Category Archives: Violence
David Satcher, MD, PhD, was a four-star admiral in the U.S. Public Health Service Commissioned Corps and served as the 10th Assistant Secretary for Health and the 16th Surgeon General of the United States—at the same time. He was Surgeon General from 1998 through 2001, and under his tenure he tackled disparities in tobacco use and overall health equity, sexual health and—critically—youth violence.
Satcher was a key speaker in a recent American Public Health Association (APHA) Annual Meeting Town Hall Meeting on a global approach to preventing violence. NewPublicHealth spoke with Satcher about approaches to preventing violence as a public health issue.
NewPublicHealth: How do you take a public health approach to preventing violence?
David Satcher: When you take a public health approach, public health experts pose four questions:
- First, what is the problem and what is the magnitude, the nature and distribution of the problem?
- The second question is: what is the cause of the problem or the major risk factors for the problem?
- The third question is: what can we do to reduce the risk of the problem?
- And finally, how can we then implement that more broadly throughout society?
So, when we say we’re taking a public health approach, that’s what we’re talking about.
What we’ve tried to do and what we need more of is to really study the different causes of violence and violent episodes. They’re not all the same. I’ve dealt with a lot of the mass murders; I was Surgeon General when Columbine took place and the Surgeon General’s Report on Youth Violence in part evolved from that. And obviously there, as in most mass murders, we’re dealing with, among other things, mental health problems and easy access to weapons combined. I don’t think the same is necessarily true for gang violence, which causes thousands of deaths each year. With youth violence and gangs, I think there you’re dealing with a culture of insecurity where young people feel that in order to protect themselves they need to be members of gangs and they need to be armed.
“We live in a culture of violence,” said Larry Cohen, MSW, founder and executive director of the Prevention Institute, in a morning session on violence prevention at the American Public Health Association (APHA) Annual Meeting, held this year in Boston, Mass.
“Just as air, water and soil affect our health, the social environment affects the spread of violence through our communities,” said Cohen.
One of the most important factors in the environment that influences the perpetration of violence is actually more violence. Basically, violence begets violence. It spreads like a disease.
“It’s like the flu,” said Gary Slutkin, MD, PhD, Founder and Executive Director of Cure Violence. “The greatest predictor of a case of the flu is a preceding case of the flu. It’s the same thing with violence. Violence is an infectious disease.”
Slutkin shared a study of one community that found that exposure to community violence in one form or another was associated with a 30 times increased risk of committing violence—but what was most striking is that statistic held true, even controlling for poverty, race, crowded housing and other factors that could have an impact on violence. The effect is also “dose dependent,” according to Dr. Slutkin. That is, the more violence you witness or experience, the more likely you are to perpetrate violence.
The good news is that “we know how to prevent epidemics,” said Slutkin. “We need to recognize that this is a preventable problem. We need to build a movement,” agreed Cohen.
Cure Violence focuses on the very same steps used to prevent the spread of infectious disease in their work to help prevent the spread of violence:
- Detect and interrupt the transmission of violence, by anticipating where violence might occur.
- Change the behavior of those most at risk for spreading violence.
- Change community norms to discourage the use of violence as an acceptable and even encouraged way to handle conflict.
Firearm Injuries Cost $16B in U.S. Health Care in Less than a Decade
Firearm injuries cost more than $16 billion in hospital care between from 2000 to 2008, according to new research to be presented today at the American Public Health Association’s 141st Annual Meeting in Boston. The 275,939 victims spent approximately 1.7 million days in the hospital, for an average stay of 6.7 days and an average cost of medical treatment of $59,620. About one in three patients did not have insurance. “The impact is probably much higher than $16 billion since the years of life lost, disability, lack of productivity, societal well-being and emotional turmoil associated with such injuries is far-reaching,” said Min Kyeong Lee, DMD, Annual Meeting presenter. “This is one of the foremost reasons why health care costs in this country have gotten out of control and underlies the need for better preventive policies.” Read more on violence.
