Firearm violence is a public health crisis in the United States and negatively impacts individuals and communities. We used data from The Healthy Chicago Survey, a citywide survey of 8754 respondents from 2020 to 2021, and police-reported shootings to estimate the effect of residential exposure to shootings on sleep duration. Exposure was measured as fatal or non-fatal shootings occurring within 400 meters of the respondent's residence, within 7 days before taking the survey. Sleep was categorized into <6, 6 to <7, 7 to <9 and ≥9 h/day. We used log-binomial regression models to estimate risk ratios (RR). We used probabilistic quantitative bias analysis to estimate the magnitude and direction of the impact of differential outcome misclassification of self-reported sleep on results. Of 8584 survey respondents, 589 (6.9%) were exposed to at least one shooting. The estimated associations between shootings and very short and moderately short sleep duration were null, while the RR for long sleep duration was 1.10 (95% CI, 1.00-1.22); results of the quantitative bias analysis for long sleep duration were null (RR = 1.04 [95% simulation interval: 0.92, 1.15]). Our findings suggest that simply living close to a recent shooting may not affect sleep duration among adults living in Chicago, but further investigation is warranted.

ImportanceReducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence.ObjectiveTo evaluate changes in firearm violence after New Jersey’s 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention.Design, Setting, and ParticipantsThis case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024.ExposureImplementation of New Jersey’s cash bail reform law in 2017.Main Outcomes and MeasuresQuarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people.ResultsAlthough New Jersey’s pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, −0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, −0.24 deaths per 100 000), or within racialized groups during the postpolicy period.Conclusions and RelevanceIncarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.

Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case–control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95

High and low daily ambient temperatures are associated with higher mortality in the general population. People experiencing homelessness (PEH) are thought to be particularly vulnerable, but there is almost no direct evidence available. We examined the temperature-mortality association among PEH in 2 populous, urban counties in hot-climate regions of the United States, focusing on heat effects. Study setting was Los Angeles County, CA, and Clark County, NV, which encompass the cities of Los Angeles and Las Vegas, respectively. Outcomes were 2015-2022 deaths among decedents categorized as homeless in county administrative records. We used quasi-Poisson distributed lag nonlinear models to estimate the association of mortality with daily temperatures and with 7-day lagged temperatures, adjusting for day of week, seasonality, and long-term trends. We estimated the minimum mortality temperature and fraction of mortality attributable to temperatures above and below minimum mortality temperature. The association between daily temperature and PEH mortality was skewed towards greater risk at higher temperatures, especially in Clark County. Temperature-attributable mortality equaled 50.1% of deaths in Clark County (95% CI, 29.0-62.8) and 7.0% in Los Angeles County (95% CI, 1.4-12.1). In both counties, most temperature-attributable deaths were attributable to heat rather than cold. In these hot-climate urban counties, our estimates of heat-attributable mortality among PEH were orders of magnitude greater than those reported in prior research on the general population. These results indicate that temperature vulnerability, particularly heat vulnerability, requires stronger public health and policy responses.This article is part of a Special Collection on Environmental Epidemiology.

BackgroundFirearm homicide and opioid overdoses were already leading causes of death in the U.S. before both problems surged during the COVID-19 pandemic. Firearm violence, overdoses, and COVID-19 have all disproportionately harmed communities that are socially and economically marginalized, but the co-occurrence of these problems in the same communities has received little attention. To describe the co-occurrence of firearm homicides and opioid overdose deaths with COVID-19 mortality we used 2017-2021 medical examiner's data from Chicago, IL. Deaths were assigned to zip codes based on decedents' residence. We stratified zip codes into quartiles by COVID-19 mortality rate, then compared firearm homicide and fatal opioid overdose rates by COVID-19 quartile.FindingsThroughout the study period, firearm homicide and opioid overdose rates were highest in the highest COVID-19 mortality quartile and lowest in the lowest COVID-19 mortality quartile. Increases in firearm homicide and opioid overdose were observed across all COVID-19 mortality quartiles.ConclusionsHigh co-occurrence of these deaths at the community level call for addressing the systemic forces which made them most vulnerable before the pandemic. Such strategies should consider the environments where people reside, not only where fatal injuries occur.

