West Side Of Chicago Research Articles

Community Violence Exposure and Adolescent Pregnancy in Chicago.

This study examined the association between community violence exposure (CVE), sex without contraception, and adolescent pregnancy in Chicago. A self-administered, online survey was conducted among 15- to 19-year-old girls from the South and West sides of Chicago from October to March 2018. Participants were recruited via community organization partnerships and social media advertising. The survey included questions about CVE, sexual behaviors, and covariates that are known to contribute to sexual risk taking. CVE was measured via a validated index of seven questions that measured individual experiences with violence. Multivariable and logistic regression analyses were performed to examine the association between CVE, penile-vaginal intercourse without contraception, and ever being pregnant. The final sample included 644 girls. Levels of CVE were high: 62.87% of girls reported that a close friend or relative died because of violence and 41.60% were a victim of violence. Nearly half (48.69%) of girls had penile-vaginal intercourse and 6.01% had been pregnant. For each standard deviation increase in CVE score, the odds of penile-vaginal intercourse without contraception (odds ratio [OR] = 1.69, 95% confidence interval [CI] = [1.27, 2.25]) and the odds of ever being pregnant (OR = 1.87, 95% CI = [1.36, 2.57]) increased. These results remained significant when adjusting for demographic, psychosocial, institutional, and interpersonal factors. Findings suggest that girls in Chicago who are exposed to higher levels of community violence have an increased likelihood of experiencing penile-vaginal intercourse without contraception and teenage pregnancy, even when adjusting for other predictors to teenage pregnancy.

Management effects on plant community and functional assemblages in Chicago’s vacant lots

AbstractQuestionWe ask whether 11‐year mowing patterns and presence of fencing influence plant community diversity and functional assemblage in urban vacant lots.LocationThis study took place in 34 vacant lots on the south and west sides of Chicago, IL, USA. Urban vacant lots are an excellent study system in which to investigate the effects of management in cities: they are ubiquitous in many cities and they experience a range of management, particularly mowing and fencing.MethodsWe used municipal data to classify infrequent and intensive mowing regimes and assessed presence or absence of fencing in situ. In our sites, these management strategies are independent. We used individual permutational analysis of variance (PERMANOVA) models to assess the effects of these management strategies on plant community composition. We then assessed species richness of plants with various traits using six individual two‐way ANOVA models with interaction terms. Our predictor variables included management strategies (mowing intensity and fencing) and three plant traits (growth form [graminoid, forb, or woody], life duration (annual, biennial, or perennial), and biogeographic origin [native or introduced]).ResultsWe found 120 plant species in the vacant lots. Most of these species were perennial, introduced forbs. We found no discernable effects of mowing intensity on plant community composition or richness of plants in the three functional groups. However, when we compared the species found along fences to those in lot interiors, we found significantly different plant communities. Fence line communities had significantly more native and woody species than lot interiors.ConclusionsPlant communities differ at very fine spatial scales within an individual vacant lot, and this pattern is related to the presence of fences. Overall, vacant lots support diverse plant communities which can differentially contribute to wildlife habitat depending on management strategy.

HIV stigma reduction and health literacy education program with a cross-generational populaton in an African American faith-based church

The aim of this study was to implement a HIV stigma reduction/health literacy educational program to investigate HIV stigma reduction and HIV knowledge and health literacy expansion within a cross-generational African American faith center on the west side of Chicago. The study included a community-based mixed method design, enveloped with elements of “stigma reduction, intergroup contact and religious social capital” theories, analyzed a sample size of fourteen (N = 14) faith center participants’ pre- and post-assessment scores and their direct quotes gathered from focused observations. The study presented significant difference found in HIV knowledge (p = .007), and (HIV) health literacy (p = .041). Additionally, significant difference was found in four out of fifteen HIV stereotypes subscales scores on the Stereotype About AIDS Questionnaire. The study suggests that HIV stigma has potentiality to reduce within the African American faith center population contrary to previous studies where HIV stigma reduction was not evident. The intervention model provided a protocol for partnership development between this faith center and the local community hospital infectious disease program to address HIV stigma, HIV knowledge and health literacy (HIV health literacy).

