And if there were another way out? Questioning the prevalent radicalization models.

Background: The COVID-19 pandemic has spread uncertainty, promoted psychological distress and fuelled conflict. The concomitant upsurge in endorsement of COVID-19 conspiracy theories is worrisome because they are associated with both non-adherence to public health guidelines and intention to commit violence. This study investigates associations between endorsement of COVID-19 conspiracy theories, support for violent radicalization (VR) and psychological distress among young adults in Canada. We hypothesized that a) endorsement of COVID-19 conspiracy theories is positively associated with support for VR, and b) psychological distress modifies the relationship between COVID-19 conspiracy theories and support for VR.Methods: A total of 6003 participants aged 18-35 years old in four Canadian cities completed an online survey that included questions about endorsement of COVID-19 conspiracy theories, support for VR, psychological distress, and socio-economic status.Outcomes: Support for VR was associated with endorsement of conspiracy theories in multivariate regression (β=0.88, 95% confidence interval (CI) 0.80-0.96). The magnitude of the association was stronger in individuals reporting high psychological distress (β=1.36, 95% CI 1.26-1.46) compared to those reporting low psychological distress (β=0.47, 95% CI 0.35-0.59).Interpretation: The association between endorsement of COVID-19 conspiracy theories and VR represents a public health challenge requiring immediate attention. The interaction with psychological distress suggests that policy efforts should combine communication and psychological strategies to mitigate the legitimation of violence.Funding: Fonds Québécois de Recherche en Santé et Culture grant #2017-SE-196373 and Équipe de Recherche et Action sur les Polarisations Sociales grant #180645.Declaration of Interests: None to declare. Ethics Approval Statement: Ethics approval was obtained from the Institutional Review Board ofthe Faculty of Medicine at McGill University before initiating the study, and all participants provided an electronic informed consent.

I. Essay: Private Foundations And The Crisis Of Alcohol And Drug Abuse

Abstract. LGBT-related hate crime is a conscious act of aggression against an LGBT citizen. The present research investigates associations between hate crime, psychological well-being, trust in the police and intentions to report future experiences of hate crime. A survey study was conducted among 391 LGBT respondents in the Netherlands. Sixteen percent experienced hate crime in the 12 months prior. Compared to non-victims, victims had significant lower psychological well-being, lower trust in the police and lower intentions to report future hate crime. Hate crime experience and lower psychological well-being were associated with lower reporting intentions through lower trust in the police. Helping hate crime victims cope with psychological distress in combination with building trust in the police could positively influence future reporting.

Across Canada, hate crimes, especially those motivated by race, ethnicity, or religion, are still prevalent. For example, in 2019, 46% of police-reported hate crimes were motivated by race or ethnicity, and 32% were motivated by religion (Moreau, 2021). In Canada, Muslims are the second most targeted religious group in terms of hate crimes. However, Canadian research on the nature of hate crime victimization amongst Muslims and the impacts on their health and well-being is limited. The present study sought to use exploratory survey data to assess the demographic characteristics of those experiencing both verbal and physical assaults based on their religion. Further, we assessed whether those that experienced these assaults also experienced psychological distress (such as feeling nervous or hopeless). Based on a sample of 230 participants (58% women), it was found that individuals that self-identified as visibly Muslim were 3 times more likely, and those living in Vancouver were 9 times more likely, to report having been physically assaulted. Furthermore, having been physically assaulted, being a woman, residing in Vancouver, or self-identifying as visibly Muslim were factors associated with higher levels of psychological distress. This study is the first of its kind exploring the effects of hate crimes on Muslims across Canada. The impacts of hate crime on the psychological well-being of this marginalized population, especially for Muslim women, suggests a need for more research on the psychological distress of these individuals

In the current context where many countries are faced with terrorism, prevention, which is based on the identification of various pathways and causes of radicalization and on the means to defuse it, occupies a central place in the actions put in place. To this end, one of the essential aspects to take into account in order to defuse is the identification of indicators which show that an individual is in the process of falling into violent radicalization. This study with a theorical contribution was therefore initiated, in order to expand the knowledge of the scientific community on these indicators and allow a more indepth understanding of phenomenon. Thus, we propose on the basis of a rich literature obtained thanks to a documentary review in databases (PubMed, Google scholar etc.), to understand the processus of adhesion to violent action and to imbue ourselves with these indicators. The expected results are the specification of these indicators with regard to the African socio-political context, and their taking into account in the formulation of an adapted public response in terms of early detection and support for the people concerned in terms of prevention violent radicalization. Keywords: Early Detection, Tipping Point Indicators, Violent Radicalization.