INTRODUCTION:To investigate differences in homicide and suicide rates across college town status and determine whether college towns were predisposed to changes in rates over time. METHODS:We analyzed county-level homicide and suicide rates (total and by firearm) across college town status using 2015-2019 CDC death certificate data and data from the American Communities Project. RESULTS:Population-level homicide rates were similar across college town status, but younger age groups were at increased risk for firearm homicide and total homicide in college towns. College town status was associated with lower population-level firearm suicide rates, but individuals aged less than 18 y were at increased risk for total and firearm suicide. Finally, college towns were not classified as outliers for changes in either firearm homicide or suicide rates over time. CONCLUSIONS:College towns had similar homicide rates and significantly lower firearm suicide rates than other counties; however, individuals aged less than 18 y were at increased risk for both outcomes. The distinctive demographic, social, economic, and cultural features of college towns may contribute to differing risk profiles among certain age groups, thus may also be amenable to focused prevention efforts.

BACKGROUNDG: unshot wounds (GSWs) remain a significant source of mortality in the United States. Timely delivery of trauma care is known to be critical for survival. We sought to understand the relationship of predicted transport time and death after GSW. Given large racial disparities in firearm violence, we also sought to understand disparities in transport times and death by victim race, an unstudied phenomenon. METHODS: Firearm mortality data were obtained from the Boston Police Department 2005 to 2023. Firearm incidents were mapped using ArcGIS. Predicted transport times for each incident to the closest trauma center were calculated in ArcGIS. Spatial autoregressive models were used to understand the relationship between victim race, transport time to a trauma center, and mortality associated with the shooting incidents. RESULTS: There were 4,545 shooting victims with 758 deaths. Among those who lived, the median transport time was 9.4 minutes (interquartile range, 5.8-13.8) and 10.5 minutes (interquartile range, 6.4-14.6; p = 0.003) for those who died. In the multivariable logistic regression, increased transport time to the nearest trauma center (odds ratio, 1.024; 95% confidence interval, 1.01-1.04) and age (odds ratio, 1.016; 95% confidence interval, 1.01-1.02) were associated with mortality. There was a modest difference in median transport time to the nearest trauma center by race with non-Hispanic Black at 10.1 minutes, Black Hispanic 9.2 minutes, White Hispanic 8.5 minutes, and non-Hispanic White 8.3 minutes (p < 0.001). CONCLUSION: Our results highlight the relationship of transport time to a trauma center and death after a GSW. Non-White individuals had significantly longer transport times to a trauma center and predicted mortality would have been lower with White victim transport times. These data underscore the importance of timely trauma care for GSW victims and can be used to direct more equitable trauma systems. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.

Gun homicide rates have risen 35% across the USA since the start of the COVID-19 pandemic. One promising intervention to prevent violent crime is summer youth employment programs (SYEPs), which provide youth with meaningful workplace experiences, prosocial engagements, and developmental opportunities during the summer months, when many otherwise lack structure. This paper presents a cost analysis of violence prevention-focused SYEPs to help implementers understand the costs generally and in their own community contexts-to advocate for adoption and secure funding of, effectively budget for, and successfully implement SYEPs. Researchers use an ingredient-based costing approach and provide a template for implementers to use and adapt for their context. SYEPs with the goal of reaching youth who are justice-involved or at risk of being victims or perpetrators of violence can cost $3331 per youth assisted, with 54% of this cost directly paid to youth through stipends. Cost per youth is driven by the intensity of the mentoring and support that community organizations provide to the program participants. Knowing the cost per youth assisted can inform further analysis, implementation, and expansion of SYEPs.

IMPORTANCE Firearm injury is a major public health burden in the US, and yet there is no single, validated national data source to study community firearm violence, including firearm homicide and nonfatal shootings that result from interpersonal violence. OBJECTIVE To assess the validity of the Gun Violence Archive as a source of data on events of community firearm violence and to examine the characteristics of individuals injured in shootings. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional observational study compared data on community firearm violence from the Gun Violence Archive with publicly available police department data, which were assumed to be the reference standard, between January 1, 2015, and December 31, 2020. Cities included in the study (Philadelphia, Pennsylvania; New York, New York; Chicago, Illinois; and Cincinnati, Ohio) had a population of greater than 300 000 people according to the 2020 US Census and had publicly available shooting data from the city police department. A large city was defined as having a population greater than or equal to 500 000 (ie, Philadelphia, New York City, and Chicago). Data analysis was performed in December 2022. MAIN OUTCOMES AND MEASURES Events of community firearm violence from the Gun Violence Archive were matched to police department shootings by date and location. The sensitivity and positive predictive value of the data were calculated (0.9-1.0, excellent; 0.8-0.9, good; 0.7-0.8, fair; 0.6-0.7, poor; and <0.6, failed). RESULTS A total of 26 679 and 32 588 shooting events were documented in the Gun Violence Archive and the police department databases, respectively, during the study period. The overall sensitivity of the Gun Violence Archive over the 6-year period was 81.1%, and the positive predictive value was 99.0%. The sensitivity steadily improved over time. Shootings involving multiple individuals and those involving women and children were less likely to be missing from the Gun Violence Archive, suggesting a systematic missingness. CONCLUSIONS AND RELEVANCE These findings support the use of the Gun Violence Archive in large cities for research requiring its unique advantages (ie, spatial resolution, timeliness, and geographic coverage), albeit with caution regarding a more granular examination of epidemiology given its apparent bias toward shootings involving multiple persons and those involving women and children.