Promoting Safe Firearm Storage in an Urban Neighborhood: The Views of Parents Concerning the Role of Health Care Providers.

Pediatric clinics are uniquely positioned to assess and advocate for the health and safety of Chicago's children in relation to accidental firearm-related injury and death. The best means of counseling families should be tailored to the individual community and patient population. We aimed to determine rates of firearm ownership and attitudes towards counseling about firearms in a community on the west side of Chicago with high rates of gun violence. An anonymous survey about gun ownership was administered at a federally qualified health center. The survey was completed by 206 adults with children less than 18 living in the home. A minority of participants (8.3%; n = 17) indicated that a gun was kept in or around the home. The majority of firearm owners reported using safe storage practices. However, just over half of the gun owners and non-gun owners had a favorable opinion of counseling about firearm safety in healthcare settings. Other strategies in addition to physician counseling will be required to promote safe firearm storage in this neighborhood with high rates of community violence.

Partnering with Churches to Conduct a Wide-Scale Health Screening of an Urban, Segregated Community.

West Side Alive (WSA) is a partnership among pastors, church members and health researchers with the goal of improving health in the churches and surrounding community in the West Side of Chicago, a highly segregated African American area of Chicago with high rates of premature mortality and social disadvantage. To inform health intervention development, WSA conducted a series of health screenings that took place in seven partner churches. Key measures included social determinants of health and healthcare access, depression and PTSD screeners, and measurement of cardiometabolic risk factors, including blood pressure, weight, cholesterol and hemoglobin A1C (A1C). A total of 1106 adults were screened, consisting of WSA church members (n = 687), members of the local community served by the church (n = 339) and 80 individuals with unknown church status. Mean age was 52.8years, 57% were female, and 67% reported at least one social risk factor (e.g. food insecurity). Almost all participants had at least one cardiovascular risk factor (92%), including 50% with obesity, 79% with elevated blood pressure and 65% with elevated A1C. A third of participants experienced ≥ 4 potentially traumatic events and 26% screened positive for depression and/or post-traumatic stress disorder. Participants were given personalized health reports and referred to services as needed. Information from the screenings will be used to inform the design of interventions targeting the West Side community and delivered in partnership with the churches. Sharing these results helped mobilize community members to improve their own health and the health of their community.

Sleep-related attitudes, beliefs, and practices among an urban-dwelling African American community: a qualitative study

ObjectivesShort sleep duration and poor sleep quality are more prevalent among African Americans (AAs) and may be a modifiable risk factor for cardiometabolic disorders. However, research is limited about sleep-related attitudes, beliefs, and practices among AAs. Our objective was to evaluate these practices and beliefs surrounding sleep among urban-dwelling AAs. DesignQualitative study comprised of five 90-minute focus groups using a semistructured interview guide. SettingFive churches located on the west side of Chicago. ParticipantsAdults (N = 43) ages 25-75 years. MeasurementsTranscripts were voice recorded, transcribed, and then coded for content analysis using NVivo 12 Pro to capture themes in the discussions. ResultsMost participants (86%) reported sleeping less than the recommended 7 or more hours. The discrepancy between actual and desired sleep duration was nearly 3 hours per night. Participants reported that sleep is essential for mental and physical health. Napping and consuming caffeine were frequently reported techniques for coping with lack of sleep. Noise, physical discomfort, and stress were reported as barriers to sleep, and participants reported using TV and other electronics to cope with racing thoughts or worry. Many participants were diagnosed with or knew someone with obstructive sleep apnea, but few participants had been diagnosed with insomnia or were aware of nonpharmacologic insomnia treatments. ConclusionA cycle of stress/disruptive environment, stress, rumination at night, and coping by use of electronics and daytime napping may perpetuate sleep disparities in this community. Results suggest that sleep-related interventions should include stress reduction and environmental improvements in addition to the typical sleep hygiene–related behavioral recommendations.

