Introduction to Violence Epidemiology by uu3u1KY

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									  Introduction to Violence
       Epidemiology


With a focus on crime-related violence


      Thomas Songer, PhD
     University of Pittsburgh
          tjs@pitt.edu
      What is Violence?


What actions characterize violence?
Definition of Violence

…...To understand violence, you
    need to define violence


How would you define violence?
 Definition of Violence

• wide ranging in the literature
  – crime-related, spouse, child, firearms
• National Research Council
  – behaviour by individuals that
    intentionally threaten, attempt, or
    inflict physical harm on others

          www.nap.edu
Categories of Violence
• Crime-based Violence
  – Homicide
  – Robbery
  – Rape
  – Serious Assaults
• Firearm-related Violence
• Suicide
• Domestic Violence
  Categories of Violence
• Crime-based Violence
• Firearm-related Violence
• Suicide
  – successful and unsuccessful
• Domestic Violence
  – partner
  – child
  – elder
     Public Health Approach to Disease
                  Control



Monitoring of     Identify       Intervene   Evaluate
 incidence       risk factors
prevalence
                                Prevention
 Identify          social
 morbidity        genetic
 mortality      environmental
  cost
               Identify
Monitoring   risk factors   Intervene   Evaluate




             Surveillance
 Surveillance of Violence from
             Crime
• Death Certificates
• Police Reports
  – Uniform Crime Reports
• Government Surveys
  – National Criminal Victimization Survey
• Medical Databases
Leading Causes of Death, U.S.
             1995




                         SOURCE: NCIPC, 1998.
                             Rate per 100,000 pop.




                     0
                         2
                                4
                                      6
                                            8
                                                     10
              1910                                        12
              1915
              1920
              1925
              1930
              1935
              1940
              1945
              1950




       Year
              1955
              1960
              1965
              1970
              1975
              1980
              1985
                                                               Trends in Homicide, United States, 1910-96




              1990
              1995
NCHS
          Homicide Rates; Selected Countries
      Norway
      France
      Holland
    England
    Denmark
     Canada
     Australia
New Zealand
       Israel
    Scotland
 United States

                 0   2          4          6           8       10
                         Rate per 100,000 population
                                                           ICE, 1998
  Crime Violence Data Sources

• Federal Bureau of Investigation
  – Uniform Crime Reporting System
  – NIBRS
• National Institute of Justice
  – National Crime Victimization Survey
   Trends in Violent Crime, Pennsylvania
1998
1997
1996
1995
1994
1993
1992
1991
1990

  45,000   47,000       49,000       51,000   53,000
               Number of Violent Crimes
                                              1994 UCR
   Down with Crime
“How to Cut City’s Crime Rate:
      Don’t Report It”

“Philadelphia’s Crime Data
    Discarded by FBI”

                 Philadelphia Inquirer 1997-98
The Pyramid of Violent Crime in the U.S., 1994

                   1.8% admitted to hospital
                      3.4% seen in an emergency department

                          14.5% received medical care

                                25% resulted in physical injury

                                     41% reported to police




    10,860,000 violent crimes
                                                    1994 NCVS
   National Estimates of Rape and
           Sexual Assault
• Uniform Crime Reports   • 102,216
  (1994)

• National Crime          • 168,000 rapes
  Victimization Survey    • 149,000 attempted
  (1994)                  • 117,000 sex. assault

• National Violence       • 302,100 females affected
  Against Women Survey    • 876,000 rape events
  (1995-96)
      Injuries from Crime


Medical Sources and Police Sources

“You look at them as victims, we look
        at them as suspects”
Definition of Health Care Events
      Related to Violence

• Based on E-codes
  – E960-969 Homicide and injury
    purposely inflicted
  – E coding to distinguish crimes is
    relatively poor
The Pyramid of Rape in the United States, 1994

                      3.4% admitted to hospital
                         4.6% seen in an emergency department
                            17.6% received medical care
                                   32% reported to police




