Homicide among adolescents in the Americas: a growing epidemic.

ABSTRACTBackground: The United States has more than 90% of all youth firearm deaths that occur in high-income countries. Purpose: We summarize the epidemiological literature on the prevalence, risk factors, and protective factors associated with adolescent homicides and suicides and the role of firearms in the loss of these lives. Methods: A systematic process was used to locate literature on adolescent homicide, adolescent suicide, and adolescent firearm deaths. The literature on these topics was summarized to provide an overview of the issues. Results: Approximately 10% of all arrests in a year for murder and nonnegligent manslaughter are by youth younger than 18 years of age; 92% of these are males. African American male teens are 20 times more likely than white male teens to be victims of homicides. Suicides are attempted more often by adolescent females than males, but males are more likely to die from suicides because they usually use a very lethal method—firearms. Firearms are the implements of choice for adolescent homicides and suicides. Discussion: Too many youth grow up in unhealthy circumstances, faced with a multitude of challenges that contribute to adolescents killing others or killing themselves. Translation to Health Education Practice: Community agencies, parents, and schools need to be proactive in enhancing youth resiliency. This literature review will assist Health Educators in community and school settings to assist communities, families, and youth with creating protective factors to minimize adolescent homicides and suicides.

Firearm injuries are a major cause of mortality in the USA. Few recent studies have simultaneously examined the impact of multiple state gun laws to determine their independent association with homicide and suicide rates. To examine the relationship between state firearm laws and overall homicide and suicide rates at the state level across all 50 states over a 26-year period. Using a panel design, we analyzed the relationship between 10 state firearm laws and total, age-adjusted homicide and suicide rates from 1991 to 2016 in a difference-in-differences, fixed effects, multivariable regression model. There were 1222 observations for homicide analyses and 1300 observations for suicide analyses. Populations of all US states. The outcome measures were the annual age-adjusted rates of homicide and suicide in each state during the period 1991-2016. We controlled for a wide range of state-level factors. Universal background checks were associated with a 14.9% (95% CI, 5.2-23.6%) reduction in overall homicide rates, violent misdemeanor laws were associated with a 18.1% (95% CI, 8.1-27.1%) reduction in homicide, and "shall issue" laws were associated with a 9.0% (95% CI, 1.1-17.4%) increase in homicide. These laws were significantly associated only with firearm-related homicide rates, not non-firearm-related homicide rates. None of the other laws examined were consistently related to overall homicide or suicide rates. We found a relationship between the enactment of two types of state firearm laws and reductions in homicide over time. However, further research is necessary to determine whether these associations are causal ones.

Objective: The use of illicit drugs by adolescents is a widespread problem in Taiwan. The aim of this study was to identify risk and protective factors. Design: Web-based survey of high school students. Setting: Senior high schools and vocational high schools in northern Taiwan. Method: Survey data were collected from 15,754 students. Logistic regression analysis examined potential risk and protective factors in individual, family and peer/school domains for lifetime, past-year and past-month illicit drug use and the single and/or multiple use of ketamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and marijuana. Results: The prevalence rates of illicit drug use varied from 1.18% to 2.19% by frequency and type of illicit drug use. Perceived availability of illicit drugs, betel nut chewing, drug use by a family member, peer drug use, missing classes and type of school were significant risk factors in lifetime, past-year and past-month use. Sensation seeking, family member and peer drug use were common factors in ketamine, methamphetamine, MDMA and marijuana use. Drug use by a family member increased the risk of multiple drug use. Smoking was a risk factor for ketamine use. Drug-related knowledge was a protective factor. Conclusions: These findings support the idea that there exist multilevel risk and protective factors for drug use, especially in the family and peer/school domains. School-based interventions should be designed to integrate different levels of risk and protective factors.

To describe the blood alcohol concentration (BAC) of adolescent homicide victims in Johannesburg, South Africa and to identify the victim and event characteristics associated with a positive BAC at the time of death. Logistic regression of mortality data collected by the National Injury Mortality Surveillance System (NIMSS). Johannesburg, South Africa. A total of 323 adolescent (15-19 years) homicide victims for the period 2001-9 who had been tested for the presence of alcohol. Data on the victims' BAC level, demographics, weapon or method used, scene, day and time of death were drawn from NIMSS. Alcohol was present in 39.3% of the homicide victims. Of these, 88.2% had a BAC level equivalent to or in excess of the South African limit of 0.05 g/100 ml for intoxication. Multivariate logistic analysis showed that a positive BAC in homicide victims was associated significantly with the victim's sex [male: odds ratio (OR) = 2.127; 95% confidence interval (CI) = 1.012-4.471], victim's age (18-19 years: OR = 2.364; CI = 1.343-4.163); weapon used (sharp instruments: OR = 2.972; CI = 1.708-5.171); and time of death (weekend: OR = 3.149; CI = 1.842-5.383; night-time: OR = 2.175; CI = 1.243-3.804). Excessive alcohol consumption is associated with a substantial proportion of adolescent homicides in Johannesburg, South Africa, and is more prevalent among male and older adolescent victims and in victims killed with sharp instruments over the weekends and during the evenings.