Sustaining affective resonance: Co‐constructing care in a school‐based digital design studio

AbstractBased on two years of ethnographic engagement in a school‐based digital design studio in a high school on the West Side of Chicago, Illinois, this paper conceptualizes the development and maintenance of an ethos of care in teaching and learning through sustaining affective resonance. Adopting musical metaphors as a vocabulary for affective movements, we operationalize practical and practiced methods for sustaining (actively extending) affective (care‐giving and care‐taking intensities) resonance (shared meaning making and cultural production). Sharing examples across years, we show the specific ways that mentors and students in the digital design studio built and nurtured care‐full practices. The purpose of the paper is to explicate the development and enactment of mentoring practices that we observed in the design studio and then to consider how these practices might be shared, spread, and adapted across contexts of teaching and learning.

Leveraging an Implementation Science Framework to Adapt and Scale a Patient Navigator Intervention to Improve Mammography Screening Outreach in a New Community.

Helping Her Live (HHL) is a community health worker-led outreach model that navigates women from vulnerable communities to mammography screening and diagnostic follow-up. The objective of this study was to evaluate HHL implementation on the southwest side of Chicago. HHL has been implemented on the west side of Chicago since 2008, where it has increased mammogram completion and diagnostic follow-up rates among Black and Hispanic women from resource poor communities. In 2014, HHL was translated to the southwest side of Chicago; implementation success was evaluated by comparing outreach, navigation request, and mammogram completion metrics with the west side. During January 2014-December 2015, outreach was less extensive in the southwest setting (SW) compared to the benchmark west setting (W); however, the proportion of women who completed mammograms in SW was 50%, which compared favorably to the proportion observed in the benchmark setting W (42%). The distribution of insurance status and the racial and ethnic makeup of individuals met on outreach in the W and SW were significantly different (p < 0.0005). This successful expansion of HHL in terms of both geographic and demographic reach justifies further studies leveraging these results and tailoring HHL to additional underserved communities.

Mapping Child Safety Seat Use in Cases of Fatal or Incapacitating Child Motor Vehicle Injury in Cook County, Illinois from 2011 to 2015.

Child safety seat use reduces the risk of fatal injury by 71% for infants and 54% for toddlers, yet more than one-third of child passengers killed in traffic crashes in the US are unrestrained. Nearly half (47%) of crash injuries occur within 5 miles of the injured person's home. Mapping the location of motor vehicle crashes resulting in serious or fatal injury to unrestrained child passengers may pinpoint high-risk neighborhoods. Illinois Department of Transportation data were used to map crashes that resulted in a fatal or incapacitating injury to a child passenger (age 0 to 8) in Cook County, IL from 2011 to 2015. Maptitude® Geographic Information System (GIS) software was used to identify hot spots of unrestrained child passenger injury on the South Side and West Side of Chicago. Of 174 zip codes in Cook County, 3 zip codes on the South Side of Chicago (60620, 60621; 60628) accounted for 11% of the total unrestrained fatalities and incapacitating injuries among children. Results of this study reveal the feasibility of detecting geographic disparities in child passenger safety at the zip code and neighborhood level and indicate the potential for more targeted allocation of resources.

Understanding violence and developing resilience with African American youth in high-poverty, high-crime communities

