Branas, Charles
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Publication Guatemala & the University of Pennsylvania: Meeting in the Middle(2013-01-01) Barg, Frances K; Weiss, Eve; Branas, CharlesThe GUATEMALA-PENN relationship is a partnership that is borne from more than a century of research, service and scholarship. Our goal, with this book and with our programs, is to grow this partnership based upon the reciprocal needs of our Guatemalan stakeholders and the mission of the university. Guatemala is only one country away from the US. Our shared heritage and joint economic and social interests make it critical to foster a strong and mutually beneficial relationship between our two countries. Our connections have evolved over time in response to new knowledge gained about each other. This book is a testament to our collective past, present and future. For more information or to donate visit: http://www.med.upenn.edu/globalhealth/guatemalapartners.shtmlPublication Homicide and Geographic Access to Gun Dealers in the United States(2009-06-23) Wiebe, Douglas J.; Nance, Michael L.; Krafty, Robert T.; Koper, Christopher S.; Branas, Charles; Elliott, Michael R.Background: Firearms are the most commonly used weapon to commit homicide in the U.S. Virtually all firearms enter the public marketplace through a federal firearms licensee (FFL): a store or individual licensed by the federal government to sell firearms. Whether FFLs contribute to gun-related homicide in areas where they are located, in which case FFLs may be a homicide risk factor that can be modified, is not known. Methods: Annual county-level data (1993–1999) on gun homicide rates and rates of FFLs per capita were analyzed using negative binomial regression controlling for socio-demographic characteristics. Models were run to evaluate whether the relation between rates of FFLs and rates of gun homicide varied over the study period and across counties according to their level of urbanism (defined by four groupings, as below). Also, rates of FFLs were compared against FS/S – which is the proportion of suicides committed by firearm and is thought to be a good proxy for firearm availability in a region – to help evaluate how well the FFL variable is serving as a way to proxy firearm availability in each of the county types of interest. Results: In major cities, gun homicide rates were higher where FFLs were more prevalent (rate ratio [RR] = 1.70, 95% CI 1.03–2.81). This association increased (p < 0.01) from 1993 (RR = 1.69) to 1999 (RR = 12.72), due likely to federal reforms that eliminated low-volume dealers, making FFL prevalence a more accurate exposure measure over time. No association was found in small towns. In other cities and in suburbs, gun homicide rates were significantly lower where FFLs were more prevalent, with associations that did not change over the years of the study period. FFL prevalence was correlated strongly (positively) with FS/S in major cities only, suggesting that the findings for how FFL prevalence relates to gun homicide may be valid for the findings pertaining to major cities but not to counties of other types. Conclusion: Modification of FFLs through federal, state, and local regulation may be a feasible intervention to reduce gun homicide in major cities.Publication Mapping Activity Patterns to Quantify Risk of Violent Assault in Urban Environments(2016-01-01) Wiebe, Douglas; Richmond, Therese S; Guo, Wensheng; Nance, Michael L.; Branas, Charles; Allison, Paul D; Hollander, Judd EBACKGROUND: We collected detailed activity paths of urban youth to investigate the dynamic interplay between their lived experiences, time spent in different environments, and risk of violent assault. METHODS: We mapped activity paths of 10- to 24-year-olds, including 143 assault patients shot with a firearm, 206 assault patients injured with other types of weapons, and 283 community controls, creating a step-by-step mapped record of how, when, where, and with whom they spent time over a full day from waking up until going to bed or being assaulted. Case-control analyses compared cases with time-matched controls to identify risk factors for assault. Case-crossover analyses compared cases at the time of assault with themselves earlier in the day to investigate whether exposure increases acted to the trigger assault. RESULTS: Gunshot assault risks included being alone (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.3, 1.9) and were lower in areas with high neighbor connectedness (OR = 0.7, 95% CI = 0.6, 0.8). Acquiring a gun (OR = 1.4, 95% CI = 1.1, 1.6) and entering areas with more vacancy, violence, and vandalism (OR = 1.7, 95% CI = 1.1, 2.7) appeared to trigger the risk of getting shot shortly thereafter. Nongunshot assault risks included being in areas with recreation centers (OR = 1.2, 95% CI = 1.1, 1.4). Entering an area with higher truancy (OR = 1.6, 95% CI = 1.1, 2.5) and