Violence: A Public H ealth - PowerPoint Presentation

Slide1

Violence: A Public Health Perspective

Josh Knox, PA-C, M.A.

PHAS 7090

Summer 2011Slide2

Educational ObjectivesDiscuss the root causes of violence and its effects on self, women, children, youth, elders & society from a health perspective.

Recognize that violence is preventable & the role of the PA in that prevention.

Discuss prevention strategies for self-directed, child, intimate partner, and youth violence.Slide3

Violence DefinedWorld

report on violence and health

(WRVH

): "

the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm,

mal-development

, or deprivation."Slide4

Types of ViolenceIntrapersonal Violence:

Suicide

Interpersonal Violence

Child

Maltreatment

Youth Violence

Intimate Partner Violence

Elder abuse

Sexual Violence

Collective Violence: War/UprisingsSlide5

Impact of Violence on Society

> 50, 000 per year die d/t violence in U.S. (2005)

1

2. 5 million injuries

due to interpersonal

&

self-directed

violence

2

.

The

total costs associated with nonfatal injuries and deaths due to violence

was more

than $70

billion (2000).

$

64.4 billion or 92

% due

to lost productivity

.

$

5.6 billion was spent on medical

careSlide6
Slide7

Why should a PA bother?There is strong evidence that

violence can be prevented

and

its impact reduced

similar to what has been done for:

Traumatic injuries

Infectious diseases

Pregnancy complicationsSlide8

What Causes Violence?

Bad

neighborhoods/housing

or

unemployment/dead-

end jobs

.

Bad

genes or bad morals. Slide9

In reality it looks like…..Slide10

Biologic Causes of Violence

“No

patterns precise enough to be considered reliable biological markers for violent behavior have yet been identified

”-NAS

1Slide11

Sociologic Factors in ViolenceDrastic differences in violence rates.

In

general

, smaller communities have

lower

rates

of violence.

Within

the same city, some neighborhoods have rates of violent crime 300 times higher than other neighborhoods.

People

who commit violence

(on

the

street)

are disproportionately poor and unemployed.

The overwhelming majority of people arrested for crimes of violence are

men.Violence is primarily the work of the young.People in their late teens and twenties are much more likely to be arrested for violence than younger or older people.

The

arrest rate--and the victimization rate--for violent crime for African-Americans is

six

times higher than for whites. Slide12

Neighborhoods & ViolenceCollective Efficacy-

social cohesion among neighbors combined with their willingness to intervene on behalf of the common good.

Collective efficacy is negatively associated with violenceSlide13

Psychological Factors Mental illness plays a small role in interpersonal violence

1

.

Effects of family are the most powerful influence

across most forms of violence. Slide14

Suicidal Violent Behavior & ConsequencesSuicidal behavior exists along a

continuum

1

:

Thinking about ending one's life "suicidal ideation“

Developing a plan

Non-fatal suicidal behavior "suicide attempt“

Ending one's life "

suicide“

33,000 suicides each year (

CDC, 2010).

392,000

people with self-inflicted injuries sought treatment in emergency departments (CDC, 2010).

It

is estimated that for every one suicide there are 25

attempts

1. Slide15

Suicide was the 11th leading cause of death among persons ages 10 years and older, accounting for 33,289 deaths in 2006

.Slide16

Suicide Risk Factors

Risk

Factors:

Family history of suicide

Family history of child maltreatment

Previous suicide attempt(s)

History of mental disorders, particularly clinical depression

History of alcohol and substance abuse

Feelings of hopelessness

Impulsive or aggressive tendencies

Cultural and religious

beliefs

Local epidemics of suicide

Isolation, a feeling of being cut off from other people

Loss

(relational, social, work, or financial)

Physical illnessEasy access to lethal methodsSlide17

Suicide Protective Factors

Protective Factors

Effective clinical care for mental, physical, and substance abuse disorders

Easy access to a variety of clinical interventions and support for help seeking

Family and community support (connectedness)

Support from ongoing medical and mental health care relationships

Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes

Cultural and religious beliefs that discourage suicide and support instincts for self-preservation Slide18

Guns and SuicideGuns in the home are the primary source for firearms that teenagers use to kill themselves in the

United States

1

. Slide19

Suicide Prevention: The Evidence

Treatment of Mental Health Disorders

Treatment of Substance Abuse

Behavioral Therapy

Restrictive firearm licensing and purchase policies?

Increasing Social Connectedness?

Suicide Prevention Centers?Slide20

Child MaltreatmentChild

maltreatment:

all types of abuse and neglect of a child under

18

by a parent, caregiver, or another person in a custodial role

.

There

are four common types of abuse:

Physical Abuse

Sexual Abuse

Emotional Abuse

NeglectSlide21

Child maltreatment prevalence & consequences

763,000

children

victims

of maltreatment in

2009

1

8,755,000

children were victims of child maltreatment during a one-year time

frame

2

. (essentially 1/7 U.S. children)

1,770

children across the country died from abuse

1.

