changes in the number of homicide and nonfatal shooting incidents per month in four intervention neighborhoods with changes in high-crime comparison areas (police posts) without the intervention, while controlling for several measures of police activity and baseline levels of homicide and nonfatal shootings. In South Baltimore there were large program-related reductions in homicide and nonfatal shooting incidents. Among three East Baltimore program sites, the program was associated with a reduction of homicides in one area, a reduction in nonfatal shootings in another area, and a simultaneous increase in homicides and decrease in nonfatal shootings in another area. In some instances, program effects extended to neighborhoods bordering the intervention areas. Program-related reductions in homicides appear to be linked with conflict mediations conducted by program outreach workers.
Article
Cradle to Grave (C2G), a hospital-based violence prevention programme, brings inner-city youth into an urban Level I trauma centre to follow the path of an adolescent gunshot victim from trauma bay to morgue. We hypothesised that C2G alters student attitudes towards gun violence. Eighty-eight adolescents were prospectively enrolled. With parental and student consent, students completed the Attitudes Towards Guns and Violence Questionnaire (AGVQ), a previously validated and reliable social science assessment tool. Two weeks later, the students participated in C2G. The survey was re-administered four weeks after C2G participation. AGVQ results are reported both as a total score and as a breakdown of the four component subscales. Higher AGVQ scores indicate proclivity towards violence. ANOVA compared scores with respect to demographics and type of school (public vs. charter). C2G altered student's attitudes towards guns and violence. Of 43 public school students, total scores decreased following C2G (p=0.02). The greatest attitudinal change occurred in subscale 1, "Aggressive Response to Shame" (p<0.01). C2G failed to produce significant changes AGVQ scores in the 45 students attending a city charter school. The two groups were found to have baseline differences, with public school students showing higher baseline tendencies towards violence. Our hospital-based programme is capable of positively impacting adolescents' attitudes towards guns and violence. This effect is most pronounced in subjects who already display increased tendencies towards violence. These results suggest that hospitals offer a unique opportunity to address the public health crisis posed by inner-city firearm violence.
Article
To explore the experience of violent injury among young African-American men with gunshot or stab wounds to better understand violent injury. Convenience sample, using open-ended, semistructured interviews. An urban, municipal hospital in Boston. Eighteen African-American men between the ages of 18 and 25, who had been shot or stabbed. Analysis of the interviews revealed that these young men identify with a concept called "being a sucker". They perceive that a person who fails to retaliate when he is disrespected or injured will be viewed as weak and will be the target of future victimization. This study reveals an important perception among these young male victims of violence that if they fail to respond violently to injury or the threat of injury, they will be at risk of further victimization. The social environment in which young male victims of violence live and the meaning of being a sucker must be considered in efforts to decrease recurrent interpersonal violence. Providers who care for young men who are victims of or at risk of violence should understand the implications of the social context on individual behaviors.
Article
Administered the Attitudes Toward Guns and Violence Questionnaire (AGVQ) to 1,619 students in Grades 3, 5, 6, 7, 9, 11, and 12 from four demographically diverse school systems. Fifty-two of the 61 items exhibited satisfactory part-whole correlation and correlation with a validity criterion. Factor analysis revealed four main factors: Aggressive Response to Shame, Comfort With Aggression, Excitement, and Power/Safety. The instrument was reduced to 23 items by deleting items with high cross-loadings. Construct validity was similar for the longer and shorter versions. Youth who self-reported owning a gun produced scores 1.5 SD higher than nonowners. Low scores were associated with a 1 in 125 chance of gun ownership, and high scores were associated with a 1 in 3 chance. Congruency coefficients indicated similar factor structure for the present sample and a separate sample of 5th-, 7th- and 9th-grade students. These results indicate that the AGVQ is a reliable and valid measure of violence-related attitudes in young people.
Article
Investigated relations between young people's scores on the Attitudes Toward Guns and Violence Questionnaire (AGVQ; Shapiro, Dorman, Burkey, Welker, & Clough, 1997), demographic variables, and exposure to firearms and violence. 1,164 students, Grades 3 to 12, from an urban, suburban, parochial, and private school system completed anonymous self-report questionnaires in their classrooms. Boys produced higher AGVQ scores than did girls. Scores were similar in Grades 3 and 5, were much higher in Grade 6 than in Grade 5, and were similar in Grades 6 and above. This pattern was found across sex, race, and school system. African Americans obtained higher scores than Caucasians on the AGVQ and on 2 of its 4 factors. Students in the urban public schools produced higher scores than did youth in the other school systems. Both traumatic and nontraumatic exposure to firearms were associated with high AGVQ scores. Sex, grade, and firearm exposure were associated with relatively large differences, while ethnic group and school system were associated with relatively small differences.
Article
Recurrent interpersonal violence is a major cause of death and disability among young Black men. Quantitative studies have uncovered factors associated with reinjury, but little is known about how these factors work together. We interviewed young Black male victims to understand their experience of violence. Qualitative analysis of their narratives revealed how their struggle to reestablish safety shaped their response to injury. Aspects of the “code of the street” (including the need for respect) and lack of faith in the police combined with traumatic stress and substance use to accentuate their sense of vulnerability. Victims then reacted to protect themselves in ways that could increase their risk of reinjury. We describe a model with implications for reducing rates of recurrent violent injuries.
Article
In a previous report, enhanced resource commitment at a Level I trauma center was associated with improved outcomes for most major categories of injured patients, except those with gunshot wounds, which disproportionately affected the young (ages 15 to 24 years). We hypothesized that a primary violence-prevention initiative geared toward changing attitudes about interpersonal conflict among at-risk youths can be effective. Between May 2002 and November 2003, 97 youths (mean age 12.6 years) were recruited from one of two Police Athletic League centers in the catchment area of our Level I trauma center. Participant attitudes about interpersonal conflicts were surveyed with six previously validated scales before and after a hospital tour with a video and slide presentation graphically depicting the results of gun violence. Mean differences in scores between pre- and postintervention surveys were assessed. Of the 97 participants, 48 (49.4%) completed the intervention program with both the pre- and postintervention tests, with a mean of 25.8 days between tests. There was a statistically significant reduction in the Beliefs Supporting Aggression scale (mean -0.38 U; 95% CI, -0.23 to -0.54; p < 0.01), and a trend toward reduced Likelihood of Violence (mean -0.17 U; 95% CI, 0.01 to -0.34; p = 0.06). A multidisciplinary violence-prevention outreach program can produce short-term improvement in beliefs supporting aggression among at-risk youth. Longterm impact of this attitude change needs to be examined in future studies.
Bureau of Justice Statistics, special report: firearm violence
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CHANGES IN ATTITUDES TOWARD GUNS AND SHOOTINGS 17. Baltimore City Health Department. Safe Streets Park Heights web site. http://health. baltimorecity.gov/sites/default/files/health/attachments/brochure_PH.pdf. Accessed on: January 7, 2016.