more vacancy, violence, and vandalism appeared to trigger the risk of nongunshot assault. Risks varied by age group. CONCLUSIONS: We achieved a large-scale study of the activities of many boys, adolescents, and young men that systematically documented their experiences and empirically quantified risks for violence. Working at a temporal and spatial scale that is relevant to the dynamics of this phenomenon gave novel insights into triggers for violent assault.Publication State Helmet Laws and Motorcycle Rider Death Rates(2001-09-24) Branas, Charles; Knudson, MarthaMotorcycles are the most dangerous form of motorized transportation. Per vehicle miles traveled, motorcyclists are about 3 times as likely as passenger car occupants to be injured in a crash, and 16 times as likely to die. Because the majority of these deaths are caused by head injury, safety advocates have recommended mandatory use of motorcycle helmets. Others contend that state laws mandating helmet use infringe on motorcyclists’ rights, and question whether such laws really reduce motorcycle deaths and injury. Scientific evidence cannot address the appropriate balance between personal freedom and public safety, but it can address the effectiveness of mandatory helmet laws. This Issue Brief summarizes a new analysis of the effects of motorcycle helmet laws on death rates, and points out the need to account for other potential factors when comparing death rates across states.Publication Acute Alcohol Consumption, Alcohol Outlets, and Gun Suicide(2011-01-01) Branas, Charles; Richmond, Therese S; Ten Have, Thomas; Wiebe, DouglasA case-control study of 149 intentionally self-inflicted gun injury cases (including completed gun suicides) and 302 population-based controls was conducted from 2003 to 2006 in a major US city. Two focal independent variables, acute alcohol consumption and alcohol outlet availability, were measured. Conditional logistic regression was adjusted for confounding variables. Gun suicide risk to individuals in areas of high alcohol outlet availability was less than the gun suicide risk they incurred from acute alcohol consumption, especially to excess. This corroborates prior work but also uncovers new information about the relationships between acute alcohol consumption, alcohol outlets, and gun suicide. Study limitations and implications are discussed.Publication No Time to Spare: Improving Access to Trauma Care(2005-09-29) Branas, CharlesSince the September 11 attacks, policymakers are paying increasing attention to the adequacy of the U.S. trauma care system to handle potential mass casualty incidents. This attention has led to questions about how well the trauma system covers the population for day-to-day trauma, such as motor vehicle accidents and gunshot wounds. Although the number of trauma centers has increased in the last decade, no national plan exists to assure that everyone has timely access to a specialized trauma center if needed. This Issue Brief summarizes a new study that estimates the proportion of residents that can reach a trauma center by ground or air ambulance within one hour of where they live, using objective measures of travel times and distances.Publication Examination of Carotid Arteries with Quantitative Color Doppler Flow Imaging(1994-02-01) Branas, Charles; Weingarten, Michael S; Czeredarczuk, Michael; Schafer, Paula FThe results of conventional duplex scanning were compared with QCDFI. A total of 224 consecutive patients comprising 442 unilateral carotid systems were examined by conventional duplex techniques. MPSV, as determined by QCDFI, were recorded for each of the 442 carotid segments and grouped according to the previously determined degrees of stenosis. The predictive value of QCDFI was confirmed by angiography with an overall accuracy of 91%. Results obtained by duplex scanning correlated with angiography 89% of the time. Based on QCDFI data, a scale to grade carotid stenosis was developed.Publication Methods for Linking Community Views to Measureable Outcomes in a Youth Violence Prevention Program(2012-01-01) McDonald, Catherine C; Richmond, Therese S; Guerra, Terry; Branas, Charles; Thomas, Nicole A; TenHave, Thomas; Walker, Alia; Leff, Stephen S; Vaughn, Nicole A; Hausman, Alice JBackground: All parties in community–academic partnerships have a vested interest prevention program success. Markers of success that reflect community’s experiences of programmatic prevention success are not always measurable, but critically speak to community-defined needs. Objective: The purpose of this manuscript was to (1) describe our systematic process for linking locally relevant community views (community-defined indicators) to measurable outcomes in the context of a youth violence prevention program and (2) discuss lessons learned, next steps, and recommendations for others trying to replicate a similar process. Methods: A research team composed