WE have worked for more than 10 years in the US Public Health Service to clarify the patterns of violence through surveillance and research and to identify and evaluate interventions to prevent and reduce the impact of violence. It is time to be clear about what we mean by violence and why we believe that violence is a public health problem. Violence is the intentional use of physical force against another person or against oneself, which either results in or has a high likelihood of resulting in injury or death. Violence includes suicidal acts as well as interpersonal violence such as rape, assault, child abuse, or elder abuse. Fatal violence results in suicides and homicides. The termviolencehas been used to connote both a subset of behaviors (which produce injuries) and outcomes (ie, the injuries themselves). We useviolenceto refer to a particular class of behaviors that cause
Abstract Intentional injuries claimed nearly two hundred lives every day in the United States in 2020, about two-thirds of them suicides, each a story of irretrievable human loss. This essay addresses the complex intersection of injurious behavior with mental illness and access to firearms. It explores what more can be done to stop gun violence while respecting the rights of lawful gun owners, preserving the dignity of persons with mental illnesses, and promoting racial equity. Strategies to prevent firearm injury in the United States are uniquely conditioned by a constitutional right to bear arms, the cultural entrenchment and prevalence of private gun ownership, and strident political disagreement on regulatory solutions to stem gun violence. Broad implementation of a range of complementary policies is needed, including community-based programs to address the social and developmental determinants of violence, improved access to a continuum of mental health services, firearm restrictions based on behavioral indicators of risk (not mental illness, per se), licensing for firearm purchase or ownership, comprehensive background checks for firearm purchase, and supply-side approaches to interrupt illegal firearm markets.
Violence in our country has reached epidemic proportions, especially among our youth. Of 22 industrialized nations, the United States has the highest homicide rate among young males 15 to 24 years of age. To reduce the incidence of violence, we must radically shift our approach to emphasize prevention and intervention. There are several ways of achieving violence reduction through these means. The scientific approach requires the determination of causation and risk factors to shed light on the patterns of violence and the effects on subgroups of the population. Also required is the development of targeted programs aimed at specific high-risk populations. In the area of youth violence intervention, programs must focus on young children and their parents, often children themselves, to prompt appropriate changes in knowledge, skills, and attitudes. Community-based programs can go a step further to initiate changes in the social environment that will create opportunities for adequate housing, job training or employment, or academic achievement. These efforts exemplify the notion that violence is not a factor of race, but rather is based on socioeconomic factors, particularly poverty and racism.
The article by Wintemute et al.1 in this issue of the Journal adds to the growing literature that connects firearms with increased risks of suicide and homicide.26 Some of these studies have examined the risks associated with the possession of firearms, and some, the risks associated with ownership; now, this article looks at the risks in relation to firearm purchase. The findings are of particular interest because they indicate that purchasers of handguns are at high risk for suicide, particularly during the period immediately after the purchase.1 This association is especially strong among women.There are other interesting findings . . .
Abstract Phthalates are endocrine-disrupting chemicals (EDCs) that alter hormone functions throughout the lifespan. Growing awareness of the adverse health effects of phthalate exposure has led to regulating certain phthalates in the United States, Canada, and Europe. However, international comparisons of urinary phthalate metabolite concentrations as biomarkers of exposure are sparse, and few studies have controlled for cohort-specific variables like pregnancy. We aimed to examine trends in urinary phthalate monoester metabolite concentrations in non-occupationally exposed populations globally, excluding locations where representative data are already available at the country level. We systematically reviewed studies published between 2000 and 2023 that reported urinary phthalate monoester concentrations. We examined changes in metabolite concentrations across time, controlling for region, age, and pregnancy status, using mixed-effects meta-regression models with and without a quadratic term for time. We identified heterogeneity using Cochran’s Q-statistic and I 2 index, adjusting for it with the trim-and-fill method. The final analytic sample consisted of 216 studies. Significant differences in phthalate metabolite concentrations were observed across regions, age groups, and between pregnant and non-pregnant cohorts. Our meta-regression identified a significant non-linear trend with time for Mono-n-butyl phthalate and Mono-isononyl phthalate concentration internationally and in Eastern and Pacific Asia (EPA). We also observed significant non-linear associations between time and Mono(2-ethyl-5-hydroxyhexyl) phthalate, Mono(2-carboxymethylhexyl) phthalate, and Mono(3-carboxypropyl) phthalate concentration internationally and/or in EPA, along with Mono(2-ethylhexyl) phthalate, Mono-carboxy-isononyl phthalate, and Mono-ethyl phthalate. Additionally, Mono-ethyl phthalate concentration showed a significant negative linear association with time in Latin America and Africa. Heterogeneity was high, indicating potential bias in our results. Our findings indicate the need for increased awareness of phthalate exposure. Further analysis of the attributable disease burden and cost at regional and international levels, especially in low- and middle-income countries, is essential to understanding these and other EDCs impact on population health and the economy. Highlights Some phthalate levels significantly differed by region, age, and pregnancy status. Many phthalates had non-linear associations internationally from 2000 to 2023. MnBP and MiNP levels increased, driven by Eastern and Pacific Asia results. Most phthalate metabolites’ levels declined overall and region-specific over time. There was insufficient data on phthalate metabolite levels for many regions.
