Creating a Healthy and Safe City

8/3/2019 Creating a Healthy and Safe City

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New Haven Public HealthDepartment

CreatingaHealthyandSafeCity:

TheImpactofViolenceinNewHaven

Complete Report

Mario Garcia, MPH

Director of Health


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CreatingaHealthyandSafeCity:TheImpactofViolenceinNewHaven

TableofContents

Preface.....1

ExecutiveSummary..2

1.BackgroundandScopeofReport .........................................................................................................................4

2.APublicHealthApproachtoAddressingViolence ................................................................................................5

3.NewHavenCrimeStatistics...................................................................................................................................6

4.TheHealthEffectsofViolence:PhysicalInjury ..................................................................................................9

5.TheHealthEffectsofViolence:BeyondPhysicalInjury.....................................................................................12

6.RiskandProtectiveFactorsforBeingInvolvedinViolence................................................................................15

7.ConclusionsandNextSteps................................................................................................................................20

Preface

TheNewHavenHealthDepartmentlaunchedaHealthEquityAlliance(HEA)in2009tofocusontheunderlying

causesofhealthdisparitiesinourcity.Drawinguponagrowingnumberofhealthequityeffortsinothercities

andregions,thegoalofHEAistoensurethatallcommunitymembershaveequalopportunitytoexperience

optimalhealth.

Webelievethathealthbeginsinourhomes,workplaces,neighborhoods,andschools.Healthisaproductofour

broaderenvironmentalcircumstancesasmuchasitisaresultofindividualbehaviors,actions,orhavingaccess

togooddoctorsandaffordablehealthcare.Neighborhoodconditionsplayalargepartindetermininghealth

statusandmustbeatargetofcity-wideeffortstoimproveoverallcommunityhealth.ToalignwiththeprioritiesoftheNewHavenBoardofHealthandothercommunityleaders,theHEAhasbegunbyemphasizingtheissues

ofneighborhoodsafety,obesityandtobaccouse.

Thisfirstissuebrieffocusesonthesubjectofviolencewithinourcommunities,andwasdevelopedbythe

HealthDataWorkgroupoftheHEAforpresentationtotheNewHaven HealthMatters!PlanningGroup.

Consistingofcommunityleadersfromavarietyofsectors,the HealthMatters!PlanningGroupwascreatedby

MayorDeStefanoin2010toinformandguidepolicychangesrelatedtohealthinNewHaven.Withinthis

document,wedescribetrendsincommunityviolenceaswellasthecommunityandsocietallevelfactorsthat

increasetheriskoforprotectagainstinjuryfromviolence.Wealsoidentifypossibleremedies. Thedatacomes

frommultiplesourcesincludingthe HealthEquityIndex(HEI),aninnovativetooldevelopedbytheConnecticut

AssociationofDirectorsofHealthforlocalcommunitiestousetoexaminetheconnectionbetweensocialand

economicconditionsinneighborhoodsandthehealthstatusoflocalresidents.TheHEIusesa10pointscale(1is

poorand10isexcellent)tomeasurehealthoutcomesandthesocialandenvironmentalfactorsthatinfluence

them,suchaseducationalattainment,environmentalquality,economicopportunity,andpublicsafety.


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ExecutiveSummary

Communityviolencecancauseinjuryanddeath.Itmayalsoresultinpsychologicalharmto,andotheradverse

healtheffectsfor,victims,witnessesandotherpeoplewholiveinareasconsideredtobeunsafe.

TheNewHavenHealthDepartmentisoneofthreelocalhealthdepartmentsinConnecticutthathasreceivedfundingfromtheConnecticutAssociationofDirectorsofHealth(CADH)tocreateaHealthEquityAlliance.This

Allianceofdiversepartnersaddressestherelationshipbetweensocialandeconomicconditionsandhealth

outcomesofNewHavenresidentsusinganoveltoolcalledtheHealthEquityIndex.Thisdocumentpresentsthe

findingsoftheAllianceoncommunityviolenceinNewHaven.

CommunityviolenceisasignificantpublichealthprobleminNewHaventhatcallsforaunitedresponse.

Althoughtheimpactofcommunityviolencecanaffectusall,theanalysispresentedhereshowsthatcertain

neighborhoods,communitiesofcolor,andyoungpeoplebearadisproportionateburdenofviolentcrimeandits

effect.