The scourge of community violence that besets young citizens in high-poverty U.S. communities of color is a compelling social problem to address. This article synthesizes studies of causes and preventive services for youth violence, including randomized controlled experiments and theoretical, case study contributions. Available evidence indicates that causes of youth violence are complex and interact across multiple layers of social systems. Accordingly, single-factor programs and policies developed for other populations tend to be ineffective for addressing the many injustices with which youth in high-poverty, high-crime communities of color contend. Therefore, we develop a perspective that is developmental, multi-systemic, and restorative of youths' dignity. Responding to researchers' calls for more contextually-grounded case studies of causes and remedies for youth violence, this article focuses on Chicago, where street violence rates in some communities are among the highest in the world and have increased in the last several years.First, we describe the intersectionalities of catalysts of violence, such as institutional racism, police brutality, deficits in child protection, and deep poverty, in a developmental systems-based framework. Next, we frame community service principles with population-specific features, recognizing cultural and community strengths and youths' significant resilience and potential. Drawing from Afrocentric social thought, positive youth development, trauma treatment models, cognitive behavioral, and empowerment approaches, we describe intervention principles for community-based services. Examples are drawn from decades of work with Chicago's impoverished African American youth on the violence-beset south and west sides of Chicago.

Nonfatal Firearm Violence Trends on the Westside of Chicago Between 2005 and 2016

This paper examines the epidemiology of nonfatal firearm violence (NFFV) on the Westside of Chicago over three finite time periods: 2005–2008, 2009–2012, and 2013–2016. The trend analysis will look at any significant changes over the time periods and describe the demographic characteristics of NFFV. A descriptive analysis of Mount Sinai Hospital (MSH) Emergency Department (ED) data was conducted. NFFV patients were identified by specific firearm ICD-9 primary eCode injury categories: accident, assault, legal intervention, undetermined intent, suicide or self-inflicted injury, and legal intervention. The Pearson Chi-square test was conducted to statistically compare the categorical frequencies of the Chicago metropolitan region of injury, cause of firearm related injury, and place of injury by time period. There were a total of 3962 nonfatal hospitalizations at MSH between the three time periods due to gun violence related injuries. Overall, nonfatal hospitalizations were most frequent for those between age groups 16–24 (52.5%). The number of nonfatal hospitalizations decreased with increasing age for the age groups 35–44 (9.7%), 45–54 (3.2%), and > 54 (1.2%). There were significantly more nonfatal hospitalizations in males (n = 3649) than females (n = 312) across the three time periods. However, there was a 74.7% increase in female nonfatal hospitalizations from 2009–2012 to 2013–2016. There were significant racial differences in nonfatal hospitalizations between the three time periods. NFFV continues to be problem on the Westside of Chicago, particularly for young, Black men. The incidence of gun violence however has not changed significantly between 2005 and 2016.

Youth as Engaged Cultural Workers: Benito Juarez High School and the Legacy of Student Uprisings on the Lower West Side of Chicago

Abstract Between 1968–1974, Black and Latinx youth on the Lower West Side of Chicago led walkouts citywide to protest racist policies and terrible school conditions, and one of the legacies of student and community activism is the founding of Benito Juarez Neighborhood Academy High School in Chicago’s Pilsen neighborhood. Art educators Nicole Marroquin and Paulina Camacho collaborated on a critical action research project with Benito Juarez High School students for 4 years. Together they explored this complex and unwritten history of the Froebel and Harrison High School uprisings, and groups of students used documentary photographs, newspaper accounts, and firsthand reports to develop artwork, performance, and public interventions in the neighborhood. They examined the role of youth in protecting and enriching our democracy, analyzed how we can recuperate culturally affirming histories that support creative responses to the discriminatory policies in our schools, and discussed how schools can continue to be sites of youth liberation and empowerment.

