Category Archives: Violence and Trauma
Among the best pieces of advice people can look to today, the day before Thanksgiving, is a primer on safe food preparation from the U.S. Food and Drug Administration, including a video on just how to stuff that turkey.
Additionally, when it comes to safety this holiday season, there are also ways to help keep yourself and your purchases safe as Thanksgiving morphs into Black Friday. Tech guru Shelly Palmer reported recently that, according to the New York City police department, 14 percent of crime in that city is linked to Apple computer products, while police in other cities note technology thefts of all kinds as the holiday shopping season gets into full swing. Apple is alerting buyers of the latest model iPhones that the devices now come with a security feature that requires a User ID and password to disable the "Find my Phone" feature, which helps police track down stolen phones. Tech experts say widespread use of the Apple feature can help deter theft--and possible harm--during a robbery.
Another thing to be aware of this shopping season, when people will be out and about on busy streets, is what's come to be known as the "Knockout Game," where the goal is knock a random person unconscious with a single punch. CNN and other news outlets have posted stories about reports of random violence in several U.S. and foreign cities, and at least one city is considering punishing juveniles found guilty of the attack as an adult rather than a child--which can mean years of jail time. However, The New York Times recently added its voice to the growing national discussion with a story questioning whether the "game" is in fact an urban myth, saying that it's possible these assaults are random acts of violence, and that even New York City police officials are still trying to determine the truth.
Nonetheless, while questions over the "game" remain, the assaults are very real. According to CNN, a police spokesman in Pittsburgh says people who appear distracted--such as those checking phones or listening to music through headphones--may be more vulnerable to attacks.
>>Bonus Link: The National Crime Prevention Council offers tips on safe holiday shopping, including shopping with a friend for added security.
A presentation at the recent American Public Health Association (APHA) annual meeting, held last week in Boston, reported on the Gun Shop Project. The program of the New Hampshire Firearm Safety Coalition shares guidelines on how to avoid selling or renting a firearm to a suicidal customer with gun advocates, gun shop owners, mental health professionals and public health professionals. The Gun Shop Project also encourages gun stores and firing ranges to display and distribute suicide prevention materials tailored to their customers
“The science shows us that not only is suicide the leading type of death from a firearm, but having a gun in the home increases the incidence of suicide, femicide [shooting a woman], and the likelihood that people in the community will be shot. Many mass shootings, like those at Sandy Hook Elementary School in Newtown, involve the suicide of the shooter,” said David Hemenway, who spoke about the Gun Shop Project at the APHA meeting. “One way to prevent the shootings may be to prevent the suicide.”
He is a member of the Project’s team as director of the Injury Control Center at the Harvard School of Public Health, as well as a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
The ultimate goal of the coalition is to change social norms around gun use and to see the Gun Shop Project achieve results similar to the national effort to stop drunk driving.
“We want to work with the gun-owning community to create reasonable norms about when to get the guns out of the house,” Hemenway said. “If a neighbor is also a gun owner, for example, that neighbor could be asked to hold the firearms until another neighbor’s difficult period has passed. It’s the same idea as the ‘don’t let a friend drive drunk’ campaign. This can make a difference…”
Hemenway says the efforts of the Gun Shop Project are a growing national effort and partners include the U.S. Army, the American Foundation for Suicide Prevention and other groups working to reduce suicides by limiting access to lethal means at critical periods.
Read more about the Gun Shop Project.
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.
“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.
A new American Public Health Association (APHA) Press book, “Veteran Suicide: A Public Health Imperative,” addresses the critical and growing issue of suicide among military veterans. The book is a collaboration between the APHA and the Department of Veterans Affairs. Both organizations previously partnered on a supplement to the American Journal of Public Health on suicide risks among veterans.
Topics addressed by the book include
- suicide prevention,
- substance abuse, and
- suicide surveillance.
The new book includes very recent research on suicide among veterans. "The research represented by the collection of manuscripts included in this volume is an important step towards addressing the national problem of suicide and a reminder that even one death by suicide is too many," said Janet Kemp, RN, PhD, Department of Veterans Affairs National Mental Health Program Director for Suicide Prevention.
“Veteran Suicide: A Public Health Imperative” is available for purchase online.
>>Bonus Link: This week the Huffington Post published an article by Kimberly Williams, Director of the Center for Policy, Advocacy, and Education of the Mental Health Association of New York City, pointing out that the connectedness members of the military feel with each other often disappears when they return to their communities, which may be a factor in the rising suicide rates among veterans.
How can we put a stop to violence? Gary Slutkin, MD, believes the key is treating it as we would any contagious disease. The epidemiologist and Founder/Executive Director of Cure Violence recently spoke at TEDMED 2013 about utilizing public health and science-based strategies to prevent violence in communities.
