Introduction to Violence Epidemiology With a focus on crime-related violence Thomas Songer, PhD University of Pittsburgh

What is Violence? What actions characterize violence?

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

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

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

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

Surveillance Monitoring Identify risk factors InterveneEvaluate

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 SOURCE: NCIPC, 1998.

Trends in Homicide, United States, NCHS

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

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

1994 UCR Trends in Violent Crime, Pennsylvania

Down with Crime “How to Cut City’s Crime Rate: Don’t Report It” “Philadelphia’s Crime Data Discarded by FBI” Philadelphia Inquirer

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

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

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 –E Homicide and injury purposely inflicted –E coding to distinguish crimes is relatively poor

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

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

Risk Factor Identification Monitoring Identify risk factors InterveneEvaluate

Epidemiologic Model Environment HostAgent Environment VictimPerpetrator Crime

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

Death Rates from Homicide,

Rape Victims by Age Group, Pennsylvania, UCR

Criminal Victimization in Schools by Student Age, US, 1995

Homicide by Type of Weapon, Pennsylvania, UCR

Location of Robberies in the United States, UCR

Workplace Homicide Rates by Occupation North Carolina, , n= 361

Perpetrators

Prevalence of Serious Violence by Age Pittsburgh

Prevalence of Serious Violence in Pittsburgh by Ethnicity and Age

Cumulative Prevalence of Serious Violence by Age 16

Prevention Monitoring Identify risk factors InterveneEvaluate

Prevention Strategies Criminal Justice Behavioural Environmental Public Health

Haddon Matrix Adapted from Haddon, 1980.

Violence in Pennsylvania