Wiebe, Douglas J.
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Publication 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 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 Youth's Strategies for Staying Safe and Coping With the Stress of Living in Violent Communities.(2010-09-01) Teitelman, Anne M; McDonald, Catherine C; Wiebe, Douglas; McDonald, Catherine C; Thomas, Nicole; Guerra, Terry; Richmond, Therese S; Kassam-Adams, NancyYouth living in urban environments of pervasive violence are exposed to a variety of violence-related stressors. This qualitative descriptive study sought to ascertain how community-dwelling youth perceived exposure to violence and how these youth identified and used available resources. The intent of this community-based participatory research study was to help inform the design of a youth violence prevention center intervention. Semi-structured interviews were conducted with a purposive sample of 18 youth ages 10-16. Youth reported high levels of exposure to neighborhood violence. A theme of identifying and navigating safe and unsafe places emerged. Other stressors were more proximal and included interpersonal issues and conflicts. Youth used neighborhood and individual resources to cope with stressors. Youth maintained a high level of vigilance and developed clear strategies to safely navigate violent neighborhoods. Implications for youth due to the constant vigilance and exquisite sensitivity to stressors of chronic neighborhood violence are discussed.Publication Military Veteran Mortality Following a Survived Suicide Attempt(2011-01-01) Weiner, Janet; Richmond, Therese S; Wiebe, Douglas; Conigliaro, JosephBACKGROUND: Suicide is a global public health problem. Recently in the U.S., much attention has been given to preventing suicide and other premature mortality in veterans returning from Iraq and Afghanistan. A strong predictor of suicide is a past suicide attempt, and suicide attempters have multiple physical and mental comorbidities that put them at risk for additional causes of death. We examined mortality among U.S. military veterans after hospitalization for attempted suicide. METHODS: A retrospective cohort study was conducted with all military veterans receiving inpatient treatment during 1993-1998 at United States Veterans Affairs (VA) medical facilities following a suicide attempt. Deaths occurring during 1993-2002, the most recent available year at the time, were identified through VA Beneficiary and Records Locator System data and National Death Index data. Mortality data for the general U.S. adult population were also obtained from the National Center for Health Statistics. Comparisons within the veteran cohort, between genders, and against the U.S. population were conducted with descriptive statistics and standardized mortality ratios. The actuarial method was used estimate the proportion of veterans in the cohort we expect would have survived through 2002 had they experienced the same rate of death that occurred over the study period in the U.S. population having the age and sex characteristics. RESULTS: During 1993-1998, 10,163 veterans were treated and discharged at a VA medical center after a suicide attempt (mean age = 44 years; 91% male). There was a high prevalence of diagnosed alcohol disorder or abuse (31.8%), drug dependence or abuse (21.8%), psychoses (21.2%), depression (18.5%), and hypertension (14.2%). A total of 1,836 (18.1%) veterans died during follow up (2,941.4/100,000 person years). The cumulative survival probability after 10 years was 78.0% (95% CI = 72.9, 83.1). Hence the 10-year cumulative mortality risk was 22.0%, which was 3.0 times greater than expected. The leading causes overall were heart disease (20.2%), suicide (13.1%), and unintentional injury (12.7%). Whereas suicide was the ninth leading cause of death in the U.S. population overall (1.8%) during the study period, suicide was the leading and second leading cause among women (25.0%) and men (12.7%) in the cohort, respectively. CONCLUSIONS: Veterans who have attempted suicide face elevated risks of all-cause mortality with suicide being prominent. This represents an important population for prevention activities.Publication Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis(2016-10-24) Kaufman, Elinore; Rising, Kristin; Wiebe, Douglas; Ebler, David; Crandall, Marie; Delgado, M. KitKey Findings: More than 11% of patients presenting to a hospital with a violent injury return to a hospital with another violent injury within two to three years. Recurrent violent injury is common and costly. Effective prevention programs should also target high-risk patients in non-trauma centers where most receive care.Publication Predicting the Future Development of Depression or PTSD After Injury(2011-07-01) Richmond, Therese S; Ruzek, Josef; Wiebe, Douglas; Ackerson, Theimann; Winston, Flaura; Kassam-Adams, NancyOBJECTIVE: The objective was to develop a predictive screener that when given soon after injury will accurately differentiate those who will later develop depression or posttraumatic stress disorder (PTSD) from those who will not. METHOD: This study used a prospective, longitudinal cohort design. Subjects were randomly selected from all injured patients in the emergency department; the majority was assessed within 1 