HealthMatters!isanambitiousmovementtoimprovethehealthstatusoftheCityofNewHaven,underthe

leadershipofMayorJohnDeStefano,Jr.andtheCommunityServicesAdministration.HealthMatters!aimstouselocaldatatoprioritizeandassesshealthissues,policiesandpracticesforlong-termhealthimpactonNew

Havenresidents.Itisintendedthattheinformationandrecommendationspresentedinthisdocumentsupport

theworkofHealthMatters!oncommunityviolence.

TheConcern

DatafromtheHealthEquityIndexandothersourcesofinformationprovidedbyresearchers,residentsand

governmentofficialsdetailwhycommunityviolenceisasignificantpublichealthconcerninNewHaven:

In2007-2008,deathsfromassaultwereassignificantacauseofprematuredeathascancer,heartdiseaseandaccidents.Deathfromassaultwastheleadingcauseofdeathamongmales1529.Non-fatalinjury

fromassaulthasalsocausedasubstantialhealthburdenintheCity.

TheimpactofcommunityviolenceonyoungBlackandHispanicmaleshasbeenparticularlypronounced.In2007and2008,deathfromassaultaccountedforoverathirdofthedeathsofBlackandHispanicmalesage

1529.AllthosekilledbygunfireduringthatperiodwereBlackorHispanicmales.

Over85%ofdeathsfromassaultin2007and2008werecausedbyhandguns.Thevastmajorityofthehandgundeathsoccurredoutdoorsinparkinglots,inthestreetandonsidewalks.

ViolentcrimeisnotevenlydistributedinNewHaven,butheavilyconcentratedinsomedistrictsoftheCity.Violentcriminalbehaviorisalsogeographicallyassociatedwith,thoughnotnecessarilycausedby,economic

distressandlocationswithparolees,prisonreleases,retailbusinesses,andillegaldrugmarkets.

Themajorityofcityresidentsareunlikelytobephysicallyinjuredbyviolentcrime.However,duetoavarietyofpotentiallynegativeimpactsonmentalhealth,physicalactivityandqualityoflife,theindirect

burdenofviolenceonresidentsofacitylikeNewHavenmaybeconsiderable.


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NextSteps

TheHealthEquityAllianceandHealthMatters!seektoidentify,developandadvancepoliciesthataddressthe

rootcausesofviolence.Communityviolencepreventioninterventionsthatarecurrentlyrecognizedasbest

practicesfocusontheknowledge,attitudes,behaviorsandrelationshipsofindividuals.Bestpracticesin

community-andsociety-levelchangeshavenotbeenwell-defined.Inthiscontextitissuggestedthatpotential

areasforpolicyinitiativesinNewHaveninclude:

Expansionofeconomicandjobopportunitiesforyouthandadults;

Physicalandenvironmentalimprovements,qualityhousing,andenhancementstocommunitystewardshipwithinneighborhoodsexperiencinghighlevelsofstreetviolence;

Improvedaccesstopositivesocialactivitiesforyouthandadults;

Furtherenhancementstoprisonerreentryprograms;

Increaseddeterrentstohandgunuseintheperpetrationofcrime.

Finally,werecommendthat:

Asystematicreviewbeundertakenofcommunity-andsociety-levelviolencepreventionstrategiesimplementedinUScities.

TheCityofNewHavenadoptaprocess,suchashealthimpactassessment,toguidedecisionsconcerningthedesignanddevelopmentofneighborhoodsthatsupportsafe,healthylives.


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1.BackgroundandScopeofReport

ViolenceisamajorcauseofprematuredeathintheUnitedStates.Nationally,homicideisthesecondleading

causeofdeathforpeople15-24andthethirdleadingcauseofdeathforpeople10-14and25-341.

Whiledevastating,homicidesareonlypartoftheburdenthatviolenceplacesoncommunityhealth.Violent

crimecanalsoleadtonon-fatalinjury,someofitsevereand/ordisabling.Moreover,violencemayhaveafar

reachingaffectonthehealthofsomecommunitiesasawhole.Fearofcrimemayimpactbehaviorsand

attitudes,suchasoutdoorphysicalactivity,neighborlytrust,collectiveefficacy,andsenseofsecurity,thatcan

helpimproveandmaintainphysicalandmentalhealth.

ViolentcrimeanditsimpactonhealthisaparticularconcernwithintheCityofNewHaven.Datafromthe

ConnecticutAssociationofDirectorsofHealths HealthEquityIndexdemonstratetheextentoftheproblem.

TheHealthEquityIndexusesa10pointscale(1ispoorand10isexcellent)tomeasurehealthoutcomesandthe

socialandenvironmentalfactorsthatinfluencethem,suchaseducationalattainment,environmentalquality,

economicopportunity,andpublicsafety.WithintheIndex,NewHavenscoresa1outof10forviolentcrime

whencomparedtotheothertownsandcitiesinConnecticut2.

