Category Archives: Community violence
Last week at the American Public Health Association (APHA) annual meeting, a number of presenters took on an important, but often overlooked topic in the public health world: violence. Violence is often primarily considered a criminal justice or public safety issue, but there is a growing movement of public health practitioners that recognize that the health of vulnerable communities cannot be improved without first stopping shootings and killings.
When violence is present in a community, it impacts the physical, mental and emotional health of all residents. Violence also often prevents other positive changes from taking place. According to Greta Massetti from the Centers for Disease Control and Prevention, the current economic impact of youth violence is an estimated $14.1 billion in combined costs from medical care and work loss.
Treating violence as a disease
For many vulnerable communities, violence is the most pressing health issue. For children growing up in violent communities, the health impact is more than just the physical threat. As Benita Tsao from Urban Networks to Increase Thriving Youth (UNITY) pointed out, growing up in a community plagued by violence can often feel like being in a war zone. That constant fear results in real health consequences, as evidenced by the increasing number of children who have grown up surrounded by violence and are now showing signs of chronic traumatic stress disorder. Experiencing ongoing trauma impacts young people’s physical, mental and emotional development, and has the ripple effect of making it harder to focus and succeed in school.
The city of Philadelphia and the Pennsylvania Horticulture Society are seeing positive results as they continue to grow their Philadelphia Green program. The program has taken on the vacant lots in Philadelphia neighborhoods and transformed them from embarrassing eye sores to points of pride – and made the community safer in the process.
“The city owned the problem even if we did not own the land” said Robert Grossmann, Director, Philadelphia Green. “We decided to use horticulture to build community and improve the quality of life in Philadelphia’s neighborhoods and downtown public spaces.”
The goal was to help build equity for the people living in the neighborhoods so they felt a sense of pride – the result was crime prevention through environmental design.
With the help of community activists and landscape contractors the program has “cleaned and greened” more than 7,000 lots. The impact is a reduction in gun crimes, lower rates of vandalism and residents even report experiencing lower stress rates and an increased urge to get out and exercise.
>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.
Sheila Regan manages hospital partnerships for Cure Violence, formerly CeaseFire, an organization based in Chicago that has pioneered a public health approach to stopping shootings and killings. A grantee of the Robert Wood Johnson Foundation, Cure Violence has been successful at reducing violence in cities across America.
This week at APHA, Cure Violence shared how violence presents all the same characteristics of an infectious disease. Like tuberculosis or cholera, violence appears in clusters; it spreads and can be transmitted. By changing the frame on violence, Cure Violence is able to use proven public health strategies from other epidemics to stop shootings and killings. Hospital partnerships are a key part in stopping the spread and transmission of violence.
NewPublicHealth: Can you explain how Cure Violence’s hospital partnerships work?
Sheila Regan: We have a number of partnerships with level I trauma centers that are committed to the public health approach to violence prevention. We serve patients who are violently injured, typically shootings, stabbings or beatings and work to prevent further violence, retaliation or re-injury, which are seen as normal in our culture. There are the doctors, police, nurses, social workers, and everybody you’d expect to see in the hospital. What we’re trying to do is introduce a third party—our workers—who can impact behavior and mindset around violence at an opportune moment.
NPH: When someone has been injured, what is the goal of Cure Violence working with them in the hospital?
Martin Fenstersheib, MD, MPH, director of the Santa Clara County Public Health Department in California led a session on safe outdoor activity for kids and adults at the 2012 Public Health Law Conference. NewPublicHealth spoke to Dr. Fenstersheib about what is keeping our communities from safely getting outside to play—violence, blight and communities built for cars—and solutions grounded in evidence-based public health law.
NewPublicHealth: You presented at a key session on making outdoor physical activity opportunities safer. What makes this an important issue for you?
Dr. Fentersheib: Often when we talk about physical activity, we hear people say that all we need to do is convince kids to go outdoors. A lot of us then say, “when we were kids, our parents let us out of the house in the morning and we came back at nighttime and all was well.” There wasn’t any problem with that. But, of course, we’ve all become aware of safety as a barrier to outdoor physical activity. And the issue has to do with not only criminal or violence safety, but safe streets generally. Do cars in an area make it less safe for example? And, is our environment built in a way that it is safe for kids to walk to school? My presentation will be an overview of the benefits of physical activity, and what some of the barriers are.
