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A Lethality Assessment Program in the Emergency Department: Program Implementation and Evaluation
Despite routine screening for intimate partner violence and validated screening tools for lethality, intimate partner violence assessment and linkage to services remain inconsistent in health care settings. This program aimed to implement and evaluate a lethality assessment program, a nurse-led screening and prevention program for intimate partner violence homicide in an emergency department that partnered with a local community agency.
A single group pre−post design was used to evaluate changes in knowledge of intimate partner violence and the lethality assessment program protocol and confidence in implementing the protocol among 143 registered nurses in the emergency department. Program outcomes were assessed during a 4-month post-implementation period. Focus group interviews were conducted and analyzed to identify barriers and facilitators of implementation.
Significant improvements in the nurses’ knowledge and confidence in implementing the protocol (all P< .001) were observed. Fourteen lethality screens were completed during the 4 months, with 13 indicating high intimate partner violence homicide danger. Eight victims received 20 services (1-5/person) from the local community organization: emergency shelter, safety planning, legal aid, and domestic violence protection order. Barriers to implementation included time, privacy, training, and access to screening forms. Facilitators included champions, resources to allow for implementation, and prompts.
The lethality assessment program is a feasible protocol in a health care setting to increase intimate partner violence awareness, link high-risk intimate partner violence victims to needed services in real time, and potentially reduce intimate partner violence homicides. Programs like this are essential to address this public health concern.
Journal Article
What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries?
Firearms account for a substantial proportion of external causes of death, injury, and
disability across the world. Legislation to regulate firearms has often been passed with
the intent of reducing problems related to their use. However, lack of clarity around
which interventions are effective remains a major challenge for policy development. Aiming
to meet this challenge, we systematically reviewed studies exploring the associations
between firearm-related laws and firearm homicides, suicides, and unintentional
injuries/deaths. We restricted our search to studies published from 1950 to 2014. Evidence
from 130 studies in 10 countries suggests that in certain nations the simultaneous
implementation of laws targeting multiple firearms restrictions is associated with
reductions in firearm deaths. Laws restricting the purchase of (e.g., background checks)
and access to (e.g., safer storage) firearms are also associated with lower rates of
intimate partner homicides and firearm unintentional deaths in children, respectively.
Limitations of studies include challenges inherent to their ecological design, their
execution, and the lack of robustness of findings to model specifications. High quality
research on the association between the implementation or repeal of firearm legislation
(rather than the evaluation of existing laws) and firearm injuries would lead to a better
understanding of what interventions are likely to work given local contexts. This
information is key to move this field forward and for the development of effective
policies that may counteract the burden that firearm injuries pose on populations.
Journal Article
The Effects of Local Police Surges on Crime and Arrests in New York City
The New York Police Department (NYPD) under Operation Impact deployed extra police officers to high crime areas designated as impact zones. Officers were encouraged to conduct investigative stops in these areas. City officials credited the program as one of the leading causes of New York City's low crime rate. We tested the effects of Operation Impact on reported crimes and arrests from 2004 to 2012 using a difference-in-differences approach. We used Poisson regression models to compare differences in crime and arrest counts before and after census block groups were designated as impact zones compared to census block groups in the same NYPD precincts but outside impact zones. Impact zones were significantly associated with reductions in total reported crimes, assaults, burglaries, drug violations, misdemeanor crimes, felony property crimes, robberies, and felony violent crimes. Impact zones were significantly associated with increases in total reported arrests, arrests for burglary, arrests for weapons, arrests for misdemeanor crimes, and arrests for property felony crimes. Impact zones were also significantly associated with increases in investigative stops for suspected crimes, but only the increase in stops made based on probable cause indicators of criminal behaviors were associated with crime reductions. The largest increase in investigative stops in impact zones was based on indicators of suspicious behavior that had no measurable effect on crime. The findings suggest that saturating high crime blocks with police helped reduce crime in New York City, but that the bulk of the investigative stops did not play an important role in the crime reductions. The findings indicate that crime reduction can be achieved with more focused investigative stops.
Journal Article
What the data say about police brutality and racial bias — and which reforms might work
Some interventions could help to reduce racism and rein in the use of unnecessary force in police work, but the evidence base is still evolving.
Some interventions could help to reduce racism and rein in the use of unnecessary force in police work, but the evidence base is still evolving.
Journal Article
Firearm and Nonfirearm Violence After Operation Peacemaker Fellowship in Richmond, California, 1996–2016
Objectives. To evaluate whether the Operation Peacemaker Fellowship, an innovative firearm violence-prevention program implemented in Richmond, California, was associated with reductions in firearm and nonfirearm violence. Methods. We compiled city- and jurisdiction-level quarterly counts of violent firearm and nonfirearm incidents from statewide records of deaths from and hospital visits for homicide and assault (2005–2016) and from nationwide crime records of homicides and aggravated assaults (1996–2015). We applied a generalization of the synthetic control method to compare observed patterns in firearm and nonfirearm violence after implementation of the program (June 2010) to those predicted in the absence of the program, using a weighted combination of comparison cities or jurisdictions. Results. The program was associated with reductions in firearm violence (annually, 55% fewer deaths and hospital visits, 43% fewer crimes) but also unexpected increases in nonfirearm violence (annually, 16% more deaths and hospital visits, 3% more crimes). These associations were unlikely to be attributable to chance for all outcomes except nonfirearm homicides and assaults in crime data. Conclusions. The Operation Peacemaker Fellowship may have been effective in reducing firearm violence in Richmond but may have increased nonfirearm violence.
