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Youth Exposure to Endemic Community Gun Violence: A Systematic Review

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Pilar Bancalari
Pilar Bancalari
Pilar Bancalari
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Marni Sommer at Columbia University
Marni Sommer
Sonali Rajan at Teachers College
Sonali Rajan
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Abstract and Figures

Community gun violence persists as a daily reality for many youth in low-income urban communities. While most gun violence research has focused on the direct victims of firearm homicide, exploration into the broader public health repercussions of community gun violence on youth has lagged. This systematic review aimed to synthesize and critically assess the state of evidence on indirect exposure to community gun violence among low-income urban youth in the U.S. PubMed, Web of Science, ProQuest, and SCOPUS were searched for peer-reviewed articles exploring the scope, risk factors, and impacts of community gun violence exposure on this population. Of the 143 studies identified and screened, 13 studies were ultimately included. The broad themes emerging include (1) a lack of consensus regarding the range of experiences that constitute community gun violence, (2) exposure to violence involving a firearm as distinct from that with other weapons, (3) a need to conceptualize multiple dimensions of gun violence exposure, (4) differential impacts of exposure to community gun violence across developmental stages, and (5) how indirect gun violence exposure uniquely contributes to cycles of community violence. Future research must move toward a consistent typology, multidimensional conceptualization, and developmental- and context-specific examination of community gun violence exposure.
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Vol.:(0123456789)
1 3
Adolescent Research Review (2022) 7:383–417
https://doi.org/10.1007/s40894-022-00178-5
SYSTEMATIC REVIEW
Youth Exposure toEndemic Community Gun Violence: ASystematic
Review
PilarBancalari1 · MarniSommer1· SonaliRajan2,3
Received: 26 August 2021 / Accepted: 1 January 2022 / Published online: 2 February 2022
© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022
Abstract
Community gun violence persists as a daily reality for many youth in low-income urban communities. While most gun vio-
lence research has focused on the direct victims of firearm homicide, exploration into the broader public health repercussions
of community gun violence on youth has lagged. This systematic review aimed to synthesize and critically assess the state
of evidence on indirect exposure to community gun violence among low-income urban youth in the U.S. PubMed, Web of
Science, ProQuest, and SCOPUS were searched for peer-reviewed articles exploring the scope, risk factors, and impacts of
community gun violence exposure on this population. Of the 143 studies identified and screened, 13 studies were ultimately
included. The broad themes emerging include (1) a lack of consensus regarding the range of experiences that constitute
community gun violence, (2) exposure to violence involving a firearm as distinct from that with other weapons, (3) a need
to conceptualize multiple dimensions of gun violence exposure, (4) differential impacts of exposure to community gun vio-
lence across developmental stages, and (5) how indirect gun violence exposure uniquely contributes to cycles of community
violence. Future research must move toward a consistent typology, multidimensional conceptualization, and developmental-
and context-specific examination of community gun violence exposure.
Keywords Child· Adolescent· Exposure to violence· Gun violence· Firearms· Public health
Introduction
The public health impact resulting from gun violence has
historically been operationalized by quantifying physical
injuries and deaths resulting from gunshots (Mitchell etal.,
2019). Less explored are the physiological and psychosocial
consequences of chronic and indirect exposure to commu-
nity gun violence among the populations who are dispropor-
tionately impacted—primarily low-income urban communi-
ties of color. Indirect exposure to community gun violence
poses broad threats to youth development and wellbeing.
These threats warrant a shift in the paradigm of gun violence
exposure to encompass indirect experiences as distinct expo-
sures to be comprehensively studied and prevented. While
the effects of direct gun violence victimization have been
described extensively throughout the literature, the dis-
tinct repercussions of indirect exposure on youth represent
an overlooked externality of endemic gun violence in the
United States (U.S.), meriting separate analysis. The aim of
this review is to summarize and critically appraise the state
of evidence on indirect exposure to community gun violence
among low-income urban youth in the U.S. Although there
is no standardized definition, for the purposes of this review,
indirect exposure to community gun violence will refer to
witnessing gunfire or hearing gunshots in public places such
as streets, parks, and schools, knowing a friend or family
member who has been shot or carries a gun, or being aware
of gun violence in one’s community.