(2008)Long-term consequences on cognitive,

language, and socio-emotional development, and mental health.

Severe

or fatal head

trauma.

Nonfatal consequences of abusive head trauma include

visual impairment, motor impairment &

cognitive

impairments.

3

Increased

risk for adverse health effects

&chronic diseases

4.

Increased risk of addictive disorders, mental health conditions, low academic achievement & relationship dysfunction.Slide22

Child maltreatment risk factors

Individual

Risk Factors

Children

< 4

Special needs

child

Risk Factors for

Perpetration

Parents

' lack of understanding of children's needs,

child

development

&

parenting skills

Parental history of maltreatment

Substance abuse and/or mental health issues including depression Parental characteristics such as young age, low education, single parenthood, large number of

children,

&d

low

income

Non-biological caregivers

in the home

Family Risk Factors

Social isolation

Family disorganization, dissolution,

& violence.

Parenting stress, poor parent-child relationships, and negative interactions

Community Risk Factors

Violence

Concentrated neighborhood disadvantage

&

poor social connections.Slide23

Evidenced Based Interventions with Impact on Child Maltreatment

Child-Parent Centers

Nurse family Partnerships

Positive Parenting ProgramSlide24

Youth Violence Definition & Consequences

Youth violence

: the

intentional use of physical force or power, threatened or actual, against another person or against a group or community that results in or has a high likelihood of resulting in injury, death, psychological harm,

mal-development

, or

deprivation typically including

persons between the ages of 10 and

24.

700,000 youth

ages 10 to 24 are treated in

ER’s/

yr

for injuries sustained due to violence-related

assaults.16 persons b/t 10

and 24 are murdered each day in the U.S.YV increases the cost of health care, reduces productivity,

decreases

property values, and

disrupts

social services Slide25

Youth Violence Risk Factors

Individual Risk Factors

Attention

deficits, hyperactivity or learning disorders

History of early aggressive behavior

Involvement with drugs, alcohol or tobacco

Low

IQ or deficits

in social cognitive or information-processing abilities

Antisocial

beliefs and attitudes

Exposure to violence and conflict in the family

Family Risk Factors

Harsh

, lax or inconsistent disciplinary practices

Low parental

involvementLow emotional attachment to parents or caregiversLow parental education and income

Parental substance abuse or criminality

Poor family functioning

Peer/Social

Risk Factors

Association with delinquent

peers/Involvement

in gangs

Lack

of involvement in conventional activities

Poor academic performance

Low commitment to school and school failure

Community Risk Factors

High

concentrations of poor residents

High level of transiency

High level of family disruption

Low levels of community

participation

Socially

disorganized neighborhoodsSlide26

Youth Violence Protective Factors

Individual/Family Protective Factors

High IQ/GPA

Positive social orientation

Religiosity

Connectedness to family or adults outside the family

Consistent

presence of parent during at least one of the following: when awakening, when arriving home from school, at evening mealtime or going to bed

Involvement in social activities

Peer/Social Protective Factors

Commitment to school

Involvement in social activities Slide27

Youth Violence Prevention: The Evidence Parent training

Skills training

Social development programs

Big Brothers/Big Sisters

Urban Ecology Center

Regulating access to alcohol

Restrictive firearm licensing & purchase

Enforced bans on public firearmsSlide28

Intimate Partner ViolenceIntimate

partner

violence

: physical

, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not

require

sexual

intimacy*.

Costs of intimate partner violence (IPV) against women in 1995 exceeded

$

5.8 billion.

Victims of severe IPV lose nearly 8 million days of paid work-the equivalent of more than 32,000 full-time jobs-and almost 5.6 million days of household

productivity/yr.

329

males and 1181 females were murdered by an intimate partner (Bureau of Justice Statistics

2007)Slide29

Intimate Partner ViolenceRisk Factors

Individual

Risk Factors

Low income/unemployment

Low academic achievement

Young age

Heavy

alcohol and drug

use

Mental health condition

Belief

in strict gender roles (e.g., male dominance and aggression in relationships)

Being

a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration)

History of experiencing poor parenting as a child

History of experiencing physical discipline as a child

Relationship Factors

Marital conflict-fights, tension, and other struggles

Marital instability-divorces or separations

Community

Factors

Poverty and associated factors (e.g., overcrowding)

Low social capital-lack of institutions, relationships, and norms that shape a community's social

interactions

Societal Factors

Traditional gender norms (e.g., women should stay at home, not enter workforce, and be submissive; men support the family and make the decisions) Slide30

Intimate Partner Violence: Prevention InterventionsInterventions for problem drinking partners

School based programs addressing gender norms

Screening and referral

Advocacy support programs

Protection ordersSlide31

A final word on firearm violence

A gun in the home is 22 times more likely to be used in an unintentional shooting, than to be used to injure or kill in

self-defense

1

.

http://changegunviolence.com/

What ways could diverse communities benefit

from 

the

examples of

engagement in Monday’s film?

What situations could you potentially

encounter as

PA’s in Monday’s film?