Violence in the United States Status, Challenges, and Opportunities

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JAMA

IMPORTANCE Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence.

OBJECTIVES To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities.

DATA SOURCES We reviewed data from health and law enforcement surveillance systems including the National Vital Statistics System, the Federal Bureau of Investigation’s Uniform Crime Reports, the US Justice Department’s National Crime Victimization Survey, the National Survey of Children’s Exposure to Violence, the National Child Abuse and Neglect Data System, the National Intimate Partner and Sexual Violence Survey, the Youth Risk Behavior Surveillance System, and the National Electronic Injury Surveillance System—All Injury Program.

RESULTS Homicide rates have decreased from a peak of 10.7 per 100 000 persons in 1980 to 5.1 per 100 000 in 2013. Aggravated assault rates have decreased from a peak of 442 per 100 000 in 1992 to 242 per 100 000 in 2012. Nevertheless, annually, there are more than 16 000 homicides and 1.6 million nonfatal assault injuries requiring treatment in emergency departments. More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver, ranging from neglect to sexual abuse, but only a small percentage of these violent incidents are reported to law enforcement, health care clinicians, or child protective agencies. Moreover, exposure to violence increases vulnerability to a broad range of mental and physical health problems over the life course; for example, meta-analyses indicate that exposure to physical abuse in childhood is associated with a 54% increased odds of depressive disorder, a 78% increased odds of sexually transmitted illness or risky sexual behavior, and a 32% increased odds of obesity. Rates of violence vary by age, geographic location, sex, and race/ethnicity, and significant disparities exist. Homicide is the leading cause of death for non-Hispanic blacks from age 1 through 44 years, whereas it is the fifth most common cause of death among non-Hispanic whites in this age range. Additionally, efforts to understand, prevent, and respond to interpersonal violence have often neglected the degree to which many forms of violence are interconnected at the individual level, across relationships and communities, and even intergenerationally. The most effective violence prevention strategies include parent and family-focused programs, early childhood education, school-based programs, therapeutic or counseling interventions, and public policy. For example, a systematic review of early childhood home visitation programs found a 38.9% reduction in episodes of child maltreatment in intervention participants compared with control participants.

CONCLUSIONS AND RELEVANCE Progress has been made in reducing US rates of interpersonal violence even though a significant burden remains. Multiple strategies exist to improve violence prevention efforts, and health care providers are an important part of this solution.

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School Menus Improve but Need Work

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JAMA

It’s getting easier for kids to heed the advice to eat their vegetables. Recent data show that nearly 80% of schools that offer federally assisted meal programs serve at least 2 choices of fruits and vegetables in their cafeterias. But schools need more assistance to fully comply with the US Department of Agriculture’s (USDA’s) required nutrition standards for federal school meals, according to the study.

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As New Orleans Looks to the Future, Questions Remain on Hurricane Katrina’s Long-term Mental Health Effects

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JAMA

September 1, 2015

Gasometers, also called gas holders, were large tanks for storing coal gas and maintaining pressure in distribution lines. In Great Britain, gas holders were common features of the industrial landscape before natural gas became the primary source of fuel for powering streetlights and heating homes. They were often constructed at the sites of gasworks, which manufactured coal gas by carbonizing coal. Although many gas holders are still standing, most are no longer in use.

Cyril E. Power (1872-1951), Gasometers, circa 1930, English. Color monotype. Platemark: 25 × 30.2 cm. Sheet: 30.2 × 37.1 cm. Courtesy of The Museum of Fine Arts, Boston (http://www.mfa.org/), Boston, Massachusetts; gift of Tom Rassieur in honor of Johanna and Leslie Garfield, 2008.104. Photograph © 2015 Museum of Fine Arts, Boston.

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JAMA Forum: A Same-Sex Infertility Health Insurance Mandate in Maryland?

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To the surprise of many, in March, the legislature of Marylandpassed 2 bills that would amend an outdated health insurance mandate that excluded same-sex couples from coverage for in vitro fertilization treatments.

Specifically, the 2 bills, proposed separately in the Maryland House and Senate and then amended to be identical, prohibit“insurers, nonprofit health service plans, and health maintenance organizations from requiring specified conditions of coverage for specified infertility benefits for a patient who is married to an individual of the same sex.”

This first-in-the-nation effort is well worth the attention it has been receiving, because the implications can hardly be overstated. Read more

Racial Bias in Health Care and Health

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JAMA

Challenges and Opportunities

August 11, 2015

A landmark report from the Institute of Medicine (IOM) in 2003 documented that from the simplest to the most technologically advanced diagnostic and therapeutic interventions, African American (or black) individuals and those in other minority groups receive fewer procedures and poorer-quality medical care than white individuals.1 These differences existed even after statistical adjustment for variations in health insurance, stage and severity of disease, income or education, comorbid disease, and the type of health care facility. Very limited progress has been made in reducing racial/ethnic disparities in the quality and intensity of care.2 The IOM report concluded that multiple factors contribute to racial disparities in medical care and that unconscious bias by health care professionals contributes to deficits in the quality of care. This Viewpoint discusses the potential contribution of societal racial bias to disparities in health care and health status.

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Association of the New York State Marriage Equality Act With Changes in Health Insurance Coverage

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JAMA

August 18, 2015

When states recognize same-sex marriage, some workplaces are required to offer employer-sponsored health insurance (ESI) to married same-sex couples.1 Research found laws establishing domestic partnerships for lesbian, gay, bisexual, and transgender (LGBT) populations increased health insurance coverage for lesbian women.2 On July 24, 2011, New York State began licensing same-sex marriages under the state’s Marriage Equality Act, and at least 12 280 marriage licenses were issued to same-sex couples in the following 18 months.3 This study investigated the association between legalizing same-sex marriage in New York and changes in health insurance coverage in men and women.

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Attacks on Health Increasing in Conflict-Ridden Countries

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July 21, 2015

Medical care personnel and facilities have become a target in many countries beset by conflict and civil unrest, according to a new report, “Attacks on Health: Global Report,” which describes violence against health workers, medical facilities, and patients, as well as interference with access to health care that has been occurring from January 2014 to April 2015 in 17 countries, including Syria, Ukraine, South Sudan, and Afghanistan (http://bit.ly/1LkKJQM).

A recent report suggests violent attacks on medical facilities and health workers is increasing globally.

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Achieving Health Equity by Design

April 14, 2015

Disparities in health outcomes by race and ethnicity and by income status are persistent and difficult to reduce. For more than a decade, infant mortality rates have been 2 to 3 times higher among African American populations, rates of potentially preventable hospitalization have been substantially higher among African American and Latino populations, and the complications of diabetes have disproportionately afflicted African American and Latino populations.1 These and other disparities have persisted despite recognition that inequity costs the economy an estimated $300 billion per year.2 In addition, health disparities threaten the ability of health care organizations to compete fiscally as insurers increasingly base payments on quality and outcomes, such as reducing preventable admissions and readmissions.

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