There There: Tracing Structural Discrimination, Health, Identity, and Resilience

Erin Grinshteyn outlines structural discrimination and resulting health disparities in Native American populations in There There by Tommy Orange

Aging in the Bay: Where We Excel and Fall Short in Serving the Needs of Older Adults

As the population of California and the Bay Area gets older, issues of high cost of living and transportation makes it difficult for elderly people. Erin Grinshteyn looks at initiatives in the Bay Area to help the aging populations

Violent Death Rates: The United States Compared to other High-Income OECD Countries, 2010

Background: Violent death is a serious problem in the US. Previous research showing US rates of violent death compared with other high-income countries used data that are more than a decade old. Methods: We examined 2010 mortality data obtained from the WHO for populous, high-income countries (n=23). Death rates per 100,000 population were calculated for each country and for the aggregation of all non-US countries overall and by age and sex. Tests of significance were performed using Poisson and negative binomial regressions. Results: US homicide rates were 7.0 times higher than other high-income countries, driven by a gun homicide rate that was 25.2 times higher. For 15-24 year olds, the gun homicide rate in the US was 49.0 times higher. Firearm-related suicide rates were 8.0 times higher in the US but our overall suicide rates were average. Unintentional firearm deaths were 6.2 times higher in the US. The overall firearm death rate in the US from all causes was 10.0 times higher. Ninety percent of women, 91% of children aged 0-14, 92% of youth aged 15-24, and 82% of all people killed by firearms were from the US. Conclusion: The US has an enormous firearm problem compared to other high-income countries with much higher rates of homicide and firearm-related suicide. Compared to 2003 estimates, the US firearm death rate remains unchanged while firearm death rates in other countries fell. Thus, the already high relative rates of firearm homicide, firearm suicide and unintentional firearm death in the US compared to the other high-income countries rose between 2003 and 2010. Violent death is a serious public health problem in the United States. Among 15-24 year olds, homicide is the second leading cause of death and suicide is the third leading cause; for 25-34 year olds, suicide is the second leading cause and homicide the third leading cause of fatality, following unintentional injuries for both groups. The United States is known to have higher levels of violent death, particularly homicide, compared to other developed nations. While the US does not appear to have higher rates of non-lethal crime, our rates of lethal violence and especially gun violence are much higher than other high-income countries. There are many more guns and less strong gun laws in the US than in other developed nations. Almost two decades ago, a report from the Centers for Disease Control and Prevention (CDC) used data from the early 1990s to compare the United States to other high-income countries in terms of violent death (i.e., suicide, homicide, firearm accidents) for children aged 5-14 years. In a previous article, we updated and expanded that comparison to examine all age groups and both sexes using 2003 data. These 2003 data are now more than a dozen years old. In this paper, we again update the data plus we provide country level data for each high-income nation and contrast the US levels of lethal violence for whites, who traditionally have lower homicide rates than non-whites in the US, with all citizens (i.e., whites and non-whites) of the other high-income nations

Racism and Stress: How a Zero Sum Approach Harms The Sum of Us

Experiencing racism is a pervasive and persistent stressor that not only negatively impacts the health of people of color (POC), but all members of a population, including Whites. This essay discusses how experiencing racism over a lifetime may cause wear and tear on the body and increase risk for premature disease, disability, and death. The authors explore how racial capitalism has created a deeply flawed economic system that exploits POC and foments hostility among working-class whites towards POC. Blue collar workers of all races currently suffer from economic misery and social malaise. Recent alarming trends of increases in death rates among middle-aged working class White men and women supports Heather McGhee’s thesis in her book, The Sum of Us, that racism harms all members of a population

The Reply

The Reply. A letter to the editor in The American Journal of Medicine, Volume 129, Issue 8, 2016, Page e143 regarding Unintentional firearm deaths among children in the United States

Violent death rates in the US compared to those of the other high-income countries, 2015