We’ll also look at the legal side of the issue, including a study on mixed use land zoning. I think the bottom line is that safer neighborhoods will have more of a mixed use flavor so that you don’t have to go far to get to work or play or to recreational areas. In such neighborhoods, there are stores and other places for you to go, and you’re closer to public transportation. The data to be presented will show that the crime rates in those areas are lower than in pure industrial areas or areas where there isn’t mixed use. Mixed use is helping to improve the built environment in the communities in which we live by having more eyes on the street, by having people basically looking out for one another and be more of a community.
NPH: What are examples in Santa Clara of new plans to create safer outdoor spaces for children and adults?
In the wake of yet one more high-profile shooting this week, at Texas A&M University, the Associated Press profiled the Violence Prevention Research Program at the University of California, Davis, which is calling for a public health approach to reducing gun violence, in the same way that public health has tackled such issues as motor vehicle deaths, tobacco and alcohol. "The greater toll is not from these clusters but from endemic violence, the stuff that occurs every day and doesn't make the headlines," says Garen J. Wintemute, MD, MPH, the program’s director.
According to information in the article from the Centers for Disease Control and Prevention, there were more than 73,000 emergency room visits in 2010 for firearm-related injuries.
Critical factors being addressed by the Violence Prevention Research Program include:
- What makes someone more likely to shoot?
- Which firearms are most dangerous and why?
- What conditions allow or contribute to shootings?
>>Bonus Link: Public Health Law Research, a program of the Robert Wood Johnson Foundation and Temple University Beasley School of Law are co-sponsoring LEPH 2012: The First International Conference on Law Enforcement and Public Health to be held in Melbourne, Australia, November 11-13, 2012.
Among the sessions will be case studies of successful collaborations between police and public health across a wide range of issues.
Several mental health organizations and government agencies have announced online or telephone resources to help citizens and professionals cope with worry, fear, anxiety and stress in the aftermath of the Colorado shooting at a movie theater early this morning that has taken at least 12 lives and injured dozens more:
- The Centers for Disease Control and Prevention has a web portal dedicated to disaster response with resources for direct victims and the larger community.
- Mental Health America, a national advocacy and education group on mental health issues, has developed guidelines and a fact sheet to help facilitate discussions about the tragedy.
- The Disaster Distress Helpline (800-985-5990) of the Substance Abuse and Mental Health Administration provides immediate crisis counseling and help to people in the US coping with the shooting incident in Colorado, or any other disaster. The helpline operates 24/7 and connects callers with trained professionals from the closest crisis counseling center in the nationwide network of centers. The helpline can also be accessed by text (Text: TalkWithUs to 66746).
- The Department of Veterans Affairs has a helpful fact sheet on post traumatic stress disorder after a disaster.
- UPDATE: One of our commenters shared resources from the National Child Traumatic Stress Network, which is funded by SAMHSA. See the comment below for more details.
>>Weigh In: Do you have a response system ready for local and national disasters?
>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.
A group of impassioned attendees of the National Association of County and City Health Officials Annual Meeting attended a screening of The Interrupters, a documentary about the CeaseFire violence prevention program that began in Chicago and is now a prominent, effective program in other U.S. and international cities. CeaseFire takes a unique public health approach to stopping gun violence in communities. Findings from a study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health show that shootings and killings in even America’s most violent communities can be reduced using the CeaseFire model—a model that employs disease control and behavior change strategies to reduce violence. CeaseFire employs ex-offenders who have unique credibility with community members and effectiveness in getting people to rethink the impulse to resolve disputes using guns.
Safe Streets Baltimore was launched by the Baltimore City Health Department in 2007 as a CeaseFire replication site. Speakers at last night’s screening included Ricardo “Cobe” Williams of CeaseFire Chicago and Oxiris Barbot, MD, the health director of the city of Baltimore in Maryland.
A health officer from Cambridge, Mass., asked the speakers about one thing they’d like to see changed in their communities. Dr. Barbot said: “We need a health in all policies approach with better housing, education [and other social changes] to improve the environment.” NewPublicHealth recently spoke with Dr. Barbot about the impact the program has made in the city.
NewPublicHealth: How does the Safe Streets program build on the CeaseFire model?