Study: Secondhand Smoke in the Workplace Down Overall, But Certain Groups Still at Risk
While recent policies and regulations have helped reduce the overall exposure rates of secondhand smoke in the workplace, certain professions continue to experience high rates, according to new findings to be presented today at the American Public Health Association’s 141st Annual Meeting. The study looked at exposure rates in Massachusetts since 2004, when its Smoke-Free Workplace Law was enacted to require all enclosed workplaces to be smoke free. However, that means that workers in installation, repair and maintenance still experience an overall secondhand smoke exposure rate of 37.4 percent; the national rate in 2010 was 5.4 percent. “We’re seeing a steady decline in prevalence of exposure, but it’s clear that there are still specific groups of workers that deserve our attention,” said Kathleen Fitzsimmons, MPH, lead researcher of the study. “Findings like these that combine information about occupation and environmental tobacco smoke provide helpful information for evaluating comprehensive statewide smoke-free workplace laws and for targeting interventions to reduce risks.” Read more on tobacco.
Study: HPV Screenings Better than Pap Tests at Protecting Against Invasive Cervical Cancer
Human papillomavirus (HPV) screenings are both more effective than Pap tests when it comes to screening against invasive cervical cancer, according to a new study in the journal The Lancet. Researchers analyzed the results of four clinical trials in Europe covering more than 175,000 women ages 20 to 64. The studies tracked them women for an average of 6.5 years after one of the screening types, finding that they were about equal in protection levels for the first 2.5 years, but that following that short time frame HPV screening provided as much as 70 percent greater protection. The findings were particularly significant in women ages 30 to 35. Read more on cancer.
Administration: Half a Million Have Applied for Health Insurance Under Affordable Care Act
Despite problems with the Healthcare.gov online portal, approximately half a million people have applied for health insurance under the Affordable Care Act. Enrollment for all 50 states and the District of Columbia opened on October 1. As many as 7 million uninsured Americans are ultimately expected to receive coverage through the program. However, as soon as the site launched users began to experience error messages and other technological glitches; the administration pointed to the unexpectedly high volume of visitors as the reason for the problems. "The website is unacceptable, and we are improving it, but the product is good and across the country people are getting access to affordable care starting January 1," said an administration spokesperson, according to Reuters. On the other hand, an article in Politico points out that the numbers being reported are only a piece of the puzzle because the number of people who applied does not equate to the number of people who "actually completed the process of choosing and enrolling in a health plan." And, according to Politico, "Extensive 'glitches'...with the online marketplaces known as exchanges have made it impossible for most people to get all the way through the signup process, even after filling out the initial online application."Read more on the Affordable Care Act.
Study: Friendships Formed on Social Networking Sites Can Help Smokers Quit
The strong supportive bonds formed on social networking sites can help people in their efforts to quit smoking, according to a new study in the Journal of Communication. "I found that people who join health-based social networking sites are able to quit smoking and abstain for longer periods of time because of the sense of community they build with other members," said study author Joe Phua, an assistant professor in the department of advertising and public relations at the University of Georgia's Grady College of Journalism and Mass Communication. Researchers surveyed 252 members of six health-centric websites, finding that the friendships formed online “seemed to boost users' sense of empowerment with respect to their ability to stop smoking for good,” according to HealthDay. Phua said the online support sites are effective because they are cheap and easy to access, while also providing a connection to “a larger and credible community” of people working to quit tobacco. Read more on tobacco.
Study: Spankings Tied to More Behavior Problems in Elementary School
Spankings of five-year-old children are tied to increased behavior problems in elementary school, according to a new study in the journal Pediatrics. Led by Michael MacKenzie, from Columbia University in New York, the researchers analyzed long-term data on approximately 1,900 children, finding that spankings by moms at least twice a week were tied to a two-point increase on a 70-point scale of problem behavior. They also found that regular spankings by fathers were tied to lower scores on vocabulary tests. Elizabeth Gershoff of the University of Texas at Austin, who was not a part of the study, said that while the findings are difficult to interpret, "There's just no evidence that spanking is good for kids. Spanking models aggression as a way of solving problems, that you can hit people and get what you want,” she said. “When (children) want another kid's toy, the parents haven't taught them how to use their words or how to negotiate." Read more on violence.
A recent article in The Atlantic on the history of competitive sports among American kids led The New York Times to write a wide-ranging debate on the pros and cons of competitive sports for kids and teenagers. The pivotal question: Do competitive sports overwhelm childhood or enhance it?