Background1Little is known of the extent of workplace bullying in Malaysia, despite its growing recognition worldwide as a serious public health issue in the workplace. Workplace bullying is linked to stress-related health issues, as well as socioeconomic consequences which may include absenteeism due to sick days and unemployment. We sought to examine the prevalence of workplace bullying and its association with socioeconomic factors and psychological distress in a large observational study of Malaysian employees.MethodsThis study employed cross-sectional, self-reported survey methodology. We used the 6-item Kessler screening scale (K6) to assess psychological distress (cutoff score ≥ 13, range 0–24, with higher scores indicating greater psychological distress). Participants self-reported their perceptions of whether they had been bullied at work and how frequently this occurred. A multivariate logistic regression was conducted with ever bullying and never bullying as dichotomous categories.ResultsThere were a total of 5235 participants (62.3% female). Participant ages ranged from 18 to 85, mean ± standard deviation (M ± SD): 33.88 ± 8.83. A total of 2045 (39.1%) participants reported ever being bullied. Of these, 731 (14.0%) reported being subject to at least occasional bullying, while another 194 (3.7%) reported it as a common occurrence. Across all income strata, mean scores for psychological distress were significantly higher for ever bullied employees (M ± SD: 8.69 ± 4.83) compared to those never bullied (M ± SD: 5.75 ± 4.49). Regression analysis indicated significant associations (p < 0.001) between workplace bullying with being female (Adjusted OR (aOR) = 1.27, 95% CI 1.12–1.44), higher individual income levels of between RM4,000 to RM7,999 (aOR =1.24, 95% CI 1.06–1.45) and RM8,000 and above (aOR = 1.31, 95% CI 1.10–1.56), and psychological distress (aOR = 1.15, 95% CI 1.13–1.16).ConclusionsMore than one in three employees reported having experienced workplace bullying, which was found to be specifically associated with being female, drawing a higher income, and greater psychological distress. In general, low individual income was associated with greater psychological distress. However, higher income employees were far more likely to report experiencing workplace bullying. Findings from this study offer relevant insight into the associations between socioeconomic status and psychological distress in workplace bullying.

The non-medical use of prescription medications among adolescents has become a concerning public health issue. This study assessed the prevalence of the non-medical use of prescription medications in Ontario high school students, and explored the moderating effect of this use on the relationship between psychological distress and unmet mental health needs. Cross-sectional data for 4896 students, age 14-18, were drawn from the 2019 Ontario Student Drug Use and Health Survey. Psychological distress was measured using the Kessler-6 Distress Scale, unmet mental health needs were defined by self-report (yes/no), and non-prescription medication use was defined by self-reported frequency of use. Using logistic regression, we explored the effect of the non-medical use of prescription medications on the relationship between psychological distress and unmet mental health needs. High proportions of Ontario students reported serious psychological distress (22%), some degree of unmet mental health need (38%), and/or non-medical use of prescription medications (13%). While there were strong associations between psychological distress and unmet mental health need, this association was weaker among those reporting non-medical use of prescription medications (OR = 3.3, 95% CI 1.9-5.7) compared to non-users (OR = 5.6, 95% CI 4.5-7.1). Our findings suggest that Ontario students experiencing distress and using non-prescribed medications are less likely to identify a need for mental health support, highlighting the consequences of apparent self-medication through misuse of prescription medications. To assist in the redirection of adolescent perceptions of healthy coping strategies, population-based educational programming, with targeted promotion of both formal and informal mental health care resources, should be considered.