562. Management and Outcomes of Patients With Acute HIV Infection in an Expanded Testing and Linkage to Care Program

BackgroundPersons with acute HIV infection have high viral loads and are highly infectious compared with those with chronic infection. Rapid linkage to care and initiation of therapy, facilitated by new testing algorithms, allows for immunologic preservation and rapid virologic control, which benefits the individual and decreases transmission events.MethodsWe analyzed testing data (2016–2017) from the xTLC Program, a collaborative effort between 13 healthcare centers on the South and West sides of Chicago. For acute HIV infections, we assessed linkage to care, initiation of antiretroviral therapy (ART) and viral suppression across sites.ResultsOf 334 new HIV diagnoses in xTLC, 33 (9.9%) had acute infection across six sites (five acute care hospitals/emergency departments, one clinic). Baseline viral load (VL) was 2.19 million copies/mL (IQR 0.47–5.00) and baseline CD4 count was 440.5/µL (IQR 287.5–568.5). Table 1 shows care continuum outcomes for patients with acute HIV infection.Table 1: Care Continuum Outcomes for Acute HIV Infections Diagnosed Through X-TLC Site (N) Days to Linkage* (IQR) Days to ART* (IQR) Days to ≥2 Log Reduction in VL* (IQR) Days to VL ≤ 200* (IQR) Retained in Care** (%) Virally Suppressed (%)A (1)27 (27–27)9 (9–9)55 (55–55)55 (55–55)1 (100.0)1 (100.0)B (6)11 (6–58)21.5 (7–58)48 (34–62)132.5 (48–321)4 (66.7)4 (100.0)C (2)39 (39–39)53 (53–53)95 (95–95)162 (162–162)1 (50.0)1 (100.0)D (4)3.5 (1.5–4.5)4 (3–6)31 (29–33)31 (29–33)3 (75.0)3 (100.0)E (14)8.5 (4–18)5.5 (4–21)55 (47–131)124 (55–162)10 (71.4)10 (100.0)F (6)14 (13–21)25.5 (23–34)92.5 (62–471)329.5 (186–643)4 (66.7)4 (100.0)Total (33)11 (5–19.5)15 (5–27)58.5 (42–117)131 (54–188)23 (69.7)23 (100.0)*Median.**Currently in care.ConclusionPatients with acute HIV infection can be successfully managed in existing programs for HIV screening and linkage to care. The xTLC program had a high linkage to care rate, timely initiation of ART, and relatively quick reduction in viral loads. Our outcomes approach those seen for intensive immediate therapy programs, but without additional costs beyond those of the xTLC program. This will likely create similar public health benefits as dedicated programs for rapid initiation of therapy.Disclosures B. Hunt, Gilead: supported by Gilead FOCUS grant, Salary. A. Tobin, Gilead: supported by Gilead FOCUS grant, Salary. A. B. Maheswaran, Gilead: supported by Gilead FOCUS grant, Salary. J. Lin, Gilead: Grant Investigator, Grant recipient. R. Novak, Gilead: Scientific Advisor, Consulting fee. Viiv: Scientific Advisor, Consulting fee. Theratech: Scientific Advisor, Consulting fee. B. Sha, Gilead Sciences: Grant Investigator and Investigator, Grant recipient and Research grant. Viiv Healthcare: Investigator, Research grant. D. Pitrak, Gilead: Grant Investigator, Grant recipient and Research grant. N. Glick, Gilead: Grant Investigator and Scientific Advisor, Grant recipient

Gender Differences in HIV Testing, Diagnosis, and Linkage to Care in Healthcare Settings: Identifying African American Women with HIV in Chicago

Women account for 25% of all people living with HIV and 19% of new diagnoses in the United States. African American (AA) women are disproportionately affected. Yet, differences in the care continuum entry are not well understood between patient populations and healthcare sites. We aim to examine gender differences in diagnosis and linkage to care (LTC) in the Expanded HIV Testing and Linkage to Care (X-TLC) program within healthcare settings. Data were collected from 14 sites on the South and West sides of Chicago. Multivariate logistic regression analysis was used to determine the differences in HIV diagnoses and LTC by gender and HIV status. From 2011 to 2016, X-TLC performed 281,017 HIV tests; 63.7% of those tested were women. Overall HIV seroprevalence was 0.57%, and nearly one third (29.4%) of HIV-positive patients identified were cisgender women. Of newly diagnosed HIV-positive women, 89% were AA. 58.5% of new diagnoses in women were made at acute care hospitals, with the remainder at community health centers. Women who were newly diagnosed had a higher baseline CD4 count at diagnosis compared with men. Overall, women had lower odds of LTC compared with men (adjusted odds ratio = 0.58, 95% confidence interval 0.44-0.78) when controlling for patient demographics and newly versus previously diagnosed HIV status. Thus, interventions that focus on optimizing entry into the care continuum for AA women need to be explored.

