CRIME RATES 2007-2010

1. Special issue on health and human security in border communities-Pan American Journal of Public Health Children’s mental health and collective violence: A bi-national study on the United States/MexicoborderRevPanam Salud Publica. 2012 May;31(5):411-6. Marie Leiner, Hector Puertas, Raúl Caratachea, Carmen Avila, Aparna Alturu, David Briones, Cecilia de Vargas.

2. CRIME RATES 2007-2010 • Crime rates of drug-related killings • Ciudad Juarez, Chihuahua – 2007 rate per 100,000 people (drug murders) = 0. • El Paso, TX, United States – 2007 rate per 100,000 people (drug murders) = 0. • Ciudad Juarez, Chihuahua – 2010 rate per 100,000 people (drug murders) = 156. • El Paso, TX, United States – 2010 rate per 100,000 people (drug murders) = 0.

3. Some current statistics • Homicide rate January to March per year 2008-2012 Homicide rate January to March in Ciudad Juarez, Chihuahua Mexico

4. El Paso For the first time, in 2011 El Paso was named the city with the lowest crime rate in the United States with a population of over 500,000 residents. From Neighborhood Scout - The crime rate in El Paso is considerably higher than the national average across all communities in America from the largest to the smallest. The chance of becoming a victim of either violent, or property crime in El Paso is 1 in 33. Based on FBI crime data, El Paso is not one of the safest communities in America. Relative to Texas, El Paso has a crime rate that is higher than 71% of the state's cities and towns of all sizes.

5. Objective To investigate the risk effects of poverty and exposure to collective violence attributed to organized crime on the mental health of children living on the United States-Mexico border. According to the World Health Organization - Collective violence is “the instrumental use of violence by people who identify themselves as members of a group –whether this group is transitory or has a more permanent identity – against another group or set of individuals, in order to achieve political, economic or social objectives”.

6. Collective Violence • Forms of collective violence: • Wars, terrorism and other violent political conflicts that occur within or between states. • State-perpetrated violence such as genocide, repression, disappearances, torture and other abuses of human rights. • Organized violent crime such as banditry and gang warfare

7. Few studies Poverty-Collective violence We could not find studies that examined both the effects of poverty, and collective violence (attributed to organized crime).

8. Effect CollectiveViolence Ciudad Juarez, Chihuahua, México Ciudad Juarez, Chihuahua, México 2007 2010 Poverty Poverty El Paso, Texas USA El Paso, Texas USA

9. Comparison 2007-2010 Ciudad Juarez - We compared the mental health of children living in poverty in 2007, with children living with poverty + collective violence in 2010. El Paso – We compared a sample population of Mexican/American children living in poverty in El Paso, Texas, United States in 2007 and 2010.

10. CRIME RATES • Crime rates of drug-related killings • Ciudad Juarez, Chihuahua – 2007 rate per 100,000 people (drug murders) = 0. • El Paso, TX, United States – 2007 rate per 100,000 people (drug murders) = 0. • Ciudad Juarez, Chihuahua – 2009 rate per 100,000 people (drug murders) = 156. • El Paso, TX, United States – 2010 rate per 100,000 people (drug murders) = 0.

11. Methods • Type of study • This is a repeated cross-sectional study, with data collected in two different years (2007 and 2010), in two border cities in the United States and Mexico. • Participants • A total of 1261 participants were included in this study, with 466 (233 United States/233 Mexico) participants in 2007 and 795 (397 United States/398 Mexico) in 2010. Participant information was extracted from electronic records databases maintained in six university-based clinics in the United States and nine clinics of the Secretaria de Salud in Mexico.

12. Database characteristics United States electronic information: This large electronic database contained more than 7,000 pediatric patients whose parents responded to a psychosocial and behavioral assessment known as the Pictorial Child Behavior Checklist (P+CBCL). Parents/caretakers responded to the self-response P+CBCL during non-emergency visits when the children were receiving their regular pediatric care. Mexican electronic information: Parents/caretakers responded to the self-response P+CBCL during non-emergency visits when the children were receiving regular care in these clinics.

13. Inclusion criteria Only parents who reported Hispanic ethnicity, and who responded to the P+CBCL questionnaire in Spanish, were sampled from the electronic records in the United States. A second criterion for being sampled from the United States database was that family income had to be below the poverty level. The sample of Mexican children included those that responded to the P+CBCL in Spanish who use Seguro Popular, an insurance program provided by the government of Mexico to extend insurance to cover health services including regular and preventive medical care, pharmaceuticals, and health facilities, to 50 million uninsured Mexicans in the lowest socioeconomic bracket.

14. INSTRUMENTS P+CBCL – PICTORIAL CHILD BEHAVIOR CHECKLIST The P+CBCL is an adaptation of the original CBCL which was developed to support parents with limited literacy. High test-retest reliability (e.g., mean r = 0.90 for empirically based scales) and strong internal consistency (e.g., α = 0.97 for the Total Problems score) have been reported for the CBCL. The P+CBCL used in this study has shown psychometric equivalence with the CBCL. The CBCL has been validated among children living in Mexico, has been used in many other Latin-American countries, and demonstrated remarkable consistency in its psychometric properties across more than 30 countries.