WE have worked for more than 10 years in the US Public Health Service to clarify the patterns of violence through surveillance and research and to identify and evaluate interventions to prevent and reduce the impact of violence. It is time to be clear about what we mean by violence and why we believe that violence is a public health problem. Violence is the intentional use of physical force against another person or against oneself, which either results in or has a high likelihood of resulting in injury or death. Violence includes suicidal acts as well as interpersonal violence such as rape, assault, child abuse, or elder abuse. Fatal violence results in suicides and homicides. The term<i>violence</i>has been used to connote both a subset of behaviors (which produce injuries) and outcomes (ie, the injuries themselves). We use<i>violence</i>to refer to a particular class of behaviors that cause

WHAT IS KNOWN ON THE SUBJECT?: There is very limited literature on the health of Middle Eastern immigrants in the United States, and the available studies were mostly conducted on small convenient samples in local communities. There is also a need to understand changes in the rates of serious psychological distress (SPD) during the 15years after 2001, as there were negative effects on Arabs' health since the September 2001 aftermath. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: The study examined the rates of SPD, the risk of SPD and its associated factors in a national sample of Middle Eastern immigrants in the United States from 2001 to 2015. The study found that serious psychological distress rate was high among Middle Eastern immigrants. Being a female and having obesity were associated with a higher risk of reporting serious psychological distress among this population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These outcomes necessitate mental health nursing interventions that provide culturally sensitive mental health care to immigrants For example, developing community-based prevention programmes is required to address risk factors of psychological distress and to increase awareness about psychological distress among Middle Eastern immigrants. ABSTRACT: Introduction While Middle Eastern immigrants are a fast-growing population in the United States, there is very limited literature on their mental health. Most of the available studies were conducted on small convenient samples in local communities. Aims To examine rates of serious psychological distress (SPD) and its associated factors among Middle Eastern immigrants in the United States, compared with US-born, non-Hispanic Whites. Methods Data from the National Health Interview Survey (NHIS) from 2001 to 2015 were analysed. The survey included 1,246 Middle Eastern immigrants and 232,392 US-born, non-Hispanic Whites. SPD was measured by the Kessler-6 psychological distress scale. Survey analysis procedures, sampling weights and variance estimates were conducted. Descriptive statistics and regression analyses were employed to examine differences and factors associated with SPD. Results SPD rate was the highest among Middle Eastern immigrants (5.99%) between 2006 and 2010. Among Middle Eastern immigrants, being female and obese were significantly associated with a higher risk of SPD. Discussion Middle Eastern immigrants in the United States suffered high rates of SPD. Gender and obesity were factors associated with SPD risk. Implications These outcomes indicate the need for mental health nursing interventions that provide culturally sensitive mental health care to immigrants, such as developing community-based prevention programmes.

Psychological distress is a public health issue as it contributes to the development of human diseases including neuropathologies. Parkinson's disease (PD), a chronic, progressive neurodegenerative disorder, is caused by multiple factors including aging, mitochondrial dysfunction, and/or stressors. In PD, a substantial loss of substantia nigra (SN) neurons leads to rigid tremors, bradykinesia, and chronic fatigue. Several studies have reported that the hypothalamic-pituitary-adrenal (HPA) axis is altered in PD patients, leading to an increase level of cortisol which contributes to neurodegeneration and oxidative stress. We hypothesized that chronic psychological distress induces PD-like symptoms and promotes neurodegeneration in wild-type (WT) rats and exacerbates PD pathology in PINK1 knockout (KO) rats, a well-validated animal model of PD. We measured the bioenergetics profile (oxidative phosphorylation and glycolysis) in the brain by employing an XF24e Seahorse Extracellular Flux Analyzer in young rats subjected to predator-induced psychological distress. In addition, we analyzed anxiety-like behavior, motor function, expression of antioxidant enzymes, mitochondrial content, and neurotrophic factors brain-derived neurotrophic factor (BDNF) in the brain. Overall, we observed that psychological distress diminished up to 50% of mitochondrial respiration and glycolysis in the prefrontal cortex (PFC) derived from both WT and PINK1-KO rats. Mechanistically, the level of antioxidant proteins, mitochondrial content, and BDNF was significantly altered. Finally, psychological distress robustly induced anxiety and Parkinsonian symptoms in WT rats and accelerated certain symptoms of PD in PINK1-KO rats. For the first time, our collective data suggest that psychological distress can phenocopy several aspects of PD neuropathology, disrupt brain energy production, as well as induce ataxia-like behavior.