A Nurse-Led Intervention to Address Food Insecurity in Chicago

Food insecurity is a social issue that is becoming more common across the nation. Individuals identified as food insecure may not have enough food in quantity and/or quality, and they may likely have limited access to obtain the food they need. Food insecurity is one social determinant of health, or a social condition that impacts a person’s good health. This article offers a brief overview of food insecurity and describes The Rush Surplus Project, developed in 2015 by concerned nurses within the Rush healthcare system to address the issue of food insecurity in surrounding communities on the west side of Chicago, Illinois. This project decreases hospital food waste by donating food to local shelters for redistribution to individuals in need. The authors offer implications for nursing and health systems concerned with food insecurity and conclude with a summary detailing next steps in progress at Rush University Medical Center.

Identifying African American Women with HIV Infection in an Expanded HIV testing and Linkage to Care (X-TLC) Program in Healthcare Settings on the South and West Sides of Chicago.

BackgroundWomen account for 25 % of HIV infections nationally, and African American (AA) women are disproportionately affected. We report important gender differences observed in an expanded HIV testing and linkage to care (X-TLC) program conducted on the South and West Sides of Chicago.MethodsX-TLC is funded by CDPH with CDC prevention B funds. X-TLC has expanded from 3 sites to 14 sites, including acute care hospitals (academic, community), community health centers (CHCs), and family planning clinics. We report descriptive stats, group comparisons by Chi-square, and multivariate analyses adjusted for demographics.ResultsSince 2011, X-TLC has conducted 308,038 HIV screens, and 63.7 % of those tested were women. Overall seroprevalence for HIV was 0.56 %, and 30.5 % of HIV patients identified were cis-gender women (seroprevalence 0.15 %). The seroprevalence for women testing in EDs was higher (0.44 %). Similar to men, only 52.9 % of HIV positive women were new diagnoses. Women accounted for 28.5 % of all new diagnoses, compared with 15.4 % for Chicago overall. In 2016 X-TLC screened 91,865 persons for HIV, and 65.2 % of those tested were women. There were 193 new diagnosis and 32.1 % (62) were women, 85.7 % AA. In comparison, in 2015 there were 139 women with a new HIV diagnosis for all of Chicago. Women newly diagnosed were less likely to be linked to care (adjusted odds ratio, aOR, 0.54, 0.35–0.85). Linkage was lower for women diagnosed at CHCs (84.6 % vs. 76.3 %, P = 0.02). Most CHCs did not have on site HIV providers. At our site, however, women linked to care were more likely to be retained in care (aOR 0.58, 0.43–0.78). We also conduct targeted outreach testing, partner services (PS) testing, and social network strategy (SNS) testing, but women are not identified by these programs (16/171 tested women, 8 new diagnoses were men for PS; 507 tested, 471 men and 36 trans-gender women, 38 new positives, 0 cis-gender women for SNS).ConclusionMore women than men were offered and/or accept HIV screening in healthcare settings. The proportion of seropositive women identified was higher than the national average. X-TLC is reaching a large proportional of AA women with HIV unaware of their status. Other testing strategies will rarely identify cis-gender women with HIV infection. Gender differences in linkage to and retention in care will require strategies targeted at women.Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; N. Glick, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient

Some lessons learned about teaching, research, and academic disputation

In teaching I learned the importance of student assent to learn, and the power of students to withhold that assent. In research I learned the importance of being open to surprises and changes of mind, looking closely at all your evidence and not sweeping any of it under the rug. In academic disputation I learned about tribal isolation and siloing across disciplines in the field of education, and the difficult but important matter of trying to avoid “othering” those with whom you disagree. I also learned a great deal from my early experience in Lawndale [on Chicago's West Side], recognizing over time that in trying to help kids and adults there I had received much more from them than I gave. [Download the PDF and read more]

A Principal’s Perspective

Based on my experiences as a teacher, administrator, and now principal of North Lawndale College Prep Charter School, this article describes how our school nurtures students and prepares them to succeed not only in high school but also in college, despite the challenges that they face as young people in the inner city. Located on the West Side of Chicago, Illinois, the mission of North Lawndale is clear: “To prepare young people from under-resourced communities for graduation from high school with the academic skills and personal resilience necessary for successful completion of college.”