It’s an important debate. Sports can represent a gateway to a life of enjoyable exercise, good for both the heart and mind. But they also pose, as currently played, some significant risks. These include the risk of injury or even death and unhealthy competitive traits, all of which can be a turn-off for physical activity of all kinds for kids made to play and practice against their will.
Those weighing in on the Times’ debate pages include the head of Little League International, who says sports teach kids valuable lessons; a sociologist who says that since so few kids ever make their living in professional sports, we need a greater emphasis on education than athletics; and the head of the American Orthopaedic Society for Sports Medicine, who says that most children's bodies are not capable of playing one sport day after day, for years on end, and because of this many kids have bone and joint injuries.
>>Bonus Links: Read NewPublicHealth interviews on preventing concussions in youth sports with MacArthur fellow Kevin Guskiewicz, and Robert Faherty, VP and Commissioner of the Babe Ruth youth baseball league.
AHA: Health Care Providers Should Emphasize Healthy Behaviors in Cardio Care
When it comes to treating cardiovascular health, health care providers should place just as much emphasis on correcting healthy behaviors as they do addressing the physical indicators of the risk for heart disease, according to a new statement from the American Heart Association (AHA). “We’re talking about a paradigm shift from only treating biomarkers — physical indicators of a person’s risk for heart disease — to helping people change unhealthy behaviors, such as smoking, unhealthy body weight, poor diet quality and lack of physical activity,” said lead author Bonnie Spring, PhD, a professor of preventive medicine and psychiatry and behavioral sciences at Northwestern University in Chicago. “We already treat physical risk factors that can be measured through a blood sample or a blood pressure reading in a doctor’s office, yet people put their health at risk through their behaviors. We can’t measure the results of these behaviors in their bodies yet.”
The AHA’s recommended “five A’s” to patient treatment:
- Assess a patient’s risk behaviors for heart disease.
- Advise change, such as weight loss or exercise.
- Agree on an action plan.
- Assist with treatment.
- Arrange for follow-up care.
AHA’s goals for 2020 include improving the cardiovascular health of all Americans by 20 percent, while also reducing deaths from cardiovascular diseases and stroke by 20 percent. Read more on heart health.
Study: 1 in 10 Youth Admit to Sexual Violence
Approximately one in 10 teenagers and young adults admit to sexual violence, according to a new study in the journal JAMA Pediatrics. Researchers said violent pornography may be partially to blame for the acts, which included coercive sex, sexual assault and rape, and most often with a romantic partner. What’s more, about two in three said the act was never discovered, so there was never a punishment. "We know a bit about youth who are victims of sexual violence, but we don't know much at all about youth as perpetrators," said study co-author Michele Ybarra, president and research director of the Center for Innovative Public Health Research in San Clemente, Calif. "It's important we know more if we're going to reduce the sexual-violence rate." Ybarra said sexual-violence-prevention programs should emphasize the understanding of explicit consent and the tactics of coercive sex. "They may say, 'Unless you have sex with me, I'm going to go have sex with someone else,’” said Angela Diaz, MD, MPH, director of Mount Sinai Hospital's Adolescent Health Center. "Young people have to learn that if their partner says that, maybe they're better off if they do go somewhere else." Programs should also focus on the role of the bystander and the importance of reporting incidents. Read more on violence.
Salmonella Outbreak Sickens 278 People in 18 States
Approximately 278 people in 18 states have become sick from a salmonella outbreak linked to raw chicken products, according to the U.S. Department of Agriculture. The products were produced at three California plants owned by Foster Farms and distributed mostly to retailers in California, Oregon and Washington state. Local, state and federal health officials made the connection. While the outbreak is “ongoing,” there is currently no recall as the U.S. Centers for Disease Control and Prevention is working with state health departments to monitor the matter while the Food Safety and Inspection Service investigated the outbreak. Read more on food safety.
“Thanks to decades of neuroscience research on brain development, adversity and toxic stress, we now understand how a child who is exposed to violence, or neglect, or homelessness at an early age may develop behavioral and physical health problems later in life,” said Jane Lowe, Senior Adviser for Program Development at the Robert Wood Johnson Foundation (RWJF). “We can now use this rapidly evolving knowledge to create real-world solutions.”
