Hohl Bernadette C, Wiley Shari, Wiebe Douglas J, Culyba Alison J, Drake Rebecca, Branas Charles C
Department of Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway2School of Criminal Justice, Rutgers University, Newark, New Jersey3Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia4Department of Mathematics, School of Science, Hampton University, Hampton, Virginia.
JAMA Intern Med. 2017 Mar 1;177(3):317-324. doi: 10.1001/jamainternmed.2016.8180.
Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates.
To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence.
DESIGN, SETTING, AND PARTICIPANTS: Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population.
Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity.
Adolescent firearm homicide identified from police and medical examiner's reports.
We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2-14.0) or drug use (AOR, 4.4; 95% CI, 1.7-11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8-48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1-9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1-10.3 vs AOR, 7.5; 95% CI, 2.2-25.8).
Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities.
在美国，凶杀是青少年的第三大死因，是非裔美国青少年的首要死因。大城市的凶杀率过高。
确定个人、家庭和社区层面的毒品和酒精接触与青少年枪支凶杀之间的关系，并为预防枪支暴力的新方法提供依据。
设计、背景和参与者：基于人群的病例对照研究，研究对象为2010年1月至2012年12月期间在费城所有成为凶杀受害者的13至20岁青少年，并与从普通人群中随机选取的13至20岁对照进行匹配。
受伤时的个人毒品和酒精使用情况、毒品和酒精使用史、照顾者的毒品和酒精使用情况以及社区中酒精和非法毒品的可得性。我们还对年龄、种族、学校停学、逮捕情况和社区种族进行了控制。
从警方和法医报告中确定的青少年枪支凶杀情况。
我们纳入了161例青少年凶杀案，其中包括157例（97.5%）枪支凶杀案，以及172例匹配对照，其中包括166例（96.5%）枪支凶杀对照。有酒精使用史（调整后的优势比[AOR]为4.1；95%置信区间为1.2 - 14.0）或毒品使用史（AOR为4.4；95%置信区间为1.7 - 11.6）的青少年发生枪支凶杀的几率增加。照顾者有毒品使用史的青少年发生枪支凶杀的几率增加（AOR为11.7；95%置信区间为2.8 - 48.0）。社区中酒精销售点密度高（AOR为3.2；95%置信区间为1.1 - 9.1）以及毒品可得性为中等或高的青少年发生枪支凶杀的几率增加（AOR为3.4；95%置信区间为1.1 - 10.3，对比AOR为7.5；95%置信区间为2.2 - 25.8）。
2010年至2012年期间费城几乎所有青少年凶杀案都是使用枪支实施的。个人、家庭和社区层面的物质使用与青少年枪支凶杀几率增加有关；毒品使用在所有三个层面都有关联，酒精使用在个人和社区层面有关联。扩大预防暴力的努力，以针对多个层面的毒品和酒精使用，可能有助于减少对美国大城市少数族裔青少年影响过大的枪支暴力。