“I’m Known”: Building Relationships and Helping Students Construct Counternarratives on the West Side of Chicago

In discussing the intersection of education and poverty, we often lose sight of what it is actually like to teach or study in an urban school. What drives our most disadvantaged students? How can teachers measure success when schools lack the resources necessary to make lasting change in the community? From the perspective of an English teacher at a public charter high school in Chicago, I explore what it means to be a student and an educator in one of the most racially segregated and violent urban communities in the country. I argue that students’ identities must be understood and affirmed before learning can occur. Educators who love students unconditionally and establish trust can help them to construct counternarratives about themselves and their communities to help them succeed in school. The neglect, violence, and social isolation experienced by children in many high poverty neighborhoods in Chicago pose a unique challenge for educators. Schools lack adequate resources to help the majority of their students succeed academically. Given the inequitable distribution of resources among schools in a state like Illinois, some teachers must find alternative paths to show students that they have value and can use their education to empower themselves.

Undertriage of Firearm-Related Injuries in a Major Metropolitan Area

National anatomic triage criteria prescribe specific transport rules for injured patients. However, there is limited information about patients with firearm-related injuries undertriaged to nondesignated facilities (ie, hospitals without specialized trauma teams or units), including what clinical outcomes are achieved and how many are transferred to a higher level of care. Without these data, it is difficult to make informed regional or national policy decisions about triage practices. Undertriage of firearm-related injuries is a good model for evaluating the undertriage of patients with trauma because the anatomic triage criteria for patients with firearm-related injuries are simple. To evaluate the prevalence, spatial distribution, and clinical outcomes of undertriage of firearm-related injuries. This study is a retrospective analysis of firearm-related injuries in residents of Cook County, Illinois, from January 1, 2009, to December 31, 2013. Outpatient and inpatient hospital databases were used. Participants included patients with International Classification of Diseases, Ninth Revision, Clinical Modification firearm-related cause-of-injury codes. Data were collected all at once in August 2014. Data analysis took place from March 12, 2015, to February 1, 2016. Undertriaged cases were defined as patients who met the national anatomic triage criteria for transfer to higher-level trauma center care. Spatial distribution, injury severity, and clinical outcomes, including death, were analyzed. Of the 9886 patients included in this analysis, 8955 (90.6%) were male, 7474 (75.6%) were African American, and 5376 (54.4%) were aged 15 to 24 years.In Cook County, Illinois, where there are 19 trauma centers, 2842 of 9886 (28.7%) firearm-related injuries were initially treated in nondesignated facilities. Among the 4934 cases with firearm-related injury who met the anatomic triage criteria, 884 (17.9%) received initial treatment at a nondesignated facility and only 92 (10.4%) were transferred to a designated trauma center. Significant spatial clustering was identified on the west side of Chicago and in the southern parts of Chicago and Cook County. In the multivariable models, patients treated in nondesignated facilities were less likely to die than were patients treated in designated trauma centers. Undertriage of firearm-related injuries was much more prevalent than expected. Although the likelihood of dying during hospitalization was greater among patients treated in designated trauma centers, these patients were substantially in worse condition across all measures of injury severity. A smaller proportion of patients treated in designated trauma centers died during the first 24 hours of hospitalization. This study highlights the need for better regional coordination, especially with interhospital transfers, as well as the importance of assessing the distribution of emergency medical services resources to make the trauma care system more effective and equitable.