of both academic and community researchers conducted a systematic process of matching community-defined indicators of youth violence prevention programmatic success to standardized youth survey items being administered in the course of a program evaluation. The research team of three community partners and five academic partners considered 43 community-defined indicators and 208 items from the youth surveys being utilized within the context of a community-based aggression prevention program. At the end of the matching process, 92 youth survey items were identified and agreed upon as potential matches to 11 of the community-defined indicators. Conclusions: We applied rigorous action steps to match community-defined indicators to survey data collected in the youth violence prevention intervention. We learned important lessons that inform recommendations for others interested in such endeavors. The process used to derive and assess community-defined indicators of success emphasized the principles of community-based participatory research (CBPR) and use of existing and available data to reduce participant burden.Publication Vacant Properties and Violence in Neighborhoods(2012-01-01) Branas, Charles; Rubin, David; Guo, WenshengObjectives. Violence remains a significant public health issue in the United States. To determine if urban vacant properties were associated with an increased risk of assaultive violence and if this association was modified by important neighborhood institutions (e.g., schools, parks/playgrounds, police stations, and alcohol outlets). Methods. Longitudinal ecologic study of all 1816 block groups in Philadelphia. Aggravated assault and vacant property data were compiled yearly from 2002 to 2006 and linked to block groups. A mixed effects negative binomial regression model examined the association of vacant properties and assaults between and within block groups. Results. Among all block groups, 84% experienced at least one vacant property, 89% at least one aggravated assault, and 64% at least one gun assault. Between block groups, the risk of aggravated assault increased 18% for every category shift of vacant properties (IRR 1.18, 95% CI: 1.12, 1.25, P < 0.001). Parks/playgrounds and alcohol outlets potentially modified the association between vacant properties and aggravated assaults but only at low levels of vacancy. Conclusions. Increasing levels of vacancy were associated with increased risk of assaultive violence in urban block groups.Publication Perceived Effectiveness of Acupuncture: Findings From the National Health Interview Survey(2008-12-01) LaRiccia, Patrick J; McMurphy, Suzanne; Gallo, Joseph J; Xie, Daiwei; Branas, CharlesBackground: Knowledge of perceived benefit from acupuncture treatment is important to predict who is using acupuncture, to inform physicians of the possible benefits of acupuncture, to determine where rigorous research should be focused, and to help policy makers predict future demand. Objectives: To determine the proportions of survey respondents who reported perceived effectiveness of acupuncture treatment for specific conditions; and to determine the association of specified demographic variables with perceived effectiveness. Design, Setting, and Participants: Publicly available data from 31,044 noninstitutionalized US adults who participated in the 2002 National Health Interview Survey, a cross-sectional in-home computer-assisted interview. Outcome Measures: The proportions of participants reporting “any help” and “great help” for perceived effectiveness across conditions treated and per condition treated; and the association of the subgroups within age, sex, and body mass index (BMI), along with the subgroups Asian race and Chinese ethnicity, with “any help” of acupuncture treatment across conditions treated. Results: Of the 1,274 respondents who reported having consulted an acupuncturist, 329 had used acupuncture in the last 12 months; 276 had used acupuncture to treat a specific condition. A total of 86% of respondents reported being helped by acupuncture, while 45% reported being greatly helped across conditions treated. In an examination of specific conditions treated, the range for “any help” was 98% to 67%, and 98% to 7% in the “great help” outcome. Older age and obesity were negatively associated with perceived effectiveness statistically but not clinically. Asian race and Chinese ethnicity were not statistically significantly associated with perceived effectiveness. Conclusions: Acupuncture is perceived to be effective by most respondents who used it to treat a specific condition. Older age and obesity are negatively associated with perceived effectiveness, but not at a clinically significant level. A larger sample of Asian and Chinese subgroups is needed to determine if there is an association of these subgroups with perceived benefit.
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