title: Firearm violence among high-risk emergency department youth after an assault injury.
abstract: BACKGROUND
  The risk for firearm violence among high-risk youth after treatment for an assault is unknown.
  
  
  METHODS
  In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months).
  
  
  RESULTS
  A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22).
  
  
  CONCLUSIONS
  High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth.
authors.affiliation: University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; cartpatr@med.umich.edu.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Carter
authors.affiliation: University of Michigan Injury Center, Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Walton
authors.affiliation: University of Michigan Injury Center, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan;
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Roehler
authors.affiliation: University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and.
authors.forename: Jason
authors.initials: J
authors.lastname: Goldstick
authors.affiliation: University of Michigan Injury Center, Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan;
authors.forename: Marc A
authors.initials: MA
authors.lastname: Zimmerman
authors.affiliation: University of Michigan Injury Center, University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; National Serious Mental Illness Treatment, Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; and.
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.affiliation: University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013997:Time Factors; D014754:Violence / Q000706:statistics & numerical data*; D014948:Wounds, Gunshot / Q000453:epidemiology*; D055815:Young Adult
keywords: emergency department; firearms; youth violence
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