week postinjury with a short predictive screener, followed with in-person interviews after 3 and 6 months to determine the emergence of depression or PTSD within 6 months after injury. RESULTS: A total of 192 completed a risk factor survey at baseline; 165 were assessed over 6 months. Twenty-six subjects [15.8%, 95% confidence interval (CI) 10.2-21.3] were diagnosed with depression, four (2.4%, 95% CI 0.7-5.9) with PTSD and one with both. The final eight-item predictive screener was derived; optimal cutoff scores were ≥2 (of 4) depression risk items and ≥3 (of 5) PTSD risk items. The final screener demonstrated excellent sensitivity and moderate specificity both for clinically significant symptoms and for the diagnoses of depression and PTSD. CONCLUSIONS: A simple screener that can help identify those patients at highest risk for future development of PTSD and depression postinjury allows the judicious allocation of costly mental health resources.Publication PhillydotMap: The Shape of Philadelphia(2009-10-01) Branas, Charles; Davitt, Joan K; Hillier, Amy; Cheetham, Robert; Cheetham-Richard, Rachel; Cohen, Rachel B; Decker, Joan; Heckert, Megan; Steinberg, Harris; Sullivan-Marx, Eileen; Hutchins, Jason; Tomlin, C. Dana; Kerman, Lucy; Volpe, Stella; Lechner, Zachary L; Wiebe, Douglas; McLarnon, Michael; Newlin, Heather; Scholssberg, Dina; Wormley, Diane-LouiseThis book is the outgrowth of a working group entitled, “Modeling Urban Environmental Impacts on Health, Development, and Behavior" sponsored by the University of Pennsylvania Institute for Urban Research. The purpose of the working gropu was to engage faculty from across campus and to encourage their collaborative use of GIS technology in the modeling of urban form and function. These ten chapters represent a wide range of GIS applications, from community-based social services to public history to social science research.Publication Guns in the Home: Risky Business(2003-05-20) Wiebe, DouglasOne in three U.S. households contains at least one firearm. Gun owners cite two main reasons for having a gun: hunting and self-protection. A majority of handgun owners believe that they are protecting their homes and families against violent assaults. But in a country where the majority of homicides and suicides involve a gun, it is reasonable to question whether access to a gun increases or decreases the risk of violent death. This Issue Brief describes case-control studies that investigate links between gun availability and gun death, and supports earlier findings that people with guns in their homes appear to increase their risk of being shot fatally (intentionally or unintentionally) or taking their own life with a gun.Publication Feasibility of an Automated Telephone Survey to Enable Prospective Monitoring of Subjects Whose Confidentiality is Paramount: a Four-week Cohort Study of Partner Violence Recurrence After Emergency Department Discharge(2008-01-01) Wiebe, Douglas; Carr, Brendan G; Datner, Elizabeth M; Richmond, Therese S; Elliott, Michael ROBJECTIVE: A goal in intimate partner violence (IPV) research is to identify victims when they are treated in a hospital Emergency Department (ED) and predict which patients will sustain abuse again after discharge, so interventions can be targeted. Following patients to determine those prognostic factors is difficult, however, especially to study IPV given the risk to be assaulted if their partner learns of their participation. We assessed the feasibility of an automated telephone survey and a wireless incentive delivery system to follow ED patients after discharge, enabling detection of IPV recurrence. METHODS: A four-week prospective cohort pilot study was conducted at an urban academic medical center ED in the U.S. Thirty patient subjects (24 women, 6 men; 18-54 years) who had sustained IPV in the past six months, 12 of whom presented for an acute IPV-related condition, were interviewed in the ED and were asked to report weekly for four weeks after discharge to a toll-free, password protected telephone survey, and answer recorded questions using the telephone keypad. A $10 convenience store debit card was provided as an incentive, and was electronically recharged with $10 for each weekly report, with a $20 bonus for making all four reports. RESULTS: Twenty-two of 30 subjects (73.3%) made at least one report to the telephone survey during the four weeks following discharge; 14 of the 30 subjects (46.7%) made all four weekly reports. Each time the telephone survey was accessed, the subject completed all questions (i.e., no mid-survey break-offs). Eight months after follow-up ended, almost all debit cards (86.7%) had been used to make purchases. CONCLUSION: Approximately three of every four subjects participated in follow-up after ED discharge, and approximately two of every four subjects completed all follow-up reports, suggesting the method of an automated telephone survey and wireless incentive delivery system makes it feasible to study IPV prospectively among discharged patients. That finding, along with evidence that IPV recurrence risk is high, suggests the protocol tested is warranted for use conducting full-scale studies of IPV. The protocol could benefit efforts to study other outcomes, especially when patient confidentiality is paramount for their safety.