RWJF.org recently pulled together a collection of resources on “adverse childhood experiences”—how common they are and what they can mean for the adults those traumatized children become. The website includes an infographic that illustrates the subject:
NewPublicHealth has previously written about the importance of addressing and changing youth violence, so that these behaviors don’t become even more severe—and more damaging—while spreading from act to act and person to person. In a Q&A, RWJF Director Kristin Schubert, MPH, spoke about the Foundation’s approach to the issue of violence prevention and strategies in the field that are working to create change.
“We know that the child who was abused is that much more likely to be a victim or perpetrator of bullying a few years down the line, and then is that much more likely to be a victim or perpetrator of dating violence a few years later in high school, and then is much more likely to be a part of more family violence later on. There’s no form of violence that stands alone,” she said. “It’s a multigenerational phenomenon that is passed down.
“This context is so essential—in considering why someone engages in violent behavior, it’s important to recognize that it’s not just the ‘bad apple,’ it’s not the person. It’s the behavior. As Gary Slutkin of CeaseFire says, ‘Violence is a learned behavior.’”
Schubert pointed to the Adverse Childhood Experiences Study, which found that the more “adverse” events a child faces in their youth—from maltreatment to neglect to abuse to witnessing violence—the more likely they are to have health problems later in life. That includes hypertension, diabetes and heart disease.
>>Read the full NewPublicHealth interview.
>>Read more about Adverse Childhood Experiences.
Study: 40 Percent of Antibiotics Released from 1980-2009 Withdrawn from Market
Safety concerns, lack of effectiveness when compared to existing drugs and weak sales led more than 40 percent of the antibiotics released between 1980 and 2009 to be withdrawn from the market, according to a new study in the Journal of Law, Medicine and Ethics. The rate was three times as high as that for any other type of drug. “This study raises the question whether or not money would be better spent on higher quality antibiotics, rather than a larger quantity” and whether “approving a flood of new lower-quality antibiotics might actually trigger much higher levels of resistance,” said author Kevin Outterson, JD, LLM, professor at Boston University School of Law and co-director of the Boston University Health Law Program. Antibiotic use can lead to bacteria becoming resistant to a strain. A recent report from the U.S. Centers for Disease Control and Prevention found that as many as 50 percent of prescriptions for antibiotics are either not needed or prescribed inappropriately. Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process. Read more on prescription drugs.
Locations of Drinking Can Influence Types of Partner Violence
Where and when a person drinks can affect the type of partner violence that can follow, according to a new study from the journal Addiction. The study looked at six drinking locations: restaurants, bars, parties at someone else's home, quiet evenings at home, with friends in one's own home and in parks/other public places. Researchers from the Prevention Research Center in California and Arizona State University found that men drinking in bars and at partners away from home and women drinking in parks/other public places were linked with an increased rate of male-to-female violence. They also found that men drinking during quiet evenings at home was associated with increased female-to-male violence. The findings could help prevent partner violence by encouraging people in risky relationships not to drink in particular places/situations, which could prove more effective than counseling people simply to drink less. Read more on alcohol.
Multiple Myeloma Group Hopes Opening Records to Hundreds of Patients Will Advance Research
The Multiple Myeloma Research Foundation's (MMRF) Researcher Gateway is opening global online access to genetic and research data on hundreds of patients in an effort to help identify biological targets for future treatments, improve enrollment in studies by pairing them with the right patients and enhance researcher collaboration. The MMRF Research Gateway is a $40-million program funding by the foundation and drug company partners. The main component of the effort will be the Commpass study which will enroll 1,000 new multiple myeloma patients and monitor them throughout the course of the disease; cancer tissue banks typically include only one sample per patient. "There is going to be new information generated there that you would never get unless you followed patients through first relapse and second relapse and beyond," said George Mulligan, director of translational medicine for Millennium Pharmaceuticals, Japan's Takeda Pharmaceutical Co.’s oncology unit, which is one of the co-sponsors. "The size of it in patient numbers and the breadth and richness of it on a biological level, it's going to grow over time and mushroom into something that's going to be really special.” About 86,000 people are diagnosed with multiple myeloma each year, with about 20,000 of those from the United States. Read more on research.