Journal Article
Evaluating advance peace in Fresno, California: An interrupted times series analysis of a community-based gun violence intervention
Gun violence is a critical public health issue, contributing to the disproportionate burden of health inequities among racially and economically marginalized populations. Advance Peace, a community-driven gun reduction program that integrates street outreach workers to interrupt conflicts with trauma-informed programming to provide mentorship and support for young people at the center of urban gun violence, may be a strategy to reduce gun violence and build healthy communities. We assessed whether the implementation of Advance Peace in Fresno, California was associated with a reduction in gun-related violence, including homicides and assaults. We hypothesized that post-implementation of Advance Peace, there would be a reduction in both gun-related homicides and assaults.
Leveraging crime statistics from the Fresno Police Department on gun-related homicides and assaults between January 2014 and June 2023, we evaluated the impact of Advance Peace programming, implemented beginning in July 2021, on gun violence in Fresno. Descriptive analysis assessed average gun violence rates over time. We used interrupted time series models to assess the rates of gun violence associated with the implementation of Advance Peace in Fresno.
In Fresno, there was evidence of a reduction in crime rates following the introduction of Advance Peace intervention. Two years post-intervention, there was a 46% decrease in the rate of all gun-related crimes, including both homicides and assaults (rate ratio: 0.54, 95% CI: 0.36-0.81). The intervention was also associated with a reduction in the rate of gun-related homicides (RR = 0.45, 95% CI: 0.21-0.95) and the rate of gun-related assaults (RR = 0.58, 95% CI: 0.38-0.89).
Findings from this study demonstrate that Advance Peace may be an effective strategy to reduce gun violence.
Journal Article
Handgun waiting periods reduce gun deaths
Handgun waiting periods are laws that impose a delay between the initiation of a purchase and final acquisition of a firearm. We show that waiting periods, which create a “cooling off” period among buyers, significantly reduce the incidence of gun violence. We estimate the impact of waiting periods on gun deaths, exploiting all changes to state-level policies in the Unites States since 1970. We find that waiting periods reduce gun homicides by roughly 17%. We provide further support for the causal impact of waiting periods on homicides by exploiting a natural experiment resulting from a federal law in 1994 that imposed a temporary waiting period on a subset of states.
Journal Article
Disarming Intimate Partner Violence Perpetrators: Stakeholder Perspectives on Enforcement Gaps and the Consequences of Federal Funding Cuts
Firearm relinquishment laws aim to prevent intimate partner homicide, yet enforcement remains fragmented and underresourced. Drawing on 25 stakeholder interviews conducted in California in 2021 and 2024 to 2025, we examined implementation challenges related to domestic violence restraining orders and gun violence restraining orders and explored how recent federal funding cuts have impacted survivor access to legal protection. Findings reveal structural enforcement gaps, design misalignments, and the compounding effects of disinvestment, highlighting urgent needs for policy realignment, sustained investment, and survivor-centered systems. ( Am J Public Health. 2025;115(12): 1967–1970. https://doi.org/10.2105/AJPH.2025.308287 )
Journal Article
Repeal of Comprehensive Background Check Policies and Firearm Homicide and Suicide
BACKGROUND:In 2016, firearms killed 38,658 people in the United States. Federal law requires licensed gun dealers, but not private parties, to conduct background checks on prospective firearm purchasers with the goal of preventing prohibited persons from obtaining firearms. Our objective was to estimate the effect of the repeal of comprehensive background check laws – requiring a background check for all handgun sales, not just sales by licensed dealers – on firearm homicide and suicide rates in Indiana and Tennessee.
METHODS:We compared age-adjusted firearm homicide and suicide rates, measured annually from 1981-2008 and 1994-2008 in Indiana and Tennessee, respectively, to rates in control groups constructed using the synthetic control method.
RESULTS:The average rates of firearm homicide and suicide in Indiana and Tennessee following repeal were within the range of what could be expected given natural variation (differences = 0.7 firearm homicides and 0.5 firearm suicides per 100,000 residents in Indiana and 0.4 firearm homicides and 0.3 firearm suicides per 100,000 residents in Tennessee). Sensitivity analyses resulted in similar findings.
CONCLUSION:We found no evidence of an association between the repeal of comprehensive background check policies and firearm homicide and suicide rates in Indiana and Tennessee. In order to understand whether comprehensive background check policies reduce firearm deaths in the United States generally, more evidence on the impact of such policies from other states is needed.
Journal Article