Daniel W. Webster

Risk factors for femicide in abusive relationships: results from a multisite case control study.

OBJECTIVES This 11-city study sought to identify risk factors for femicide in abusive relationships. METHODS Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. RESULTS Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrators access to a gun and previous threat with a weapon, perpetrators stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrators use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. CONCLUSIONS There are identifiable risk factors for intimate partner femicides.

The Danger Assessment: Validation of a Lethality Risk Assessment Instrument for Intimate Partner Femicide

The Danger Assessment (DA) is an instrument designed to assess the likelihood of lethality or near lethality occurring in a case of intimate partner violence. This article describes the development, psychometric validation, and suggestions for use of the DA. An 11-city study of intimate partner femicide used multivariate analysis to test the predictive validity of the risk factors on the DA from intimate partner femicide cases (N = 310) compared with 324 abused women in the same cities (controls). The results were used to revise the DA (four items added; one “double-barreled” item divided into two), and the calculated weights (adjusted odds ratios) used to develop a scoring algorithm with levels of risk. These levels of risk were then tested with an independent sample of attempted femicides (N = 194) with a final outcome of .90 of the cases included in the area under the receiver operating characteristic (ROC) curve.

Weapon carrying among inner-city junior high school students: defensive behavior vs aggressive delinquency.

OBJECTIVES The purpose of this study was to estimate associations between beliefs and experiences hypothesized to be related to weapon carrying among youths. METHODS Students in two inner-city junior high schools completed anonymous questionnaires. Logistic regression models were fit for having ever carried a weapon for protection or use in a fight and were stratified by sex and weapon type. RESULTS Among males, 47% had carried knives and 25% had carried guns. Key risk factors for knife carrying were being threatened with a knife, getting into fights, and disbelief that having a weapon increases the carriers risk of injury. Gun carrying was associated with having been arrested, knowing more victims of violence, starting fights, and being willing to justify shooting someone. Among females, 37% had carried a knife; knowing many victims of violence and being willing to justify shooting someone predicted knife carrying. CONCLUSIONS Knife carrying was associated with aggressiveness but did not appear to be related to serious delinquency. Gun carrying within this nonrandom sample appeared to be a component of highly aggressive delinquency rather than a purely defensive behavior.

The Role of Alcohol Use in Intimate Partner Femicide

The purpose of this study was to examine alcohol use by victims and perpetrators as a risk factor for intimate partner violence and femicide. A case control design was used to describe alcohol use among Femicide/Attempted Femicide victims (n = 380), Abused Controls (n = 384) and Non-Abused Controls (n = 376), and their intimate partners. Telephone interviews of proxies (family members or friends) of femicide victims and actual survivors of attempted femicide were conducted in 10 cities. The purpose of the interviews was to gather information about relationship violence and alcohol use by femicide victims, attempted femicide survivors, and their perpetrators. Telephone interviews of controls, recruited from the same cities by random digit dialing, were also conducted. Perpetrator problem drinking was associated with an eight fold increase in partner abuse (e beta = 8.24, p < .0001) and a two fold increased risk of femicide/attempted femicide (e beta = 2.39, p = .001), controlling for demographic differences.

Risk factors for femicide-suicide in abusive relationships: results from a multisite case control study

The killing of women by men who then take their own lives (femicide-suicide) is the most common form of homicide-suicide. This study identified femicide-suicide risk factors in an 11-city case-control study of femicide in the United States. Perpetrator, victim, relationship, and incident characteristics were analyzed for femicide-suicide cases (n = 67) and controls (n = 356, women living in the community with nonfatal physical abuse) using logistic regression modeling. Two risk factors emerged that were unique to femicide-suicides cases compared to overall femicide risk analyses: prior perpetrator suicide threats and victims having ever been married to the perpetrator.

