Youth Violence and African Americans: Perspectives from Emergency Medicine

1. Youth Violence and African Americans: Perspectives from Emergency Medicine Rob Gore, MD SUNY Downstate - Kings County Department of Emergency Medicine February 10, 2007

2. Outline • Epidemiology, Demographics and Trends • Youth Violence Risk Factors • Intervention and Prevention

3. Youth Violence • > 800, 000 violent acts involving youth • 5,570 homicides – U.S. 2003 • Firearm 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

4. Youth Homicide • Most murder victims ages 12-17 are black • Males account for > 67% of homicides US Dept of Justice - OJJDP Image by Hank Willis Thomas

7. Violence and the Emergency Department • 3 million ED visits/year related to violence • Traumatic assault is recurrent • Hospital readmission rates • Subsequent assault – 44% • Subsequent homicides – 20% Denninghoff, et al.

8. Recent Observed and Projected Firearm- and Motor Vehicle Related Injury and Deaths

9. Nonfatal Violent Injury • Increased rates across U.S. • Major cause of disability • 94 nonfatal injuries for every homicidal death • Recurrent rates between 5% and 45% over the 5 years subsequent to the initial injury Rich, et al.

10. Economic Costs of Gun Violence • > $18,000 for gun assault injuries • Indirect costs: • $800 million – 1997 • $100 – 126 billion per year (Cook et al.) http://www.bradycampaign.org/

11. Re-injury Risk Factors • Substance abuse • School failure • Weapon possession • Poverty • Male gender • Black race • Gang involvement • Exposure to television violence Rich, et al.

12. Urban Youth Perspectives on Violence and the Necessity of Fighting • Johnson et al. • 13 focus groups • 120 Urban youth • Causes of Violence – Multi-factorial • Stress • Substance abuse • Witnessing violence • Disrespect • Standing up for friends • Neighborhood “Beef”

13. Pathways to Recurrent Trauma Among Young Black Men • Rich et al. • Qualitative analysis • 49 Black male violence victim narratives • Factors Related to safety after violent Injury • Loss of Respect • Code of the Street • Lack of Faith in Police • Trauma Stress Rich, et al.

14. “Code of the Street” • “Informal rules governing interpersonal public behavior, particularly violence” • Lack of aggressive response associated as “tolerating victimization”

15. Pathways to Recurrence Rich, et al.

16. Risk Factors in School Shootings • Verlinden et al. – 2000 • 9 incidents of multiple homicides in Secondary schools • Risk Factors identified

17. Columbine, Oregon, Conyers -Risk Factors for School Shootings • School Failure • Frequent fighting • Weapon possession • Alcohol abuse • Exposure to violence • Gang involvement • Family problems Verlinden et al

18. 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 Denninghoff, et al.

19. 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 Denninghoff, et al.

20. Competencies for Effective Practice • Three Levels of Competence in Youth Violence • Level 1 – Generalist • Level 2 – Specialist • Level 3 – Scholars / Leaders Denninghoff, et al.

21. Level 1 - Generalist • Basic knowledge of youth violence • Understanding of risk and protective factors • Self knowledge - personal experience

22. Level 2 - Specialist • Specific clinical interventions • Initiation of violence related injury referrals • Screening persons at risk for violence related injury • Aware of community programs and advocacy groups

23. Level 3 - Scholars and Leaders • Training other health professionals in violence prevention

24. Strategies to Reduce Youth Violence • Kellerman et al. 1998 • Types of Programs Studied • Early Childhood Family Interventions • Youth and Adolescent Interventions • Community Level Interaction

25. Take Home • Youth violence is a public health issue • Screen for risk factors • Educate those at risk • Get Involved!!!!

26. Youth 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

27. Questions? “Priceless” by Hank Willis Thomas

28. Bibliography • 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

29. 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/