April 17, 2015

Over the years that I’ve been writing about health care through a nursing lens, I am always impressed, if not outright astounded, by the work being done to further public health. This month, the American Journal of Nursing has published my latest article, “A Cure for Gun Violence,” on a successful epidemiologic model for curbing urban violence.


In 2013 Gary Slutkin, the founder of Cure Violence, gave a TEDMED talk in which he describes how “clustering” works in the spread of disease—and of violence, especially shootings: “The greatest predictor of a case of violence is a preceding case of violence,” he said. In other words, a shooting can have the same effect on a community as any contagion, spreading by close personal contact.


Cure Violence works to interrupt retaliatory violence by training community members to intervene on violent situations, especially in the aftermath of a shooting. This process is powerfully depicted in The Interrupters, an award-wining documentary. After disrupting transmission, the work shifts focus to educating communities, with a goal of establishing new norms for interacting and resolving conflict.


Cure Violence has reduced the number of shootings and deaths from 41% to 73% in the seven Chicago neighborhoods where it was used. Other cities have shown similar successes.


For my AJN report I talked with nurses and others working with Aim4Peace, a Cure Violence affiliate in Kansas City, Missouri. That program’s director, Tracie McClendon-Cole, told me that although some may scoff at the idea of preventing and treating community violence as a contagious disease, they appreciate it when it’s explained to them. She said:

We look at violence disease-colonies the same way we look at cholera disease-colonies. It’s a scientific approach, not a moral one. We’re looking at the brain and behavior and how the disease of violence is transmitted, how it affects group function.

A study published this month in Pediatrics demonstrates the need for this kind of approach. Young people seen in an urban ER for assault-related injuries showed a much higher risk of becoming involved in subsequent violence. Carter and colleagues followed two groups for two years. All were young drug users: one group was seen in the ER for assault-related injuries and the other was not. The researchers found that 59% of the young people treated for assault were involved in firearm violence in some way in the following two-year period, almost all of them as victims—threatened, injured, or killed by guns. Nearly a third were aggressors, as well.


Preventing retaliatory violence is where hospitals can intervene, to profound effect. One recent study (abstract here) showed hospital violence-intervention programs to be effective in reducing rates of injury and reinjury, as well as costs. Those researchers recommend that such programs be implemented in all trauma centers. I’ve gathered some resources for health care providers and others who may want to look into starting such a program.


The National Network of Hospital-based Violence Intervention Programs consists of more than two dozen programs working “to stop the revolving door of violent injury in our hospitals.” The Web site features support materials for starting a hospital program.


Violence Is Preventable: A Best Practices Guide for Launching and Sustaining a Hospital-based Program to Break the Cycle of Violence, produced by Youth ALIVE!, encourages nurses and other clinicians to expand their patient advocacy to encompass policy advocacy.

Preventing Youth Violence: Opportunities for Action.
This 2014 report from the Centers for Disease Control and Prevention proposes that violence against children, teens, and young adults isn’t inevitable and recommends a strategy of collaboration among educators, public health professionals, religious organizations, law enforcement, and business owners.


Contagion of Violence: Workshop Summary. A 2012 Institute of Medicine Forum on Global Violence Prevention convened a workshop to explore the “epidemiology” of violence, including modes of transmission and strategies for interruption. The book is available for free download.


And check out this Cure Violence video that explains the model and shows Aim4Peace community workers in action.

Joy Jacobson is a CHMP senior fellow. Follow her on Twitter: @joyjaco