Thedecriminalisation of homosexuality on September 6, 2018 in India has led to focus of Indian researchers towards mental health of Sexual and Gender Minorities (SGMs) who face day-to-day challenges such as social-unacceptance, identity under-expression,discrimination and hate crimes. The present study focuses onanalysing psychological distress among one of the most developed country i.e. United States of America (US) and the fast-developing country i.e. India with the inclusion of the LGBTQ+ and Cishet population. To fulfil the objective, data was collected from 200 young adults falling under 18-40 years of age from both Indians (N=100) and Americans (N= 100) through Purposive Sampling Technique. Furthermore, there were 50 LGBTQ+ and 50 Cishet sample inboth group of each country. The responses were collected through SurveyMonkey. Every respondent was individually assessed using Kessler’s Psychological Distress Scale (K10; Kessler et al.,2002) for evaluating the extent of psychological distress in the individual.The data analysis was done by Independent sample t-test using IBM SPSS software.The results indicate that 1.) Young adults of India have higher psychological distress than that of Americansas well as both the group (LGBTQ+ and Cishet Population) of India have higher psychological distress than that of the US;2) LGBTQ+ population has higher psychological distress in comparison to Cishet population in both India and US as well as for young adults.

Perhaps at no time in recent history has a threat to the public health been so great. The prevalence of overweight and obesity now affects two-thirds of the adult population and more than one in seven of our youth, and it is getting worse. Projected adverse health effects and reduced quality of life associated with overweight and obesity are staggering and threaten to bankrupt our health care system in the coming years. An early vision of what is to come is seen in the 10-fold rise in the past decade in the incidence of type 2 diabetes among children and adolescents in association with the dramatic increase in the prevalence of obesity. Beyond the direct healthcare-cost implications, this worsening situation among our youth raises the specter of dramatic increases in disease-related morbidity and mortality and dramatic losses in human capital and quality of life, as a consequence of the decades of treatment that individuals must undergo. In response to these trends, public health officials and medical experts alike have declared the obesity problem to be an epidemic. Unfortunately, although obesity has been recognized as a serious problem for years, we seem little closer today to a clear solution for prevention and treatment than we were a decade ago. More and more people are beginning to ask, what has gone wrong and what can we do? There is a growing consensus among experts that the secular trend in obesity sweeping the nation is not caused by defective biology but rather is environmentally driven. In fact, obesity may be viewed as a normal biological adaptation to the prevailing environment rather than a physiological system gone awry. For many people, weight gain is the only means to achieve energy balance in an environment that encourages excess energy intake and very low levels of physical activity. Because levels of physical activity are so low, energy consumption frequently exceeds energy expenditure, and the only way to restore energy balance is to increase body mass, which elevates the resting metabolic rate. Energy balance is thus, restored, but at the expense of a greater fat mass. The series of articles published in this volume examine three key aspects of this alarming public health issue. First, Jeffery and Utter (1) provide a comprehensive review of the current scientific literature concerning environmental contributions to obesity, emphasizing current understanding of environmental factors that affect eating and physical activity behaviors. Next, Lowe (2) examines whether it is feasible, given the prevailing environment, for individuals to self-regulate energy intake to maintain weight. Finally, Baranowski et al. (3) describe current knowledge about the effectiveness of behavioral change models and their potential application to obesity prevention. Each of these groups of investigators has done a thorough job of reviewing the literature in these key areas. Rather than discussing their particular findings and conclusions, in this brief introduction I comment on some of the overarching challenges that we face in dealing with obesity in the United States and the implications for making meaningful progress in stopping the advancing epidemic. So, what is wrong with the environment? What specific environmental factors are responsible for the dramatic increase in the prevalence of obesity? Numerous features of the food and physical activity environments can easily be pointed to as possible causal factors by applying old-fashioned common sense or what might be called "kitchen logic." On the surface, it just makes sense that people are heavier in a world where food is nearly everywhere in giant portions, and it is possible to lead a gainful life without having to do any appreciable physical activity. Unfortunately, however, little hard scientific evidence can apportion a role for any specific factor to the alarming rise in the prevalence of obesity that has occurred within just the past two decades. Many of the data are observational, and, therefore, causal inferences cannot be drawn. Likewise, different data sets do not always agree, making interpretation difficult. For example, as Jeffery and Utter (1) point out, nationwide food consumption surveys between the 1960s and the present indicate that total energy intake has not increased appreciably, despite the increase in the