The socioeconomic conditions of communities in which young South Africans live may be an important contributor to the high levels of violence in the country. Informed by social disorganization theory, this study examined the relationship between neighborhood sociostructural context and adolescent (15-19 years) homicide victimization in Johannesburg (2001-2009). The results revealed that neighborhood-concentrated disadvantage and measures of family structure were significantly related to levels of male and female adolescent homicide. The study underscores the importance of neighborhood structure in understanding adolescent homicide, particularly in Johannesburg, and can inform interventions that target high-risk communities.

Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates. To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence. Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population. Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity. Adolescent firearm homicide identified from police and medical examiner's reports. We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2-14.0) or drug use (AOR, 4.4; 95% CI, 1.7-11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8-48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1-9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1-10.3 vs AOR, 7.5; 95% CI, 2.2-25.8). Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities.

In February 1994, the Brady Handgun Violence Prevention Act established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales. The effects of this act have not been analyzed. To determine whether implementation of the Brady Act was associated with reductions in homicide and suicide rates. Analysis of vital statistics data in the United States for 1985 through 1997 from the National Center for Health Statistics. Total and firearm homicide and suicide rates per 100,000 adults (>/=21 years and >/=55 years) and proportion of homicides and suicides resulting from firearms were calculated by state and year. Controlling for population age, race, poverty and income levels, urban residence, and alcohol consumption, the 32 "treatment" states directly affected by the Brady Act requirements were compared with the 18 "control" states and the District of Columbia, which had equivalent legislation already in place. Changes in rates of homicide and suicide for treatment and control states were not significantly different, except for firearm suicides among persons aged 55 years or older (-0.92 per 100,000; 95% confidence interval [CI], -1.43 to -0.42). This reduction in suicides for persons aged 55 years or older was much stronger in states that had instituted both waiting periods and background checks (-1.03 per 100,000; 95% CI, -1.58 to -0.47) than in states that only changed background check requirements (-0.17 per 100,000; 95% CI, -1.09 to 0.75). Based on the assumption that the greatest reductions in fatal violence would be within states that were required to institute waiting periods and background checks, implementation of the Brady Act appears to have been associated with reductions in the firearm suicide rate for persons aged 55 years or older but not with reductions in homicide rates or overall suicide rates. However, the pattern of implementation of the Brady Act does not permit a reliable analysis of a potential effect of reductions in the flow of guns from treatment-state gun dealers into secondary markets. JAMA. 2000;284:585-591

Introduction: illicit drug use is a public health problem associated with high rates of school, work, and social disability. The population with the highest rate of increase in illicit drug use are adolescents, due to their age and biological immaturity. Studies in Latin America mainly identify personal, biological, psychological, and sociocultural risk factors for illicit drug use. Objective: to analyze the scientific evidence on the risk and protective factors of illicit drug use in adolescents in Latin America. Method: the literature search was carried out in: Web of Science, CINAHL, PubMed, MEDLINE, LILACS, SCIELO. Results: in the initial search, a total of 1181 reports were obtained. For the full text evaluation, 147 potentially relevant articles were retrieved, selecting a total of 17 publications that met the inclusion criteria. The findings were grouped into two thematic categories: 1) Risk factors: biological, family, individual, socio-environmental, psychological, and socio-educational; 2) Protection factors: family, religious, psychological and socio-environmental. Discussion and conclusions: the findings of the scope review reveal that there are numerous investigations on the various risk and protective factors of illicit drug use in school adolescents. In addition, it was confirmed that united families and religiosity are protective factors for illicit drug use.

