youth violence and african americans: perspectives from emergency medicine rob gore, md suny...
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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”
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
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/