UN: Improved Access to HIV/AIDS Treatment Reduces Number of AIDS-related Deaths
The United Nations’ annual report on HIV infections and AIDS related-deaths around the world concluded that increased access to treatment in poorer and middle-income countries has led to positive health outcomes. “AIDS-related deaths in 2012 fell to 1.6 million, down from 1.7 million in 2011 and a peak of 2.3 million in 2005. And the number of people newly infected with the disease dropped to 2.3 million in 2012 down from 2.5 million in 2011.” The executive director of UNAIDS, Michel Sidibé, said that the international community is well on its way to surpass the 2015 goals of expanding access to treatment. Read more on the public health impact of AIDS.
Racism Leads to Negative Effects on Mental Health of Children and Teens
A new report published in the journal Social Science & Medicine examines the link between the mental health and well-being of youth ages 12-18 and racism. The review shows that being a victim of racial discrimination can lead to low self-esteem, reduced resilience, and increased behavior problems. There was also evidence of increased risk of poorer birth outcomes for children when mother experienced racism while pregnant. These types of detriments to children and teen’s mental health and well-being can lead to larger problems in terms of engagement in education and employment later in life, according to study authors. Read more on health disparities.
Positive Relationships May Help Break the Cycle of Maltreatment
In a special supplement released by the Journal of Adolescent Health, investigations on the effects of safe, stable, nurturing relationships found that these types of relationships could help break the cycle of child maltreatment that is often passed along from parents to children. Findings also showed that supportive and nurturing relationships between adults can help protect children as well. This study can provide helpful prevention strategies for breaking the cycle of maltreatment and promoting improved health in the long term. Read more on violence prevention.
Antibiotic-resistant Infections on the Rise; Threat Called "Urgent"
Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). The report ranked the threats according to seven factors, including health impact, economic impact, how common the infection is and how easily it is spread. It classified carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile as “urgent." C. difficile alone causes about 250,000 hospitalizations and at least 14,000 deaths each year. Excessive antibiotic use is the number one cause of the increase in antibiotic-resistant infections, with as many as 50 percent of prescriptions either not needed or prescribed inappropriately. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” said Steve Solomon, MD, director of CDC’s Office of Antimicrobial Resistance. “These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.” Antibiotic-resistant infections also add as much as $20 billion in excess direct health care costs and account for as much as $35 billion in lost economic productivity. Read more on prescription drugs.
Survey: Nearly 80 Percent of College Students Oppose Concealed Handguns on Campus
Nearly 80 percent of the students in 15 Midwestern colleges and universities oppose allowing concealed handguns on their campuses, according to a new study in the Journal of American College Health. Ball State University researchers surveyed 1,649 undergraduate students, finding 78 percent were against the handguns and would not apply for a permit if they were legal. “Firearm morbidity and mortality are major public health problems that significantly impact our society,” said study co-author Jagdish Khubchandani, a member of Ball State’s Global Health Institute and a community health education professor in the university's Department of Physiology and Health Science. “The issue of allowing people to carry concealed weapons at universities and colleges around the U.S. has been raised several times in recent years. This is in spite of the fact that almost four of every five students are not in favor of allowing guns on campus.”
The study also found that:
- About 16 percent of undergraduate students own a firearm and 20 percent witnessed a crime on their campus that involved firearms
- About 79 percent of students would not feel safe if faculty, students and visitors carried concealed handguns on campus
- About 66 percent did not feel that carrying a gun would make them less likely to be troubled by others
- Most students also believed that allowing concealed carry guns would increase the rate of fatal suicides and homicides on campus
Read more on violence.
‘Bath Salts’ Drugs Led to 23,000 ER Visits in 2011
The use of “bath salts” drugs accounted for almost 23,000 emergency department visits in the United States in 2011, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The report is the first national study to analyze the link between the street drugs and emergency department visits. "Although bath salts drugs are sometimes claimed to be 'legal highs' or are promoted with labels to mask their real purpose, they can be extremely dangerous when used," said Elinore McCance-Katz, MD, SAMHSA's chief medical officer. The drugs can cause heart problems, high blood pressure, seizures, addiction, suicidal thoughts, psychosis and even death. About two-thirds of the visits also involved at least one other drug, with 15 percent of the visits also being linked to marijuana or synthetic forms of marijuana. There were approximately 2.5 million U.S. emergency department visits linked to drug misuse or abuse in 2011. Read more on substance abuse.