1. Introduction to Violence Epidemiology With a focus on crime-related violence Thomas Songer, PhD University of Pittsburgh tjs@pitt.edu

2. What is Violence? What actions characterize violence?

6. Definition of Violence How would you define violence? …...To understand violence, you need to define violence

7. 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

8. Categories of Violence Crime-based Violence –Homicide –Robbery –Rape –Serious Assaults Firearm-related Violence Suicide Domestic Violence

9. Crime-based Violence Firearm-related Violence Suicide –successful and unsuccessful Domestic Violence –partner –child –elder Categories of Violence

10. Public Health Approach to Disease Control Monitoring of incidence Identify risk factors InterveneEvaluate Identify morbidity mortality cost social genetic environmental prevalence Prevention

11. Surveillance Monitoring Identify risk factors InterveneEvaluate

12. Surveillance of Violence from Crime Death Certificates Police Reports –Uniform Crime Reports Government Surveys –National Criminal Victimization Survey Medical Databases

13. Leading Causes of Death, U.S. 1995 SOURCE: NCIPC, 1998.

14. Trends in Homicide, United States, 1910-96 NCHS

15. Homicide Rates; Selected Countries ICE, 1998 France England Canada New Zealand Scotland

16. Crime Violence Data Sources Federal Bureau of Investigation –Uniform Crime Reporting System –NIBRS National Institute of Justice –National Crime Victimization Survey

17. 1994 UCR Trends in Violent Crime, Pennsylvania

18. 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

19. 10,860,000 violent crimes 1994 NCVS 41% reported to police 25% resulted in physical injury 14.5% received medical care 3.4% seen in an emergency department 1.8% admitted to hospital The Pyramid of Violent Crime in the U.S., 1994

20. National Estimates of Rape and Sexual Assault Uniform Crime Reports (1994) National Crime Victimization Survey (1994) National Violence Against Women Survey (1995-96) 102,216 168,000 rapes 149,000 attempted 117,000 sex. assault 302,100 females affected 876,000 rape events

21. Injuries from Crime Medical Sources and Police Sources “You look at them as victims, we look at them as suspects”

22. Definition of Health Care Events Related to Violence Based on E-codes –E960-969Homicide and injury purposely inflicted –E coding to distinguish crimes is relatively poor

23. 433,000 rapes/sexual assaults 1994 NCVS 32% reported to police 17.6% received medical care 4.6% seen in an emergency department 3.4% admitted to hospital The Pyramid of Rape in the United States, 1994

24. 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

25. Risk Factor Identification Monitoring Identify risk factors InterveneEvaluate

26. Epidemiologic Model Environment HostAgent Environment VictimPerpetrator Crime

27. 1994 UCR Violent Crime Victims by Age Group, Pennsylvania, 1994

28. Death Rates from Homicide, 1980-86

29. Rape Victims by Age Group, Pennsylvania, 1994 1994 UCR

30. Criminal Victimization in Schools by Student Age, US, 1995

31. Homicide by Type of Weapon, Pennsylvania, 1994 1994 UCR

32. Location of Robberies in the United States, 1997 1997 UCR

33. Workplace Homicide Rates by Occupation North Carolina, 1977-1991, n= 361

34. Perpetrators

35. Prevalence of Serious Violence by Age Pittsburgh

36. Prevalence of Serious Violence in Pittsburgh by Ethnicity and Age

37. Cumulative Prevalence of Serious Violence by Age 16

38. Prevention Monitoring Identify risk factors InterveneEvaluate

39. Prevention Strategies Criminal Justice Behavioural Environmental Public Health

40. Haddon Matrix Adapted from Haddon, 1980.

41. Violence in Pennsylvania http://www.pitt.edu/~tjs/vio/viopenn.htm