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Original Investigation
Firearm Violence
January 03, 2017

Association of Drug and Alcohol Use With Adolescent Firearm Homicide at Individual, Family, and Neighborhood Levels

Author Affiliations
  • 1Department of Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway
  • 2School of Criminal Justice, Rutgers University, Newark, New Jersey
  • 3Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 4Department of Mathematics, School of Science, Hampton University, Hampton, Virginia
  • 5The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 6Medical Examiner's Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
JAMA Intern Med. Published online January 3, 2017. doi:10.1001/jamainternmed.2016.8180
Key Points

Question  Is there a relationship between alcohol- and drug-related factors and adolescent firearm homicide at the individual, family, and neighborhood levels?

Findings  In a population-based, case-control study of 13- to 20-year-old residents of Philadelphia, Pennsylvania, we found that almost all adolescent homicides were firearm homicides. Drug use at all 3 levels and alcohol at the individual and neighborhood levels were associated with increased odds of adolescent firearm homicide.

Meaning  Expanding violence prevention efforts to target substance use at multiple levels within society may help to reduce the firearm violence that disproportionately affects minority populations in large US cities.

Abstract

Importance  Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates.

Objective  To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence.

Design, Setting, and Participants  Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population.

Exposures  Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity.

Main Outcomes and Measures  Adolescent firearm homicide identified from police and medical examiner’s reports.

Results  We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2-14.0) or drug use (AOR, 4.4; 95% CI, 1.7-11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8-48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1-9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1-10.3 vs AOR, 7.5; 95% CI, 2.2-25.8).

Conclusions and Relevance  Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities.

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