Preventing Retaliatory Gun Violence in Violently Injured Adults: A RCT of a Hospital-Based Intervention

摘要 在美国，与枪支有关的暴力已经达到流行的程度，并成为一种主要的公众 健康问题。为了帮助防止与枪支有关的高死亡率，大多数暴力干预方案 以年轻人(18岁)为目标，希望减缓成年初期暴力的迅速增加。 然而，大多数与枪支有关的暴力行为的受害者是成年人(18岁)，国家统计数据显示年轻人 尤其是成年人(18-35岁)最有可能死于与枪支有关的暴力。重要的是要 认识到这种风险并不是在成人亚群中平均分担，而是年轻的非裔美国人 来自经济困难社区的男性，他们接触暴力的比率很高， 最容易受到与枪支有关的暴力的人。不幸的是，他们很难参与以社区为基础的活动 干预努力。然而，最近，以医院为基础的暴力干预方案已经成为 越来越受欢迎，因为它们成功地吸引了遭受暴力伤害的人。猛烈地 受伤的成年人不仅是目前的受害者，40%的人将被暴力再次伤害，20%的人将在 5年；这些患者实施报复性暴力的可能性也高出88倍(Cunningham等人，2009年)。它 很明显，这些成年人迫切需要有效的暴力干预。在弗吉尼亚联邦大学 (VCU)健康，我们已经开发了弥合差距(BTG)，这是一种很有前途的暴力干预策略， 包括以医院为基础的暴力干预、枪支咨询计划和为期6个月的社区案例 对暴力受害者的管理。BTG最初是为遭受暴力伤害的年轻人开发的，结果表明 它对减少青少年暴力是有效的。然而，它是否有效地减少了枪支--还有待确定。 与成人相关的暴力。BTG是否是减少枪支的成本效益战略也有待确定。 相关的暴力和伤害。本研究涉及这项筹资公告的目标二； 严格评估创新和前景看好的战略的有效性，以确保个人安全免受枪支- 相关的伤害、死亡和犯罪。这项研究提案属于资助备选方案B；该方案支持研究 收集新数据的项目。本研究的目的是用随机对照的方法评估BTG的疗效。 对616名成年暴力受害者进行为期一年的大样本对照试验设计。药效将 使用与枪支有关的暴力的多种数据来源进行评估(例如，刑事逮捕记录、自我报告、 对未被定罪的与枪支有关的暴力行为的半结构化临床评估)和与枪支有关的再伤害和 死亡率(例如，医院记录)。为了提高我们对BTG对枪支相关的影响的理解 对于暴力，我们将测试是否有心理社会调解人将BTG与减少与枪支有关的暴力联系起来。我们也 目的了解哪些心理社会脆弱性可能会削弱BTG对与枪支有关的暴力的影响。 最后，成本效益分析将确定实施BTG的经济效益。总而言之，结果 这项研究可能支持将BTG用作与枪支有关的暴力干预措施，以帮助成年暴力受害者。

Abstract In the United States, firearm-related violence has reached epidemic proportions and has become a major public health problem. To help prevent the high rates of firearm-related deaths, most violence intervention programs have targeted youth (<18 years old) in the hope to slow the rapid increase of violence seen in early adulthood. However, most victims of firearm-related violence are adults (>18 years old), and national statistics show young adults (18-35 years) in particular are the most likely to die from firearm-related violence. It is important to recognize that this risk is not evenly shared among subpopulations of adults, and it is young African American men who come from economically disadvantaged communities with high rates of exposure to violence that are the most vulnerable to firearm-related violence. Unfortunately, they are difficult to engage in community-based intervention efforts. More recently, however, hospital-based violence intervention programs have become increasingly popular because of their success at engaging individuals who have suffered a violent injury. Violently injured adults are not only victims in the present, but 40% will be violently re-injured and 20% will be killed within 5 years; these patients are also 88 times more likely to commit retaliatory violence (Cunningham et al., 2009). It is clear that these adults are in dire need of effective violence intervention. At Virginia Commonwealth University (VCU) Health, we have developed Bridging the Gap (BTG), a promising violence intervention strategy that includes a hospital-based violence intervention, a firearm counseling program, and 6-months of community case management to victims of violence. BTG was originally developed for violently injured youth and results indicate it is effective for reducing youth violence. However, it is yet to be established if it is effective for reducing firearm- related violence in adults. It is also yet to be established if BTG is a cost effective strategy for reducing firearm- related violence and injury. The present study addresses Objective Two of this funding announcement; to rigorously evaluate the effectiveness of innovative and promising strategies to keep individuals safe from firearm- related injuries, deaths, and crime. This research proposal falls under Funding Option B; which supports research projects that collect new data. The goal of the present study is to assess the efficacy of BTG using a randomized control trial design in a large sample of 616 adult victims of violence over a 1-year follow-up period. Efficacy will be assessed using multiple sources of data for firearm-related violence (e.g., criminal arrest records, self-report, semi-structured clinical assessment of non-convicted firearm-related violence) and firearm-related re-injury and mortality (e.g., hospital records). To improve our understanding of the impact BTG has on firearm-related violence, we will test for psychosocial mediators linking BTG to reductions in firearm-related violence. We also aim to understand what psychosocial vulnerabilities may weaken the impact of BTG on firearm-related violence. Lastly, a cost-benefit analysis will determine the economic benefits of implementing BTG. Collectively, results from this study may support the use of BTG as a firearm-related violence intervention for adult victims of violence.