                                                    1994 NCVS
   433,000 rapes/sexual assaults
    Problems in Crime Violence
           Surveillance
• Definition of violence may not be
  standard across sources
• Reporting of violence by victims varies
  considerably
    • Rape
• Reporting of violence by the police may
  vary
                Identify
 Monitoring   risk factors   Intervene   Evaluate




Risk Factor Identification
  Epidemiologic Model

Host     Agent



Environment
                          Crime

                 Victim       Perpetrator



                   Environment
      Violent Crime Victims by Age Group,
               Pennsylvania, 1994
Percent
 35

 30

 25

 20

 15

 10

  5

  0
          < 11   11-14   15-24   25-34   35-44   45-54   55-64   65+
                                                                 1994 UCR
Death Rates from Homicide, 1980-86

                        Native American    White    African American   Asian
                   70
per 100,000 pop.




                   60
                   50
                   40
                   30
                   20
                   10
                    0
                        0    8    10      20   30    40    50   60     70      80
     Rape Victims by Age Group, Pennsylvania, 1994

Percent
    30

    25

    20

    15

    10

     5

     0
          < 11

                 11-1

                        15-1

                               20-2

                                      25-2

                                             30-3

                                                    35-3

                                                           40-4

                                                                  45-4

                                                                         50-5

                                                                                55-5

                                                                                       60-6

                                                                                              65+
           yrs

                  4

                         9

                                4

                                       9

                                              4

                                                     9

                                                            4

                                                                   9

                                                                          4

                                                                                 9

                                                                                        5
                                                                                       1994 UCR
                         Criminal Victimization in Schools
                            by Student Age, US, 1995
                     8
Percent Victimized




                     7
                     6
                     5
                     4
                     3
                     2
                     1
                     0
                          12   13   14    15    16     17   18   19
                                         Age (years)
  Homicide by Type of Weapon, Pennsylvania, 1994


     Firearm


       Knife


    Personal
    Weapon


Other Weapon


               0   10   20      30     40      50   60    70
                             Percent Distribution

                                                         1994 UCR
    Location of Robberies in the United
                States, 1997
   Street or Highway                                                  50

Commercial Business                       13.8

         Gas Station       2.4

  Convenience Store              5.7

          Residence                     11.6

               Bank        1.9

              Other                       14.6

                       0           10            20     30      40   50       60
                                                      Percent

                                                                           1997 UCR
                                         Workplace Homicide Rates by Occupation
Homicide Rate per 100,000 worker-years




                                         45    42.3
                                         40
                                         35
                                         30
                                         25
                                         20
                                         15
                                                          9.1         9.1           9             8.9
                                         10
                                          5                                                                     0.83
                                          0
                                              Taxicab   Private        Law        Retail          Retail         All
                                              Drivers   Security   Enforcement   Cashiers      Supervisors   Occupations
                                                        Guards       Officers                      and
                                                                                                Propietors


                                                                                        North Carolina, 1977-1991, n= 361
Perpetrators
               Prevalence of Serious Violence
                     by Age Pittsburgh
          18
          16
          14
          12
Percent




          10
           8
           6
           4
           2
           0
                10   11   12   13   14         15   16   17   18   19
                                         Age
               Prevalence of Serious Violence in
               Pittsburgh by Ethnicity and Age
          25                                              African American
                                                          Caucasian

          20


          15
Percent




          10


          5


          0
                10   11   12   13   14         15   16   17    18    19
                                         Age
               Cumulative Prevalence of Serious
                    Violence by Age 16
          45
          40
          35
          30
          25
Percent




          20
          15
          10
           5
           0
                Rochester   Denver    Rochester   Pittsburgh   Denver
                 Females    Females    Males        Males      Males
               Identify
Monitoring   risk factors   Intervene   Evaluate




             Prevention
Prevention Strategies

  • Criminal Justice
  • Behavioural
  • Environmental
  • Public Health
                             Haddon Matrix




Adapted from Haddon, 1980.
Violence in Pennsylvania




 http://www.pitt.edu/~tjs/vio/viopenn.htm

								
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