prevalence of obesity. Other data sources, however, indicate that per capita food availability has increased by ∼15% since 1970. The latter data are difficult to interpret, given that food wastage has also increased over the same time frame (4), making it hard to estimate how much actual food consumption may have increased. Clearly, other trends related to food intake correspond temporally with the rise in the prevalence of obesity, and Jeffery and Utter (1) also enumerate these trends. Overall, there seems to be a unidirectional trend toward increasing convenience in food availability, both in the home and away from home. The rise in the proportion of meals consumed away from home, including the increased numbers of fast food offerings, and the relatively high energy densities of many of the most popular foods, may increase the probability of excess energy consumption. Portion sizes have also increased dramatically over the last two decades, and human feeding studies have indicated that total energy intake tends to increase with increased portion size, at least in the short term (5). In addition, the composition of the U.S. food supply has shifted in the past few decades, providing relatively less red meat, less refined sugar, and less whole milk and butter, whereas increases in the amounts of chicken, fruits and vegetables, cooking oil, cheese, corn sweetener, and both regular and diet soft drinks in the common diet have been seen (1). At the same time, the cost of food continues to fall as a portion of disposable income (6). In consumer terms, this means that the cost of eating has gone down and food is a better "deal" now than ever before. Even less information on temporal trends in physical activity behaviors in the U.S. is available. Recent surveys indicate that the amount of physical activity performed during leisure time has not changed in recent decades (1). However, less information is available on how patterns of non-leisure time physical activity have been affected by the changing environment. Certainly, the increased reliance on personal automobiles, automation in the workplace, and the shift from a manufacturing-based economy to an automation-, service-, and information-based economy have likely contributed to a reduction in the amount of daily physical activity required on the job. The requirement of physical activity in schools has been systematically eliminated in favor of more classroom time, and even the provision of opportunities to engage in physical activity at recess seems to be a thing of the past. Likewise, in nearly every other aspect of daily life, we have developed technologies and products that save time, increase convenience, and reduce the need for physical effort. In many cases, we spend the "saved" time engaging in attractive sedentary pursuits like watching television or surfing the Internet. Taking all these trends together, one might conclude that we have systematically engineered physical activity out of our lives. Despite the circumstantial evidence that numerous environmental factors may promote a positive energy balance and obesity, it is essentially impossible, retrospectively, to assign proportional causality to any of these factors. Too many things have changed simultaneously over the past three decades to disentangle what is cause, what is effect, and what is simple association. Even if we knew which factors were responsible for fractions of the variance associated with a given weight outcome, would this ensure a solution to the obesity problem? I hypothesize that the factors examined thus far are not the core drivers of the obesity problem. The environmental characteristics discussed above may merely be surface signs and symptoms of deeper causal forces. In effect, what some have described as a "toxic environment" (7) can be viewed as an unintended consequence of economic and social choices made for reasons not related to concerns about health. In searching for an environmental solution to the obesity epidemic, the first question that we should ask is why is the environment the way it is? If the environment is being driven by a larger set of economic forces and social values, it seems reasonable to ask whether it is feasible to expect meaningful individual or population behavioral change by targeting only certain environmental features associated with eating and physical activity behaviors, without changing the larger system within which these behaviors operate and are encouraged, penalized, and rewarded. It can be argued that obesity is a social problem (8), driven in many dimensions by our deeply held values and beliefs and the systems that we as a society have constructed to develop, reward, and perpetuate this value system. Our forefathers founded this country on strongly held beliefs about the value of personal liberty and being able to pursue one's own dream. At the core of these values is the seemingly inherent drive to secure a better future for ourselves and our children. This may mean different things to different people, and the way social systems evolve to sustain this drive may change over time, but in today's more uncertain world, being able to secure a better future seems to translate to earning more money and to raising your standard of living, and to do so as quickly as possible. This equation seems to operate at the societal level as well. As a nation, year after year, we pursue the goal of increasing the total output of goods and services, of growing the economy. To increase output, however, productivity must increase, and this, in turn, demands that more technology be invented and that more effort be spent in the pursuit of making and selling more goods and services. It is noteworthy that at no time in history have more individuals been invested in the stock market (9). This