The risk for firearm violence among high-risk youth after treatment for an assault is unknown.
In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months).
A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22).
High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth.
This study was important to me as an educator because it focused on collecting data to prevent trends of violence and aggression. Prevention and access to social services are important to philosophies of discipline in school systems. There are implications for administrators of schools as well hospitals.
Since I heard a synopsis on the radio, more conclusions and applications were made on-air than in the written publication I found. So, I have some questions.
ER reactions were described as changing from the statement, "Why did you do this?" to "What happened to you?" The same change can be made in approaches to discipline for students at-risk or those who are involved in aggressive behavior.
What other changes are being made or studied as a result of this report?
What types of responses are most common for "What happened to you?"
What other shifts in questioning and treatment of patients surfaced?
What prevention plans are most successful in deterring repeat victims or offenders?
Conflict of Interest:
None declared