15. Scales Factor analysis of this assessment tool yields eight problem scales: Anxious/Depressed, Withdrawn/Depressed, and Somatic Complaints load in the internalizing scales. Rule Breaking and Aggressive Behavior load onto the broad-band Externalizing scale. Social, Thought and Attention problems.

16. Statistical Analysis The effects of time (2007 and 2010), place of residence (United States or Mexico), gender (male or female), and age group (6-9, 10-12, and ≥13 years) were examined using a series of eight mixed-model analyses of variance (ANOVAs) with a 2x2x2x3 design. The Bonferroni correction for multiple comparisons was applied to the nine ANOVAs, which were all evaluated at the p = 0.006 (i.e., 0.05/8) level. Effect sizes (Cohen’s d) were also calculated. Guidelines for interpretation were: 0.2 = small, 0.5 = medium, and 0.8 = large (0.40).

18. Results There was not an apparent, or significant, difference between age groups or gender among the United States vs. Mexico groups in 2007 and 2010. Rawscores of the P+CBCL among the four groups and year indicate that higher scores in all problem scales corresponded to Mexican children in 2010

19. Results Raw scores of the P+CBCL among the four groups and year indicate that higher scores in all problem scales corresponded to Mexican children in 2010. When comparing the United States mean scores in 2007 with those in 2010, there was only one significant difference in Somatic Complaints problem scores, with a higher score reported in 2007. In the Mexican site, when comparing scores between 2007 and 2010, there were significant differences in three scales, the Social Problems, Rule Breaking, and Aggressive Behavior problem scales, with higher scores reported in 2010.

21. Raw scales comparison 2007-2010 - USA

22. Raw scales comparison 2007-2010 - Mexico

23. Effect sizes There were significant effects of group (United States/Mexico) in all the problem scales (Anxious/Depressed, Withdrawn/Depressed, Somatic Complains, Rule Breaking, Aggressive Behavior, Social Problems, and Thought and Attention Problems), but all effect sizes were small, the direction of the group effect indicated higher scores in Mexico. Effects by age groups (6-9, 10-12, and ≥13 years) were significant, with higher scores among younger children in Withdrawn/Depressed, and Social and Attention Problems (small effect sizes). Aggressive Behavior Problems effects were found to be higher in older children, with small effect sizes. Gender effects (male/female) were found, with the effect direction toward higher scores for boys when compared with girls in Rule Breaking, Aggressive Behavior, and Attention Problems (all effect sizes were small).

24. Effect sizes There were significant effects in the interaction of group (United States/Mexico) and year (2007/2010) in Rule Breaking, Aggressive Behavior, and Social Problems, with the effect direction showing higher scores in Mexico in 2010 with medium effect sizes in Social Problems, and a small effect in the rest of the problem scales.

25. Effect sizes Additionally, there was an interaction between group (United States/Mexico), year (2007/2010), and age groups (6-9, 10-12, and ≥13 years) in Somatic and Social Scale Problems, with the effect direction toward younger children 6-9 years old in Mexico having the higher scores (effect sizes were small).

26. Effectsizes The significant resulting interaction between group (United States/Mexico) and time (2007/2010), with higher scores reported by children and adolescents living in Mexico in 2010 in Rule Breaking, Aggressive Behavior, and Social Problems scales, seem to indicate an additive effect of poverty plus exposure to collective violence in this group. Vulnerability of younger children in Somatic and Social Problem scales was found among children in Mexico in 2010 in the youngest group as a result of the interaction between group (United States/Mexico), year (2007/2010), and age groups (6-9, 10-12, and ≥13 years), although the effect sizes were small.

27. Discussion These findings seem to indicate that problems reported by parents increased in 2010 in a city that was considered one of the most violent cities of the world not at war.

28. Mental Health Risks Genetics Material deprivation including parental lack of education Poor physical and mental health Lack of employment or income Exposure to community violence, hostile environments and lack of resources are seeds that can create undesired conditions in the mental health of individuals and families.

29. Cumulative effects • Multiple risks occurring at once have a cumulative effect. • Collective violence effects on children • Cumulative adverse events contribute to a higher vulnerability of children exposed to traumatic experiences. A large number of studies have indicated that exposure to community violence, including armed conflicts or war and gangs, has profound detrimental effects on children.

30. Limitations There are some limitations to this study, including the lack of measurement of concurrent intra-familial violence, child abuse, or other types of violence confronted by children at the time of the study, which could contribute independently to the mental health of children. Additionally, personal experiences were not quantified, which could confound the final results of this study. We did not include personal experiences of the families as victims, or experiences of witnessing or learning about incidents. Poverty levels in the groups could be different, despite our attempt to compare children of similar socioeconomic status. It is possible that children living in poverty in Mexico are poorer than children living in poverty in the United States, and that difference could have an effect on the problems reported.

31. Thank you