IMPORTANCE:
Homicide
is a leading cause of adolescent mortality. To our knowledge, relatively little
has been studied in terms of the association between environmental neighborhood
features, such as streets, buildings, and natural surroundings, and severe
violent injury among youth.
OBJECTIVE:
To
assess associations between environmental neighborhood features and adolescent
homicide in order to identify targets for future place-based interventions.
DESIGN, SETTING, AND PARTICIPANTS:
Population-based
case-control study conducted in Philadelphia, Pennsylvania, from April 15,
2008, to March 31, 2014. We identified adolescents who died by homicide at 13
to 20 years of age from 2010 to 2012 while residing in Philadelphia. We used
incidence-density sampling and random-digit dialing to recruit control
participants ages 13 to 20 years matched on sex and indoor-outdoor location at
the time of each index case participant's homicide.
EXPOSURES:
To
obtain environmental data about modifiable features that were present in the
immediate surroundings of our case and control participants, blinded field
researchers used standardized techniques to photograph case and control
participant outdoor locations. Photographic data were stitched together to
create 360° panoramic images that were coded for 60 elements of the visible
environment.
MAIN OUTCOME AND MEASURE:
RESULTS:
We
enrolled 143 homicide case participants (mean [SD] age, 18.4 [1.5] years) and
155 matched control participants (mean [SD] age, 17.2 [2.1] years) who were
both outdoors at the time of the homicide. In adjusted analyses, multiple
features of Philadelphia streets, buildings, and natural surroundings were
associated with adolescent homicide. The presence of street lighting, illuminated walk/don't walk signs, painted marked crosswalks, public transportation, parks, and maintained vacant lots were significantly associated with decreased odds of homicide. The
odds of homicide were significantly higher in locations with stop signs, security bars/gratings on houses, and private bushes/plantings.
CONCLUSIONS AND RELEVANCE:
Using
a population-based case-control design, we identified multiple modifiable
environmental features that might be targeted in future randomized intervention
trials designed to reduce youth violence by improving neighborhood context.
- 1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
- 2Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
- 3Biobehavioral and Health Systems Department, School of Nursing, University of Pennsylvania, Philadelphia.
- 4The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
- 5Department of Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway.
- JAMA Pediatr. 2016 Mar 7. doi: 10.1001/jamapediatrics.2015.4697.
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