Dr. Barbot: We replicated what was done in Chicago, but our implementation differs in that the Baltimore health department houses the Safe Streets program–our name for the CeaseFire model—and we provide technical assistance for that community-based organization to actually carry out the model. We think that that works for us because it helps to create community ownership of the model, and it also allows us to focus on administering the program and making sure that the fidelity of the model is adhered to. We oversee the program and community groups implement it.
We’ve got staff on board that work intensively with the community-based organizations to make sure that they are tracking the number of mediations that occur, that they are tracking the number of face to face meetings, and if those numbers aren’t at a particular level, we do retraining so that the interrupters that are working in that particular neighborhood feel more comfortable in what they’re doing. Similar to any other chronic disease intervention model, the folks who are actually doing the work need to have ongoing professional development to make sure that their tools are as up to date as possible.
NPH: What has your success been since the program began?
Teen drivers and passengers are more likely to use seat belts in states with "click it or ticket" laws, according to a new study in the American Journal of Public Health. These laws, also known as primary enforcement laws, allow police to stop and ticket drivers for not wearing a seat belt. Under a secondary law, police can only ticket drivers not buckled up if they are stopped for some other reason, such as speeding.
The study found that in states with secondary laws teens were 12 percent less likely to wear a seat belt when driving and 15 percent less likely to do so as a passenger than teens in states with primary laws. Read more on public health law.
A new study by researchers at the University of British Columbia found that a survey of 17,000 Canadian students in grades 8 to 12 showed that 25 to 30 percent admitted to cyberbullying, while only twelve percent said they had participated in schoolyard bullying. The researchers say that indicates that current prevention programs may not be sufficient to protect kids from online bullying. Read more on violence prevention.
Researchers analyzing data from a survey of Vietnam War veterans have found that those with more killing experiences were twice as likely to have suicidal thoughts as those with fewer or no experiences of killing.
The researchers, who published their findings in the journal Depression and Anxiety, say the association between killing and suicidal thoughts remained even after adjusting for variables such as post-traumatic stress disorder, depression, substance use disorders and combat exposure.
"We want clinicians and suicide prevention coordinators to be aware that in analyzing a veteran's risk of suicide, killing in combat is an additional factor that they may or may not be aware of,” says Shira Maguen, PhD, the study’s lead researcher. Read more on military health.
“They said he was a geek, he was worthless and that he should go and just hang hisself, and I think he just got to the point where enough was enough” – spoken by Kirk Smalley, father of Ty, in the forthcoming documentary, Bully. Ty, 11, hanged himself in 2010.
An astonishing thirteen million kids face bullying each year according to government surveys, making it the most common form of violence experienced by young people in the United States. Bullying’s effects can impact every aspect of a child’s life from grades to self-esteem and, as Ty’s story shows, even the desire to live. The new documentary Bully, set to hit theaters across the U.S. on March 30, offers an intimate look at how bullying has affected five children and their families.
Parents and schools have been invited to sign on to a Twitter Town Hall on bullying to be hosted TODAY by the Centers for Disease Control and Prevention (CDC) between 3 p.m. and 4 p.m. EST. Follow the conversation using the hashtag #vetoviolence, or by following the CDC Injury Center on Twitter. The Town Hall will feature experts from the CDC, the Anti-Defamation League, the Health Resources and Services Administration, and the Department of Education.
>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.
Earlier this week on The Colbert Report, Stephen Colbert likened Ameena Matthews, a violence “interrupter” at CeaseFire, a Chicago-based organization that employs a public health approach to stop the epidemic of gun violence in cities around the country, to an antibody. Matthews works in tough neighborhoods to stop the transmission of violence from person to person in much the same way that disease control professionals contain and prevent the spread of infectious illnesses.
Matthews can be seen in “The Interrupters," a documentary about CeaseFire that will be aired on PBS Frontline on February 14, 2012.
- Read NewPublicHealth interviews with CeaseFire founder Gary Slutkin and Tio Hardiman, director of CeaseFire Illinois, first posted when “The Interrupters” was released last year.
- Also check out the first rigorous evaluation of the CeaseFire model outside of Chicago. In Baltimore, researchers found the Safe Streets program cut homicides by more than half in the Cherry Hill neighborhood.
- Watch The Colbert Report video and read more over at APHA's Public Health Newswire.