The Supreme Court's decision in New York State Rifle & Pistol Association Inc. v. Bruen undermines the ability of cities and states to regulate firearms safety. Nonetheless, we remain hopeful that firearm violence can decline even after the Bruen decision. Several promising public health approaches have gained broader adoption in recent years. This essay examines the key drivers of community firearm violence and reviews promising strategies to reverse those conditions, including community violence intervention (CVI) programs and place-based and structural interventions.

Vacant and abandoned buildings are common features in many post-industrial US cities, and are consistent predictors of violence. Demolition programs are regularly employed as an urban land use policy to stabilize housing markets and mitigate public health problems including violence. The objective of this research was to examine the effect of vacant building removals on violent and property crimes in Baltimore, MD from 2014 to 2019. We conducted a difference-in-differences analysis using spatio-temporal Bayesian mixed models on six crime types on block faces with and without building removals, before compared with after removal. There were significant reductions in total, violent crimes (with and without assaults), thefts, and burglaries on block faces with building removals relative to their controls. Total crimes decreased 1.4

Inequalities in Exposure to Firearm Violence by Race, Sex, and Birth Cohort From Childhood to Age 40 Years

To describe the co-occurring trends of firearm homicides and opioid overdose deaths before and during the COVID-19 pandemic, the authors used 2017-2021 medical examiner’s by firearm homicide, opioid overdose, and COVID-19 mortality data from Chicago, IL. Deaths were assigned to zip codes based on decedents’ residence. We stratified zip codes into quartiles by COVID-19 mortality rate, then compared firearm homicide and fatal opioid overdose rates by COVID-19 quartile. Throughout the study period, firearm homicide and opioid overdose rates were highest in the highest COVID-19 mortality quartile and lowest in the lowest COVID-19 mortality quartile. Increases in firearm homicide and opioid overdose were observed across all COVID-19 mortality quartiles. High co-occurrence of these deaths at the community level call for addressing the systemic forces which made them most vulnerable before the pandemic. Such strategies should consider the environments where people reside, not only where fatal injuries occur.

Importance Much is unknown about how individual and neighborhood factors converge in the association with risk for violent reinjury and violence perpetration. Objectives To investigate the association of exposure to neighborhood racialized economic segregation with reinjury and use of violence against others among survivors of violent penetrating injury. Design, Setting, and Participants This retrospective cohort study was performed using data obtained from hospital, police, and state vital records. The study was performed at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. The cohort included all patients treated for a nonfatal violent penetrating injury from 2013 to 2018. Patients with no Boston metropolitan area home address were excluded. Individuals were followed up through 2021. Data were analyzed from February to August 2022. Exposure American Community Survey data were used to measure neighborhood deprivation using the racialized economic Index of Concentration at the Extremes (ICE) for patient residential address upon hospital discharge. ICE was measured on a scale from −1 (most deprived) to 1 (most privileged). Main Outcomes and Measures Primary outcomes were violent reinjury and police-reported perpetration of violence within 3 years of an index injury. Results Of 1843 survivors of violence (median [IQR] age, 27 [22-37] years; 1557 men [84.5%]; 351 Hispanic [19.5%], 1271 non-Hispanic Black [70.5%], and 149 non-Hispanic White [8.3%] among 1804 patients with race and ethnicity data), the cohort was skewed toward residing in neighborhoods with higher racialized economic segregation (median [IQR] ICE = −0.15 [−0.22 to 0.07]) compared with the state overall (ICE = 0.27). There were police encounters for violence perpetration among 161 individuals (8.7%) and violent reinjuries among 214 individuals (11.6%) within 3 years after surviving a violent penetrating injury. For each 0.1-unit increase in neighborhood deprivation, there was a 13% (hazard ratio [HR], 1.13; 95% CI, 1.03 to 1.25; P = .01) increase in risk of violence perpetration but no difference in risk for violent reinjury (HR, 1.03; 95% CI, 0.96 to 1.11; P = .38). The greatest occurrence for each outcome was within the first year after index injury; for example, incidents of violence perpetration occurred among 48 of 614 patients (7.8%) at year 1 vs 10 of 542 patients (1.8%) at year 3 in tertile 3 of neighborhood deprivation. Conclusions and Relevance This study found that living in a more economically deprived and socially marginalized area was associated with increased risk of using violence against others. The finding suggests that interventions may need to include investments in neighborhoods with the highest levels of violence to help reduce downstream transmission of violence.