* Pilar Bancalari
pilarbancalari@gmail.com
1 Department ofSociomedical Sciences, Mailman School
ofPublic Health, Columbia University, 722 West 168th
Street, NewYork, NY10032, USA
2 Department ofHealth andBehavior Studies, Teachers
College, Columbia University, 525 West 120th Street,
NewYork, NY10027, USA
3 Department ofEpidemiology, Mailman School ofPublic
Health, Columbia University, 722 West 168th Street,
NewYork, NY10032, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... 11 Likewise, youth indirectly exposed to community violence exhibit poor mental health outcomes to varying degrees depending on physical proximity to the shooting and time since the event. 12 Firearm injuries of all types (e.g., peer and partner violence, mass shootings, suicide and self-harm, and unintentional injury) are associated with high rates of mental and physical harm for children and adolescents. 13 Each year, these injuries lead to approximately 30,000 initial in-patient hospital stays, with each stay costing around $31,000. ...
... 3 Similar reviews addressed youth exposure to firearm violence, noting a need to conceptualize the 'multiple dimensions of firearm violence exposure'. 12, 13 Sorenson and Schut investigated non-fatal firearm use in intimate partner violence, underscoring a need to expand homicide research to include the impact non-fatal usage of firearms for control. 15 Notably, these reviews focus on mass shootings, emphasize prevention, and highlight a lack of evidence regarding cumulative impacts of firearm violence. ...
... Isolation caused by physical and social restriction due to fear is particularly common in urban areas and may lead to negative coping mechanisms including gun carrying or avoidance of medical services as a result of distrust. 12,38 • "It made me think that anything can happen at any given time. Anything. ...
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Gun Violence Exposure and Posttraumatic Symptoms Among Children and Youth
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Full-text available
  • Dec 2019
Although statistics on youth homicide and injury from gun violence are available, little research has focused on how gun violence overlaps with other victimizations or on the psychological impact of gun violence on children. Pilot survey data were collected on the experiences of 630 U.S. children (age range: 2–17 years) from Boston, Philadelphia, and rural areas of eastern Tennessee. Youth aged 10–17 years completed a self-report survey on a wide range of gun violence exposures, and parents of younger children (aged 2–9 years) completed the survey as a proxy for that child. Direct gun violence exposure, witnessing gun violence, and hearing gunshots were all significantly associated with other forms of victimization, rs =.10–.38, p <.001. The findings suggest that youth who experience direct gun violence are often exposed to multiple violent contexts. For older youth (ages 10–17 years) polyvictimization was most strongly associated with posttraumatic symptoms, β =.35, p <.001, although witnessing gun violence still uniquely predicted a higher level of symptoms, β =.18, p <.01. For younger children (ages 2–9 years), hearing and witnessing gun violence were both related to posttraumatic symptoms, β =.15, p <.01 for both, even after controlling for polyvictimization. Mental health professionals and trauma-informed services should be mindful that the traumatic impact of gun violence for children may not necessarily be attached to direct victimization experiences but may also result from simply seeing or hearing it in their neighborhoods.
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Longitudinal pathway from violence exposure to firearm carriage among adolescents: The role of future expectation
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  • Jun 2020
Introduction Exposure to violence is a risk factor for firearm carriage. Youth exposed to violence also have difficulty envisioning positive future outcomes (e.g., educational outcomes), which can increase the likelihood of firearm carriage over time. Researchers, however, have not yet examined whether changes in exposure to violence over time can influence the developmental trajectories of firearm carriage. To address this gap, we (1) examined the longitudinal association between exposure to violence and firearm carriage (grades 9 to 12) and then (2) examined whether changes in future expectations mediated this longitudinal association. Method The longitudinal association between exposure to violence and firearm carriage through future expectations was examined among 850 adolescents from the Flint Adolescent Study. Participants were recruited from four high schools in a midwestern city in the United States. Parallel latent growth models and latent growth mediation models were estimated. Results A positive association was observed between the rate of change in exposure to violence and firearm carriage. Exposure to violence also indirectly increased the risk for firearm carriage over time by decreasing future expectation in the 9th grade. Conclusions Our results support the idea that helping youth develop positive attitude about educational success may help reduce firearm carriage. Increasing positive expectations about future may help prevent firearm carriage within the context of violence exposure.