BackgroundAlcohol and illicit drug use has been recognized as a growing problem among adolescents in Botswana. Little is known about factors affecting alcohol and drug use among Botswana’s secondary school students. To aid the design and implementation of effective public health interventions, we sought to determine the prevalence of alcohol and drug use in secondary school students in urban and peri-urban areas of Botswana, and to evaluate risk and protective factors for substance use.MethodsWe performed a 72-item cross-sectional survey of students in 17 public secondary schools in Gaborone, Lobatse, Molepolole and Mochudi, Botswana. The World Health Organization’s (WHO) Alcohol Use Disorder Identification Test (AUDIT) was used to define hazardous drinking behavior. Using Jessor’s Problem Behavior Theory (PBT) as our conceptual framework, we culturally-adapted items from previously validated tools to measure risk and protective factors for alcohol and drug use. Between-group differences of risk and protective factors were compared using univariate binomial and multinomial-ordinal logit analysis. Relative risks of alcohol and drug use by demographic, high risks and low protections were calculated. Multivariate ordinal-multinomial cumulative logit analysis, multivariate nominal-multinomial logit analysis, and binominal logit analysis were used to build models illustrating the relationship between risk and protective factors and student alcohol and illicit drug use. Clustered data was adjusted for in all analyses using Generalized Estimating Equations (GEE) methods.ResultsOf the 1936 students surveyed, 816 (42.1%) reported alcohol use, and 434 (22.4%) met criteria for hazardous alcohol use. Illicit drug use was reported by 324 students (16.7%), with motokwane (marijuana) being the most commonly used drug. Risk factors more strongly associated with alcohol and drug use were reported alcohol availability, individual and social vulnerability factors, and poor peer modeling. Individual and social controls protections appear to mitigate risk of student alcohol and drug use.ConclusionsAlcohol and illicit drug use is prevalent among secondary school students in Botswana. Our data suggest that interventions that reduce the availability of alcohol and drugs and that build greater support networks for adolescents may be most helpful in decreasing alcohol and drug use among secondary school students in Botswana.

Youth who experience difficulty in school are at risk for suicide, yet there is little published information specific to risk and protective factors among this group. The purpose of this study was to conduct an in-depth examination of risk and protective factors associated with suicidal behaviour among youth who were experiencing problems in school and to compare these factors between suicide risk and non-suicide risk subgroups. Participants were 730 high school students in the Northwest and Southwest regions of the United States, aged 14-21 years. All participants were known to be experiencing difficulty with grades and/or attendance. Students completed a paper-and-pencil questionnaire and a one-on-one interview, which assessed suicidal behaviours as well as risk factors (e.g. drug involvement, emotional distress, stress), and protective factors (e.g. self-esteem, coping, support). Analysis of covariance tests, controlling for age and sex, were conducted to examine differences between the suicide risk and non-suicide risk groups on each risk and protective factor. The suicide risk subgroup reported higher levels of all risk factors, except alcohol and marijuana use, and lower levels of protective factors. While the groups did not differ on frequency of alcohol or marijuana use, they did differ on other illicit drug use and consequences of alcohol and other illicit drug use. Recommendations for nurses practising in school settings are discussed.

Early risk and protective factors for problem gambling: A systematic review and meta-analysis of longitudinal studies

Relationships of State Alcohol Policy Environments With Homicides and Suicides

Illicit substance use has increased in Hispanics. Recent trends also warrant focus on prescription drug misuse, given its increased prevalence among college students. The aims of this study were to assess prescription drug misuse and illicit drug use in Hispanic students, as well as potential theoretically and empirically based risk and protective factors. Hispanic students (n = 435; 59% female) from a U.S. university located on the border with México completed a sociodemographic survey, licit, illicit, and prescription drug use frequency questionnaires, an attitudes and beliefs about prescription drugs survey, the Short Acculturation Scale for Hispanics, the Depression, Anxiety, and Stress Scales, the Collectivist Coping Styles Measure, and the Multidimensional Scale of Perceived Social Support. A hierarchical logistic regression assessed prescription drug misuse predictors including demographics, licit/illicit substance use, attitudes toward prescription drug use, acculturation, distress symptoms, coping style, perceived social support, and the interaction between distress symptoms and acculturation. A negative binomial regression assessed predictors of past 30-day illegal drug use (the same predictors as the previous model except illicit drug use). Results indicated that positive attitudes toward prescription drugs, higher anxiety, and lower depressive symptomatology increased the odds of prescription drug misuse. Past 30-day alcohol use, positive attitudes toward prescription drugs, and higher acculturation predicted past 30-day illicit drug use. Prescription drug misuse was differentially associated with distress symptoms, whereas the convergence model of acculturation was supported regarding illegal drug use. Inconsistent with hypotheses, protective factors were not significantly associated with substance use.

We sought to estimate the effect of Connecticut's implementation of a handgun permit-to-purchase law in October 1995 on subsequent homicides. Using the synthetic control method, we compared Connecticut's homicide rates after the law's implementation to rates we would have expected had the law not been implemented. To estimate the counterfactual, we used longitudinal data from a weighted combination of comparison states identified based on the ability of their prelaw homicide trends and covariates to predict prelaw homicide trends in Connecticut. We estimated that the law was associated with a 40% reduction in Connecticut's firearm homicide rates during the first 10 years that the law was in place. By contrast, there was no evidence for a reduction in nonfirearm homicides. Consistent with prior research, this study demonstrated that Connecticut's handgun permit-to-purchase law was associated with a subsequent reduction in homicide rates. As would be expected if the law drove the reduction, the policy's effects were only evident for homicides committed with firearms.

World report on violence and health: What it means for children and pediatricians