in itself creates even greater pressure for industry to make and sell more, because a much larger proportion of the population is directly invested in the productivity-prosperity equation. Aside from these direct investors, large segments of the population have a sizeable piece of their retirement nest eggs tied to the fortunes of the stock market. What individual or institutional shareholder does not want his or her investment to grow? This broader participation in the global economy by increasing segments of the population undoubtedly helps perpetuate the more frenzied pace of commerce that seemingly has but one objective: to make and sell more products and services. It is interesting that many of the Fortune 500 companies that dominate retirement funds and institutional investment portfolios are industries involved in producing and selling food, inventing and selling technologies that save labor and reduce physical activity, and offer ever more attractive forms of sedentary entertainment. So, the very industries that we rely on to build our own economic future are integral to the environment that we now recognize as helping to promote obesity. As if these forces were not enough to drive us toward creating an environment that promotes obesity, the challenge of preventing obesity is made even more daunting by our own biology: a blueprint that seems to reinforce our predisposition to find even better, cheaper ways to deliver high-energy food and to find even more ways to provide incentives for sedentariness. Humans are essentially "hardwired" to prefer foods high in sugar and fat and, hence, rich in energy, and we are not predisposed to engaging in physical activity for the purpose of being physically active per se (8). Thus, it is not surprising that after reviewing the evidence about factors affecting human food intake, Lowe (2) concludes that it is essentially infeasible for humans to self-regulate food intake under current environmental circumstances, at least not without applying substantial cognitive control. So, what is the point? The point is that at an overarching level, the environment is the way it is because that is the way we want it to be. It best serves the needs we currently value most as a society. In addition, economists would likely argue that the current configuration approximates the most efficient way to meet those needs within the prevailing set of social and economic priorities. As former U.S. Department of Labor Secretary and social economist Robert Reich wrote recently, "If people wanted to live according to different priorities and were willing to accept the sacrifices that those different priorities entailed, presumably they'd do so" (Ref. (9), p. 218). We have more fast food restaurants and packaged foods because people want more convenience. Convenience foods are generally high in fat, sugar, and calories because they make foods taste good and those ingredients are inexpensive, made so by years of agricultural advances designed expressly to provide more of these ingredients at lower cost. In addition, "supersizing," which amounts, of course, to paying relatively less to get more, is part of our American culture and has become the definition of the "deal." However, environmental factors affecting body weight control go beyond the food environment. We engineer the need for physical activity out of workplaces because it takes time away from being more productive. We design communities and businesses alike to be "drive-through" to save time, so that we can devote more time to being productive or spend more time with our families, because we have spent too much time being productive. "Our incentive and reward system is also set up to perpetuate this situation. In the U.S., we reward hard work in a manner that encourages people to work harder" (Ref. (9), p. 273). The role of economics in driving environmental trends and perpetuating our social system cannot be overstated. Our drive to earn more and to be more productive as a society affects not only decisions made by individuals, but also pervades institutional decisions, many of which affect the shape of our environment and the attendant consequences for promoting obesity. In reference to how economic forces affect social choices, Reich writes, "Judges, legislators, editorial writers, and average citizens alike typically form their opinions on the basis of what alternative best promotes economic growth or best advances the well-being of consumers by lowering prices and generating better products" (Ref. (9), p. 235). Even if one accepts that the current shape of our "obesigenic" environment is driven by deeper social and economic forces and that we are all a party to its current form, does this mean that we really want the world to be this way? Does this mean that we are powerless to do anything about it? Certainly not. As a society, we are empowered to choose the direction in which we go. So, why have we not acted? Perhaps it is because we have never before been faced with such a crisis driven by myriad factors affecting multiple behaviors. In addition, we have only limited experience (e.g., creating smoke-free environments) in figuring out how to make socially relevant decisions that change the environment in ways that reinforce positive individual health behaviors. What changes will be necessary to have a meaningful impact on obesity in the next several decades? How do we make healthy lifestyle choices more socially normative, increasing demand for goods and services and policies that perpetuate a new healthier future state? How do we change the current value equation to make this happen? In this issue of Obesity Research, Baranowski et al. (3) point out that current behavioral change models have not been very successful at changing long-term eating and physical