Violence is a serious public health issue in the U.S. This research compares the US and other high-income countries in terms of violent death. we used data from the World Health Organization for populous, high-income countries. Data from CDC\u27s WISQARS and WONDER systems were used to assess mortality data among US white and non-white populations and in low-, medium-, and high-gun states in 2015. Death rates per 100,000 population were calculated overall, by age, and by sex. Poisson and negative binomial regression were used to test for significance. The homicide rate in the US was 7.5 times higher than the homicide rate in the other high-income countries combined, which was largely attributable to a firearm homicide rate that was 24.9 times higher. The overall firearm death rate was 11.4 times higher in the US than in other high-income countries. In this dataset, 83.7% of all firearm deaths, 91.7% of women killed by guns, and 98.1% of all children aged 0-4 years killed by guns were from the US. Firearm homicide rates were 36 times higher in high-gun US states and 13.5 times higher in low-gun US states than the firearm homicide rate in other high-income countries combined. The firearm homicide rate among the US white population was 12 times higher than the homicide rate in other high-income countries. The US firearm death rate increased between 2003 and 2015 and decreased in other high-income countries. The US continues to be an outlier among high-income countries with respect to firearm deaths

The Association Between Electronic Bullying and School Absenteeism Among High School Students in the United States

BACKGROUND: This study examines the relationship between exposure to electronic bullying and absenteeism as a result of being afraid. METHODS: This multivariate, multinomial regression analysis of the 2013 Youth Risk Behavior Survey data assessed the association between experiencing electronic bullying in the past year and how often students were absent in the last month due to feeling unsafe at/in transit to school. The model controlled for other predictors of school absence including demographics, physical / behavioral health, and risk factors. Missing data were multiply imputed. RESULTS: Electronic bullying was significantly associated with absences. Controlling for model covariates, the relative risk of missing one day of school was 1.77 times higher, the relative risk of missing two to three days of school per month increased by a factor of 2.08, and the relative risk of missing four or more days of school per month increased by a factor of 1.77 for those who experienced electronic bullying in the past year compared with those who were not electronically bullied. CONCLUSIONS: Electronic bullying’s association with absenteeism places it among already recognized negative influences such as depression and binge drinking, necessitating schools to implement policies to mediate the resulting harmful effects

Using the General Social Survey - National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA

Objectives Fear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death. Setting and participants Data from the 1978–2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297). Methods GSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex. Results Among those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14). Conclusions Research has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully

Voter Suppression Undermines Public Health for All

In the US, policies have actively suppressed the voices of Black, Indigenous, and people of color (BIPOC) while amplifying their oppressors’ voices. In spite of multiple constitutional amendments to guarantee access to the right to vote for those who initially were deprived of this right, attacks on this civil liberty have persisted. While some states have expanded access to voting rights in the past year, many others have made voting more difficult and some states have had a mixed approach of making voting easier in some ways and harder in others. This continued interest in creating systems in which it is harder for people to vote has had indelible effects on population health and has widened health inequities. This essay explores the overlap in restricting access to voting and Medicaid expansion, decisions that disproportionately disadvantage BIPOC while also negatively affecting White residents by hindering expanded access to healthcare. This type of zero-sum decision making, as Heather McGhee articulates in her book, The Sum of Us, exacerbates poorer health outcomes, undermines public health, and widens health inequities

The associations of area-level crime rates and self-reported crime exposure with adolescent behavioral health

The effects of witnessing and experiencing crime have seldom been disaggregated. Little research has assessed the effect of multiple exposures to crime. We assess independent contributions of self-reported crime and area-level crime to adolescent behavioral health outcomes. Cross sectional data on 5519 adolescents from the Comprehensive Community Mental Health Services for Children and their Families Program was linked to FBI crime rate data to assess associations of mutually exclusive categories of self-reported crime exposure and area-level crime rates with mental health and substance abuse. Self-reported crime exposure was significantly associated with poorer behavioral health. Violent victimization had the largest association with all outcomes except internalizing scores. All self-reported crime variables were significantly associated with three of the outcomes. Area-level crime rates were associated with one mental health outcome. Providers should assess direct and indirect crime exposure rather than only focusing on violent victimization