This cross-sectional study examines changes in rates and disparities of fatal and nonfatal firearm assaults among children in New York, Los Angeles, Chicago, and Philadelphia before and during the COVID-19 pandemic.

Neighbourhood environments are a known social determinant of health. Vacant and abandoned buildings and lots and poor or hazardous housing conditions, combined with crime and violence, can affect residents' health and wellbeing. Nationwide Children's Hospital and its partners launched the Healthy Homes initiative in 2008, which sought to improve nearby residents' health and wellbeing by rejuvenating vacant and abandoned properties and increasing homeownership in the South Side neighbourhood of Columbus, Ohio. Between 2008 and mid-2019 the initiative funded 273 repairs or renovations in this neighbourhood. We conducted a ZIP-code-level comparative case study of the Healthy Homes housing interventions using synthetic control methodology to evaluate changes in crime rate in the intervention area compared with those in a synthetic control area. While findings were mixed, we found some evidence of reduced thefts in the Healthy Homes area, relative to its synthetic control. This initiative to repair, rebuild and increase ownership of housing has the potential to reduce crime rates for neighbours of the Nationwide Children's Hospital.

Neighborhood segregation by race and income is a structural determinant of firearm violence. Addressing green space deficits in segregated neighborhoods is a promising prevention strategy. This study assessed the potential for reducing firearm violence disparities by increasing access to tree cover. Units of analysis were census tracts in six U.S. cities (Baltimore, MD; Philadelphia, PA; Richmond, VA; Syracuse, NY; Washington, DC; Wilmington, DE). We measured segregation using the index of concentration at the extremes (ICE) for race-income. We calculated proportion tree cover based on 2013-2014 imagery. Outcomes were 2015-2020 fatal and non-fatal shootings from the Gun Violence Archive. We modeled firearm violence as a function of ICE, tree cover, and covariates representing the social and built environment. Next, we simulated possible effects of "tree equity" programs, i.e., raising tract-level tree cover to a specified baseline level.In our fully-adjusted model, higher privilege on the ICE measure (1 standard deviation, SD) was associated with a 42% reduction in shootings (incidence rate ratio (IRR) = 0.58, 95% CI [0.54 0.62], p < 0.001). A 1-SD increase in tree cover was associated with a 9% reduction (IRR = 0.91, 95% CI [0.86, 0.97], p < 0.01). Simu-lated achievement of 40% baseline tree cover was associated with reductions in firearm violence, with the largest reductions in highly-deprived neighborhoods. Advancing tree equity would not disrupt the fundamental causes of racial disparities in firearm violence exposure, but may have the potential to help mitigate those disparities.

Community violence is a serious public health problem, and generational investments are being made to address it. Agent-based models (ABMs) are computational tools that can help to optimize allocation of those investments, analogous to how computer simulation models, broadly, have informed decision making in other fields, such as infectious disease control. In this review, we describe ABMs, explain their potential role in community violence research, discuss recent studies that have applied ABMs to community violence, and point to opportunities for further progress. We identified three recent studies that applied ABMs to community violence research, which points to the paucity of this line of work. Each of these works leverages a major advantage of ABMs—their ability to study the natural evolution of a process governed by the actions of autonomous agents, and how that evolution changes under counterfactual conditions, such as different intervention strategies (e.g., violence interruption), and policy changes (e.g., alcohol outlet licensing policies). ABMs continue to be an underutilized tool for the study of community violence. Their increased use could add important information to help stakeholders decide between competing intervention strategies in terms of their costs and the overall resulting changes in violence rates. In addition, ABMs have value in identifying unintended changes/diffusions resulting from interventions. Regardless of the application, ABMs can only be impactful if stakeholders believe and use the information, pointing to the importance of engaging policy makers and other stakeholders in the model formulation process when possible.