VIOLENCE IS A PUBLIC HEALTH PROBLEM

1. VIOLENCE IS A PUBLIC HEALTH PROBLEM CARNELL COOPER, MD, FACS Attending Surgeon R Adams Cowley Shock Trauma Center Associate Professor Department of Surgery University of Maryland School of Medicine

2. TRAUMA Leading cause of death between the age of 1 and 44 75% teenagers More children than all other causes combined

3. TRAUMA Costs 75 million suffer injuries per year 150,000 deaths 11 million temporary disabilities 100,000 permanent disabilities 186 billion per year

4. PENETRATING INJURIES Juveniles comprise up to 15% of victims of GSW�s 75% unintentional 75% occur in the home

5. PUBLIC HEALTH PROBLEM Suicide is the 9th leading cause of death Homicide is the 11th leading cause of death For those age 15-24, homicide is the 2nd and suicide the 3rd leading causes of death For African Americans 15-24, homicide is the leading cause of death

6. GUNSHOT WOUND DEATHS 34,040 (1996) Suicide 54% Homicide (41%) Unintentional (3%)

7. COST (1994) 134,445 GSW injuries Average medical costs: $17,000 Lifetime costs: $2.3 billion $1.1 billion paid for by the government 74% of injuries due to assault

8. VIOLENCE Maryland (1998) 511 murders Baltimore City: 315 murders Handgun used in 61% of the cases

9. VIOLENCE Maryland Ethnicity Victim/Perpetrator Race relations Black 412 96.0% White 92 78.0% Asian 5 0.2%

10. VIOLENCE Poverty Drugs Alcohol Abuse Racism Family Instability Teen Pregnancy Overcrowding School Failure

13. DEATH BY CATEGORY R Adams Cowley Shock Trauma Center Violence 87 Automobile Crash 80 Fall 45

14. PUBLIC HEALTH PROBLEM DOMESTIC VIOLENCE is a pattern of psychological, economic and sexual coercion of one partner in a relationship by the other that is punctuated by physical assaults or credible threats of bodily harm.

15. DOMESTIC VIOLENCE The most common cause of non-fatal injury to women in the U.S. 1/3 of the homicides of women in the U.S. are committed by a spouse or a partner

16. DOMESTIC VIOLENCE Lifetime risk: Severe injury 9% Any injury 22% The most dangerous time for any abused woman is when she is threatening to leave or has left the relationship

17. DOMESTIC VIOLENCE:RISK FACTORS Male partners: Abuse drugs/alcohol Are unemployed or intermittently employed Have less than a high school education Are former husbands, estranged husbands or former boyfriends of the women

18. VIOLENCE

26. GUN VIOLENCE IN SCHOOLS(1997-1998) Jonesboro, Arkansas West Paducah, KY Pearl, MS Springfield, Oregon Edinboro, Pennsylvania

27. GUN VIOLENCE IN SCHOOLS Homicide, suicides--1992-1993, 1997-1998 27.3 Incidence � school-associated 1 in a million CDC

28. VIOLENCE & DRUGS Peak in homicide 1980s crack cocaine Methamphetamine Ecstasy

29. COMMUNITIES & GANGS 1980 � 2,000 gangs with 100,000 in 286 cities 1996 � 31,000 gangs with 846,000 in 4,800 cities

30. COMMUNITIES & GANGS Recruit adolescent with guns Twice as likely to own guns Risks of being killed � 60 x

31. COMMUNITIES & GANGS(1989 � 1995) Street gang presence in schools increased 186% suburbs 250% rural

32. COMMUNITIES & GANGS Urban Schools 41% Suburban Schools 26% Rural Schools 20%

33. WORKPLACE VIOLENCE Warning Signs History of violence or conflicts with others Suspected alcohol or drug problems Denied claims (worker�s compensation, other suits) Obsession (romantic or hate) with another employee Suspected alcohol or drug abuse

34. WORKPLACE VIOLENCE Prevention Strategies Training supervisory personnel Assessing threats and personnel Managing escalating crises Fair treatment of employees Access to a grievance or appeals process Protective equipment and security alarms

35. WORKPLACE VIOLENCE EMS Tips on Survival �Always know when to get the heck out of Dodge.� �Always know how you are going to get the heck out.� �Realize the vehicle you are driving is from the lowest bidder.�

36. INTERVENTIONS Changes in gun laws and regulations Restrictions on assault rifles, SNS Restrictions on sales to high risk individuals Public modifications Public education and awareness programs Behavior modification Clinical services to victims

37. KEY COMPONENTS TO ANEFFECTIVE INTERVENTION Comprehensive, multi-faceted that includes family peer, media, community components Began in the primary grades and be reinforced across grade levels Program content should promote personal and social competencies Ethnically and culturally sensitive The program must be repeatedly evaluated

38. PROACTIVE POLICING New York � aggressive enforcement against loitering and panhandling Boston (David Kennedy) Gang focused interventions Aggressive enforcement of terms of parole Systemic tracing of illegal firearms

39. LIFE AFTER PRISON The number of people released from prison rising�

40. VIOLENCE PREVENTION CURRICULA Social Problem Solving Anger management Conflict resolution

41. VIOLENCE: THE 4 R�S Reading wRiting aRithmetic Conflict Resolution

42. PREVENTION OF PREGNANCY U.S. has the highest rate of western institutionalized nations.

43. GUN BUY-BACK PROGRAMS Seattle, Washington after six months � no decline Atlanta, Georgia: < 1% participation

45. DATA Repeat victims of violence 10% (CDC) 45% (Goins et al, 1992)

46. RECIDIVISM 48% of recidivists are injured by the same mechanism as the first admission 7.9 months between injuries 18.8 months between injury and death

47. OBJECTIVES Identify and investigate risk factors for repeat hospitalization due to violent injury Using this data, design an effective intervention and prevention program

48. GOALS AND OBJECTIVES Patterns to be investigated include: Home and environment including neighborhood safety factors Family history of abuse or violence Substance abuse involvement of the victim Justice and connections with police involvement

49. GOALS AND OBJECTIVES Type and seriousness of injury sustained Employment, education and economic status Victim�s role as a perpetrator Victim�s perceptions and knowledge of lifestyle Victim�s attitudes toward violence and use of a weapon

50. CONCLUSION 29 years old Black male Unemployed < High school No medical insurance < $10,000 History of drug abuse/dealing Average 27 months in jail