Support for New Policies to Regulate Firearms — Results of Two National Surveys

BACKGROUND New policy options are emerging in the debate regarding the regulation of firearms in the United States. These options include the treatment of firearms as consumer products, the design of which can be regulated for safety; denial of gun ownership to those convicted of misdemeanors; and strategies to curtail the illegal sale of guns. The publics opinion of these innovative gun-policy options has not been thoroughly assessed. METHODS We conducted two telephone surveys of 1200 adults each in the United States in 1996 and 1997-1998. Cognitive interviews and pretests were used in the development of the survey instruments. Potential participants were then contacted by random-digit dialing of telephone numbers. RESULTS A majority of the respondents favored safety standards for new handguns. These standards included childproofing (favored by 88 percent of respondents), personalization (devices that permit firing only by an authorized person; 71 percent), magazine safeties (devices that prevent firing after the magazine or clip is removed; 82 percent), and loaded-chamber indicators (devices that show whether the handgun is loaded; 73 percent). There was strong support for policies prohibiting persons convicted of specific misdemeanors from purchasing a firearm. Support for such prohibitions was strongest for crimes involving violence or the illegal use of a firearm (83 to 95 percent) or substance abuse (71 to 92 percent). There was also widespread support for policies designed to reduce the illegal sale of guns, such as mandatory tamper-resistant serial numbers (90 percent), a limit of one handgun purchase per customer per month (81 percent), and mandatory registration of handguns (82 percent). Even among the subgroup of respondents who were gun owners, a majority were in favor of stricter gun regulations with regard to 20 of the 22 proposals covered in the poll. CONCLUSIONS Strong public support, even among gun owners, for innovative strategies to regulate firearms suggests that these proposals warrant serious consideration by policy makers.

Rethinking Opioid Prescribing to Protect Patient Safety and Public Health

PRESCRIPTION DRUGS, INCLUDING AMPHETAMINES, OPIoids, and benzodiazepines, provide therapeutic value to millions of Americans. At the same time, there are increasing concerns about the skyrocketing rates of prescription abuse and overdose deaths. The annual number of fatal drug overdoses in the United States now surpasses the annual number of motor vehicle deaths, and overdose deaths attributable to prescription opioids—nearly 15 000 in 2008—exceed those attributable to cocaine and heroin combined. These trends have co-occurred while clinicians and policy makers have attempted to improve the undertreatment of chronic pain through efforts such as the “Pain as the 5th Vital Sign” campaign and the promulgation of quality measures by professional organizations. Many of these initiatives do not specifically advocate greater opioid use. However, the initiatives have coexisted with, and in some cases been supported by, a pharmaceutical industry in which increasing sales of opioids have grossed billions of dollars. A recent senatorial inquiry hints at the opaque flow of funding from industry to consumer and advocacy organizations that promote increased use of pain medication. To address the increasing epidemic of opioid abuse, a variety of strategies have been implemented, including limits on the number of opioid prescriptions covered by insurers, requirements that these drugs be supplied through a single physician or pharmacy, and state prescription drug monitoring programs. Despite these efforts, reduction of opioid abuse may not succeed until there is a broader clinical shift from such widespread use of these medicines. There are clear correlations between national trends for prescription opioid sales, admissions for substance abuse treatment, and deaths. Between 1999 and 2010, each of these has steadily and inexorably increased in parallel with the others. This suggests that substantial increases in the nonmedical use of opioids is a predictable adverse effect of substantial increases in the extent of prescriptive use. Under current regulatory and market conditions, it is likely that a significant and increasing amount of opioids produced to meet clinical demand will be misused or diverted from the legal to illegal markets, leading to more addiction and death. This has important implications for policy makers, because it highlights the difficulty of selectively decreasing abuse and diversion while keeping the overall supply of opioids for legitimate use constant or increasing. To curtail the current epidemic of opioid abuse, overdoses, and related deaths, regulatory and enforcement measures to prevent nonmedical use and diversion should be complemented by changes to clinical guidelines to treat chronic pain that are less reliant on opioids. A public health approach to the treatment of pain in the context of an epidemic of abuse would place greater weight on considering the harmful effects, or what economists consider to be negative externalities, that clinicians’ treatment decisions have on other individuals beyond the individual patient being treated. There are sources of diversion of opioids at every step in the supply chain, and some observers have argued that because the majority of opioid addicts report that their access to the drugs is through friends or family rather than physicians, the misuse of these therapies may not be considered a “clinical problem.” Publicity regarding robberies of warehouses storing opioid medications serves to reinforce the perception that physician practices, aside from “pill mills,” are not of concern. Such reasoning fails to consider that increased access of opioids through friends and family is due, in part, to the increasing prescribing of medications commonly diverted for illicit use. Greater clinical judiciousness is especially warranted given the limited evidence to support many clinical applications in which opioids are used. For example, although opioids may be efficacious for acute lower back pain, the safety, efficacy, and abuse data are limited for chronic back pain. There are serious gaps in the knowledge base regarding opioid use for other chronic nonmalignant pain as well, including a lack of randomized trials that have active treatment groups or that examine major harms and benefits of