activity patterns and may be inadequate to support successful interventions that would reverse the obesity epidemic. Why have we been largely unsuccessful? One might argue that we have attempted to change eating and physical activity patterns, behaviors that are motivated by multiple drivers not necessarily related to health, through mediators that are not of primary importance to the individual at the point of decision, given the totality of immediate personal priorities and rewards facing the individual. Why would someone want to make a healthier food or physical activity lifestyle choice in today's world? Our natural biological drive is to eat more and move less, behaviors that are inherently rewarding. Why would we do otherwise, unless there is a greater incentive to behave differently? In the context of obesity and healthy lifestyles, we are rarely provided incentives or rewarded for making healthful lifestyle choices, whether the choices concern food or physical activity. The rewards currently must come from within the individual, and these rewards alone have not been successful in motivating large segments of the population to change their health behaviors. It is time that we seriously examined what external incentives and rewards would be required to change the behavior of a significant fraction of the population. It seems unlikely in the short term that we can rely on more people reaching a high enough state of self-actualization that health behaviors ascend to a priority level of importance in their lives. Rather, we must begin examining what conditions would be required to make more people see that making healthy lifestyle choices is in their immediate self-interest. As a society we have made certain choices that served us well in the past, and these unintentionally led to the current obesity-promoting environment. Given the obesity-related health crisis that is looming, we clearly need to make some new choices: about what we want the future to look like, about what consequences and tradeoffs we are willing to accept, and about what we will adopt as new social norms. So, what will we choose, and how should we engage in moving ahead? At one end of the social change spectrum there are voices calling for policies that would limit or restrict choice and that would penalize people for making certain choices. At the other end of the spectrum there are those who would have us do nothing, keep going "full speed ahead." For these stakeholders, the status quo looks better in immediate economic terms. For many, I would venture to guess that a better future state lies somewhere in between: a state that balances our American ideals of personal liberty (e.g., choice) and opportunity (e.g., commercial freedom) with social policies that ensure that as we continue to modify our environment, we examine publicly the consequences of our actions for the health of the population, and we make informed choices. In the end, we will have to find the right balance of tradeoffs and consequences that the majority of Americans will be able to live with. As for how to proceed, we also have choices. Some would argue that positive change will happen faster if we eliminate commercial interests from engaging in the dialog, as they are blinded by self-interest and would only work to delay moving ahead from the status quo. Others would embrace all sectors and interests to get to the endgame sooner, that is, to identify what is needed from each sector to support and perpetuate the new state and to get on with creating the future, unleashing the power and innovation of the market that will certainly drive rapid change once the target is identified. There are no experimental data that can answer the question of which approach will be better and take us to a solution faster. One thing is clear, however, at least for the food environment. There will always be a need for an industry to produce and sell food. When that industry has been called on in the past to respond to consensus public health needs, it has responded quickly and efficiently. For example, in the Healthy People 2000 report (10), the food industry was challenged to introduce 5000 new reduced-fat food products by the year 2000. The industry met the goal by 1995, five years ahead of schedule. This example highlights, in essence, a form of public—private partnership that can be used as a model of how involving private interests in addressing public health issues can be effective. Because the obesity issue is tied so strongly to economics, and economics is tied to social change, I conclude with a final quote by Reich (Ref. (9), p. 250), in which he writes about the impact of the new global economy on social evolution. I believe that this applies directly to the obesity situation in the U.S. today. "This cannot be—it must not be—solely an economic conversation. It is more fundamentally a moral one. We are not mere instruments of the new economy. We are not slaves to its technological trends. And we should not misdirect the blame for its less desirable, more worrisome consequences. As citizens, we have the power to arrange the new economy to suit our needs and, in so doing, to determine the shape of our emerging civilization. Every society has the capacity—indeed, the obligation—to make these choices. Markets are structured by them. Families and communities function according to them. Individuals balance their lives within them. It is through such decisions that a society defines itself. The choices will be made, somehow. They cannot be avoided. The question is whether we make the most important of these choices together, in the open, or grapple with them alone in the dark." Perhaps the single most important thing we can do to combat obesity is to engage in an honest, open, and inclusive dialog, and soon.

