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Original Investigation | Adolescent and Young Adult Health

Modifiable Neighborhood Features Associated With Adolescent Homicide

Alison J. Culyba, MD, MPH1,2; Sara F. Jacoby, PhD, MPH2; Therese S. Richmond, PhD, CRNP3; Joel A. Fein, MD, MPH1; Bernadette C. Hohl, PhD, MPH4; Charles C. Branas, PhD2
[+] Author Affiliations
1The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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
4Department of Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway
JAMA Pediatr. 2016;170(5):473-480. doi:10.1001/jamapediatrics.2015.4697.
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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  Adolescent homicide.

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 (odds ratio [OR], 0.24; 95% CI, 0.09-0.70), illuminated walk/don’t walk signs (OR, 0.16; 95% CI, 0.03-0.92), painted marked crosswalks (OR, 0.17; 95% CI, 0.04-0.63), public transportation (OR, 0.13; 95% CI, 0.03-0.49), parks (OR, 0.09; 95% CI, 0.01-0.88), and maintained vacant lots (OR, 0.17; 95% CI, 0.03-0.81) were significantly associated with decreased odds of homicide. The odds of homicide were significantly higher in locations with stop signs (OR, 4.34; 95% CI, 1.40-13.45), security bars/gratings on houses (OR, 9.23; 95% CI, 2.45-34.80), and private bushes/plantings (OR, 3.44; 95% CI, 1.18-10.01).

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.

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