“The greatest predictor of a case of violence is a preceding case of violence,” said Slutkin.
And as with an epidemic such as cholera, the way to stop violence is to find those “first cases” and interrupt the transmission. Cure Violence’s model involves violence interrupters who play a similar role as health workers during epidemics, going into communities to help re-frame issues and cool down situations that could lead to violence. At the same time, outreach workers help people change their behavior and—in time—change the social norms of a community.
>> Watch the full TEDMED presentation.
>>Read more about the public health approach to public safety from Cure Violence.
Crime and violence in U.S. inner cities has a profound impact on public health. The question is how best to combat it. According to recent studies, one answer could be as simple as assigning more police officers to foot patrols in crime hotspots.
With funding in part from the Robert Wood Johnson Foundation’s Public Health Law Research program, researchers from Temple University worked with the Philadelphia Police Department to conduct a study on the impact of police foot patrols on inner city crime. Findings published in Criminology in 2011 found foot patrols helped reduce violent crime — at least temporarily — by 23 percent in high-crime areas of the city. A recent follow-up study in Policing and Society revealed a qualitative look at how the participating officers developed extensive local knowledge and formed community relationships — both of which contributed to the cuts in crime.
These and other results demonstrate the need to involve officers on foot patrol in the development of violence prevention strategies, according to researchers.
>> Read more about the study.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. In this Idea Gallery, Bryan Samuels, Commissioner of the Administration on Children, Youth and Families, provides his perspective on how communities and organizations and families can work together to keep children safe, in honor of Child Abuse Prevention Month.
Nancy Barrand, Senior Adviser for Program Development at the Robert Wood Johnson Foundation (RWJF), also weighed in to provide some context for Commissioner Samuels' post:
Few events are more traumatic for children than being removed from their families and entered into the foster care system. In 2010, the Robert Wood Johnson Foundation funded the Corporation for Supportive Housing to develop and implement a pilot program in New York City that uses supportive housing to offer stability to families with children who are at risk of recurring involvement in the child welfare system. The New York pilot initiative, called Keeping Families Together (KFT), showed positive results in keeping and reuniting children with their families in a safe, stable environment. A 2011 evaluation indicates that the KFT pilot generated a 91 percent housing retention rate among participating families. By the end of the evaluation, 61 percent of the child welfare cases open at the time of placement in supportive housing had been closed, and there were fewer repeat incidents of child maltreatment.Now, RWJF has partnered with the U.S. Department of Health and Human Services, Administration on Children Youth and Families and three private foundations – the Annie E. Casey Foundation, Casey Family Programs, and the Edna McConnell Clark Foundation – to jointly fund a $35.5 million initiative to further test how supportive housing can help stabilize highly vulnerable families. The national replication effort will be evaluated and we’re anxious to see whether, again, secure and affordable housing, when paired with the right services for struggling families, can reduce instances of child abuse and neglect. The long-term gains in health and well-being, and costs saved, could be tremendous.
Commissioner Bryan Samuels on Child Abuse Prevention
Throughout the month of April, we turn our attention to the prevention of child abuse and neglect, celebrating those efforts in neighborhoods, faith communities, and schools that keep children safe and help families thrive. Whether formal or informal, these efforts involve wrapping caregivers and children in supports that reduce risk factors for maltreatment and promote protective factors, by decreasing stress, boosting parenting skills, and helping parents manage substance abuse or mental health issues.
Last year, more than 675,000 U.S. children were victims of maltreatment. These children are more likely than their peers to have emotional and behavioral problems, struggles in school, and difficulty forming and maintaining relationships. The effects of abuse and neglect can be pernicious and lifelong.
In recent years, we’ve come a long way in learning what it takes to help children who have experienced abuse and neglect heal and recover. We have interventions that help put families back together after maltreatment has occurred. But preventing abuse and neglect in the first place by giving families the support they need, when they need it, yields the best outcomes.
On July 20, 2012, during a midnight showing at a local movie theatre in Aurora, Colorado, a gunman opened fire, killing and injuring unsuspecting moviegoers. Ultimately the massacre killed 12 and injured 57 — presenting an enormous challenge for local emergency dispatch, fire departments, police, hospitals, public health, and more, and requiring all to work together on an integrated response in the midst and the wake of a chaotic, unprecedented active shooter situation. Partners came together to share their lessons learned at the 2013 Public Health Preparedness Summit.
>>Read continued NewPublicHealth coverage from the Summit.
When the first 9-1-1 calls came in following the shooting, the University of Colorado Hospital, a level II trauma center, already had full emergency department — 49 out of 50 beds were filled.
“We’d been notified we were going to get three to five gun shot victims,” said Patrick Conroy, manager of support services and safety officer for the University of Colorado Hospital. “But we had this queasy feeling something was not quite right. We started notifying emergency services to get ready.”