Effects of domestic violence policies, alcohol taxes and police staffing levels on intimate partner homicide in large US cities.

Objective To assess the relationships between intimate partner homicide (IPH) and public policies including police staffing levels in large US cities. Design The research uses a multiple time-series design to examine the effects of statutes aimed at restricting access to firearms for perpetrators of domestic violence, allowing or mandating arrest for violators of domestic violence restraining orders (DVROs), beer excise taxes, and police staffing levels on IPH in 46 of the largest US cities from 1979 to 2003. Both total IPH and IPH committed with a firearm are analysed. Generalised estimating equations using a Poisson distribution are used to regress IPH on the policies and potential confounders. Results State statutes restricting those under DVROs from accessing firearms, and laws allowing the warrantless arrest of DVRO violators are associated with reductions in total and firearm IPH. Police staffing levels are also negatively associated with IPH and firearm IPH. There was no evidence that other policies to restrict firearm access to domestic violence offenders or alcohol taxes had a significant impact on IPH. Conclusions Reducing access to firearms for DVRO defendants, increasing police staffing levels and allowing the warrantless arrest of DVRO violators may reduce the city-level risk of IPH. Future research should evaluate factors that may mediate the effect of these laws and increased police staffing levels on IPH to determine whether there are opportunities to increase their protective effect. Further research is needed on firearm law implementation to determine why the other tested laws were not found effective.

Effects of Baltimore’s Safe Streets Program on Gun Violence: A Replication of Chicago’s CeaseFire Program

Chicago’s CeaseFire program is an evidence-based public health approach to preventing gun violence. Baltimore is one of many US cities attempting to replicate the program. We compared changes in the number of homicide and nonfatal shooting incidents per month in four intervention neighborhoods with changes in high-crime comparison areas (police posts) without the intervention, while controlling for several measures of police activity and baseline levels of homicide and nonfatal shootings. In South Baltimore there were large program-related reductions in homicide and nonfatal shooting incidents. Among three East Baltimore program sites, the program was associated with a reduction of homicides in one area, a reduction in nonfatal shootings in another area, and a simultaneous increase in homicides and decrease in nonfatal shootings in another area. In some instances, program effects extended to neighborhoods bordering the intervention areas. Program-related reductions in homicides appear to be linked with conflict mediations conducted by program outreach workers.

Relationship between licensing, registration, and other gun sales laws and the source state of crime guns

Objective—To determine the association between licensing and registration of firearm sales and an indicator of gun availability to criminals. Methods—Tracing data on all crime guns recovered in 25 cities in the United States were used to estimate the relationship between state gun law categories and the proportion of crime guns first sold by in-state gun dealers. Results—In cities located in states with both mandatory registration and licensing systems (five cities), a mean of 33.7% of crime guns were first sold by in-state gun dealers, compared with 72.7% in cities that had either registration or licensing but not both (seven cities), and 84.2% in cities without registration or licensing (13 cites). Little of the difference between cities with both licensing and registration and cities with neither licensing nor registration was explained by potential confounders. The share of the population near a city that resides in a neighboring state without licensing or registration laws was negatively associated with the outcome. Conclusion—States with registration and licensing systems appear to do a better job than other states of keeping guns initially sold within the state from being recovered in crimes. Proximity to states without these laws, however, may limit their impact.