This paper examines empirically the effect of some commonly used indicators of social capital, such as the prevalence of trust on community members and the participation in voluntary secular and religious organizations, on the incidence of violent crimes. This is a cross-country study whose basic sample consists of 39 developed and developing countries and whose dependent variable is the national intentional homicide rate. The paper identifies and deals with three challenges in the empirical estimation of the effect of social capital on the incidence of violent crimes. The omittedvariable problem is dealt with by including income inequality and economic growth as additional determinants of a country’s violent crime rate. The joint endogeneity (or reverse-causation) problem is accounted for by using instrumental variables for social capital in the crime regression. The specificity problem, that is the potentially opposite effects of group-specific and society-wide social capital, is noted and addressed only indirectly by emphasizing the results applied to the social capital indicators that have application for society as a whole. The main result of the paper is that only the component of social capital measured by trust on community members has the effect of reducing the incidence of violent crimes. The results regarding measures of other indicators of social capital are rather unclear. This may be due to a combination of limited samples, inability to fully control for reverse causation, and most likely, the opposite effects that society-wide and group-specific social capital may have on violent crime. ∗ Lederman and Menendez are economists with the Office of the Chief Economist for Latin America and the Caribbean of the World Bank. Loayza is a senior economist with the research department of the Central Bank of Chile, and he is currently on leave from the Development Economics Research Group of the World Bank. The opinions expressed herein should not be attributed to the World Bank. The authors are grateful to Ed Glaeser, Jeff Grogger, Gale Johnson, Sanjay Marwah, Steve Messner, Nicholas Sambanis, and an anonymous referee for invaluable comments and suggestions. The authors are responsible for any remaining errors.

The purpose of this review was to provide an evidence-based recommendation for community-based programs to mitigate gun violence, from the Eastern Association for the Surgery of Trauma (EAST). Firearm Injury leads to >40,000 annual deaths and >115,000 injuries annually in the United States. Communities have adopted culturally relevant strategies to mitigate gun related injury and death. Two such strategies are gun buyback programs and community-based violence prevention programs. The Injury Control and Violence Prevention Committee of EAST developed Population, Intervention, Comparator, Outcomes (PICO) questions and performed a comprehensive literature and gray web literature search. Using GRADE methodology, they reviewed and graded the literature and provided consensus recommendations informed by the literature. A total of 19 studies were included for analysis of gun buyback programs. Twenty-six studies were reviewed for analysis for community-based violence prevention programs. Gray literature was added to the discussion of PICO questions from selected websites. A conditional recommendation is made for the implementation of community-based gun buyback programs and a conditional recommendation for community-based violence prevention programs, with special emphasis on cultural appropriateness and community input. Gun violence may be mitigated by community-based efforts, such as gun buybacks or violence prevention programs. These programs come with caveats, notably community cultural relevance and proper support and funding from local leadership.Level of Evidence: Review, Decision, level III.

Charlottesville: symptomatic of a broader pain