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Firearm Violence Exposure and Suicidal Ideation Among Young Adults Experiencing Homelessness
Article
  • Apr 2020
  • J ADOLESCENT HEALTH
Purpose This study aimed to explore the association between direct exposure, indirect exposure, and perpetration of gun violence and suicidal ideation among young adults experiencing homelessness (YAEH). Methods YAEH (n = 1,426) in seven cities across the U.S. were surveyed. Logistic regression analyses were conducted to examine the association between lifetime gun violence exposure and suicidal ideation in the past 12 months. Results Forty-five percent (n = 641) of YAEH had experienced direct or indirect gun violence, whereas 17% (n = 247) had engaged in gun violence perpetration. Gun violence perpetration is associated with elevated suicidal ideation risk (odds ratio = 1.46; 95% confidence interval = 1.02–2.01) among YAEH. Conclusions A high percentage of YAEH were exposed to firearm violence. Cross-sector, multiagency collaborations are warranted to reduce firearm violence exposure among this vulnerable population. Homeless service providers should screen for gun violence exposure and suicide risk and target prevention efforts on YAEH with a history of gun violence perpetration.
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Distress Level and Daily Functioning Problems Attributed to Firearm Victimization: Sociodemographic Specific Responses
Article
  • Dec 2019
  • ANN EPIDEMIOL
Purpose: The purpose of this study was to estimate the effect of firearm involvement during violent victimization on the level of distress experienced and daily functioning within sociodemographic subgroups. Methods: We used cross-sectional data from the National Crime Victimization Survey (n = 5698) and Targeted Maximum Likelihood Estimation. Sociodemographic subgroups were defined by age, race, sex, and socioeconomic position. Outcomes included experiencing the victimization as severely distressing and problems in the workplace or at school, or with peers or family. Results: Among people victimized with a firearm, nearly 40% experienced the victimization as severely distressing and 28% reported daily functioning problems as a result of the victimization, compared with 25% and 27% of those victimized without a firearm. In most of the subgroups examined, a greater proportion of people described the event as severely distressing when a firearm was involved in the victimization, ranging up to 19 percentage points higher among women and among black respondents (95% CI for women = 10%-28%; for blacks = 6%-31%). Conclusions: Our findings suggest an almost universal negative response to firearm involvement during a violent victimization as compared with violent victimizations involving other or no weapons. These findings highlight the need for efforts by medical and mental health practitioners to address the potential sequelae of experiencing severe distress during a firearm victimization.
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The impact of secondary exposure to gun violence fatality on mental health outcomes in four urban United States settings
Article
  • Oct 2019
Rationale: Given the widespread availability of firearms, high prevalence of gun violence in the U.S., and the intersection of race, cumulative violence and adverse mental health outcomes, it is important to understand the mental health consequences of exposure to gun violence fatality on racially/ethnically diverse secondary victims. Objective: The aims of this study were to examine 1) the prevalence and demographic differences in exposure to gun violence fatality; 2) the associations between exposure and depression, psychological distress, suicidal ideation and psychosis-like experiences; and 3) the interaction between race and exposure in relation to depression, psychological distress, suicidal ideation and psychotic experiences. Methods: Participants (n=1615) were adult community residents from Baltimore, New York, Philadelphia, and Washington, D.C, who participated in the online Survey of Police-Public Encounters. Chi-square, linear, and logistic regression were used to test study aims. Results: Twenty-four percent of respondents reported exposure to gun violence fatality. Black, Latinx, younger, and those of lower income and education were disproportionately exposed. Exposed respondents had significantly higher levels of psychological distress, depression, suicidal ideation and/or psychotic experiences compared to those not exposed. There was a significantly stronger association between exposure and depression among Latinxs and "other" races relative to Whites. Conclusions: Findings suggest that vicarious exposure to gun violence fatality is widespread, disproportionately experienced by racial/ethnic minorities, and related to a higher prevalence of mental health symptoms. Implications of these findings are that clinicians should attend to the mental health needs of people vicariously exposed to gun violence fatality, and that gun violence reduction interventions may positively impact community-level mental health. Given that Blacks and Latinxs are disproportionately exposed to gun violence, a more extensive examination of exposure to gun violence fatality as a social determinant of mental health is warranted using longitudinal and nationally representative data.
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