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达到流行病的程度，并已成为一个主要的公共 健康问题。为了帮助防止高比率的枪支相关死亡，大多数暴力干预计划 针对青少年（<18岁），希望减缓成年早期暴力的迅速增加。 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， 尤其是成年人（18-35岁）最有可能死于与火器有关的暴力。重要的是要 认识到这种风险在成年人的亚群中并不均匀， 来自经济上处于不利地位的社区的男子，他们很容易遭受暴力， 最容易受到枪支暴力的伤害。不幸的是，他们很难从事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计划已经成为 越来越受欢迎，因为他们成功地吸引了遭受暴力伤害的人。剧烈 受伤的成年人不仅是现在的受害者，而且40%的人会被暴力再次伤害，20%的人会在短期内死亡。 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）的报告。它 很明显，这些成年人迫切需要有效的暴力干预。弗吉尼亚联邦大学 (VCU)在卫生方面，我们制定了“弥合差距”，这是一项有前途的暴力干预战略， 包括基于医院的暴力干预，枪支咨询计划和6个月的社区案例 对暴力受害者的管理。BTG最初是为暴力受伤的年轻人开发的，结果表明， 这对减少青少年暴力是有效的。但是，它是否能有效地减少枪支，还有待确定。 与成人有关的暴力。BTG是否是一种具有成本效益的减少枪支的战略，这一点也有待确定。 相关的暴力和伤害。本研究涉及本资助公告的目标二; 严格评估创新和有前途的战略的有效性，以使个人免受枪支的伤害， 相关的伤亡和犯罪。本研究建议福尔斯属于资助方案B;资助研究 收集新数据的项目。本研究的目的是使用随机对照试验评估BTG的疗效。 对照试验设计在一个大样本的616名成年暴力受害者超过1年的随访期。功效将 使用多个与枪支有关的暴力数据来源进行评估（例如，刑事逮捕记录自我报告 对未定罪的枪支相关暴力的半结构化临床评估）和枪支相关再伤害， 死亡率（例如，医院记录）。为了更好地了解BTG对枪支相关的影响， 我们将测试将BTG与枪支相关暴力减少联系起来的心理社会中介。我们也 旨在了解哪些心理社会脆弱性可能会削弱BTG对枪支相关暴力的影响。 最后，成本效益分析将确定实施BTG的经济效益。总体而言，成果 这项研究可能支持使用BTG作为暴力成年受害者的枪支相关暴力干预。

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.