Aspartofourcollectiveeffortstocreateacitywhereallneighborhoodsandfamiliesaresafeandprosperous,

thisdocumentwillattempttodescribecommunityviolenceanditsimpactonhealthinNewHaven.Wewillalso

considerwhysomepeopleandareasmayexperiencehigherratesofviolence.Todothis,wewillsupplement

datafromtheHEAIndexwithavarietyofstories,surveys,anddatatodemonstratewhysafetyisaneveryday

concernofmanycityresidents.WewillfocusoninformationaboutNewHavenbutwillincludefindingsfrom

othersimilarUSurbanenvironmentsasneeded.

Forthepurposesofthisdocument,wedefineviolenceas theexerciseofaphysicalforceinamannerthat

createsorisintendedtocreateinjurytoanotherperson3.Althoughintentionalself-harmandunintentional

injurycausedbyunsafeconditionsornegligentbehavior,suchasaggressivedriving,areextremelyimportant

publichealthissues,theyarebeyondthescopeofouranalysis.

Thenextsectionofthisdocumentwillprovideabriefoverviewofthepublichealthapproachtoaddressing

communityviolence.Section2willgiveanoverviewofthepublichealthapproachtocommunityviolence

prevention.Section3willpresentNewHavencrimestatisticsprimarilyfromtheFBIUniformCrimeReportand

NewHavenIndependentCrimeLog.Section4examinesphysicalinjurycausedbyviolenceinNewHaven.

Section5considersavailableinformationontheeffectsofcommunityviolenceonotheraspectofhealth.

Section6willdescribefactorsthatmayincreaseorprotectagainstthelikelihoodofinvolvementincommunity

violence.Finally,section7willpresentconclusionsincludingrecommendationsandpotentialareasforpolicy

developmenttopreventcommunityviolence.


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2.APublicHealthApproachtoAddressingCommunityViolence

Thepublichealthapproachtoimprovingcommunitysafetyisbasedontheassumptionthatviolentcrime,like

othertypesofinjury,ispreventable

througha4stepprocessofstudyand

action(Figure1)1.Thesestepsare:

Step1:Describetheproblemofviolence.

Step2:Identifythingsthatputpeopleat

risk(orprotectagainst)involvementwith

violence.

Step3:Develop,implementandevaluate

violencepreventionstrategies.

Step4:Disseminatesuccessfulviolence

preventionstrategiesandensuretheiradoption.

Thesocial-ecologicalmodel(Figure2)1helpstoexaminefactorsthatincreaseordecreasetheriskof

involvementinviolencebydividingthemintothefollowinglevels:

Individual:Biologicalandpersonalhistory

factors,suchasage,attitudestoviolence,

orhistoryofaggressivebehavior.

Relationship:Relationshipswithfamily,

friends,intimatepartnersandpeers,suchashavingpeersengagedinviolence,

victimizationorlackofadequate

supervision.

Community:Thecommunitycontextin

whichrelationshipsexist(schools,

workplaces,neighborhoods).Thesefactors

includepopulationdensity,availabilityof

qualityemployment,andexistenceofan

illegaldrugtrade.

Societal:Societalfactorsthathelpcreateaclimateinwhichviolenceisencouragedorinhibited,suchaslaws

andregulations,socialnorms,andcross-sectorhealth,housing,economic,educationalandsocialpolicies.


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3.NewHavenCrimeStatistics

Crimeratesarean

indicatorofthesafetyof

ourcommunityandits

qualityoflife.Part1ofthe

FBIUniformCrimeReport

(UCR)providesuswith

standardized,auditeddata

oncrimesreportedtoor

otherwiseknownbylaw

enforcementauthorities.

Thisreportincludes

informationonthe

numberofviolentcrimes:

murder,forciblerape,

robbery.Crimesthatare

notknowntolawenforcementarenot

includedintheUCR.

BasedonUCRdata,there

were2183violentcrimes

reportedinNewHavenin

2009,or17.7per1,000

residents(95%

confidenceinterval:

17.0-18.4).This

comparesto3.0per1,000residentsinthe

StateofConnecticut

overallinthesameyear

(95%confidenceinterval:

2.9-3.1).Amongthe

2183reportedviolent

crimesin2008,there

were12(1%)reported

murders,58(3%)

reportedrapes,906

(42%)reported

robberies,and1207

(55%)reported

aggravatedassaults4.


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Trends.TimetrendsinUCRPart1ViolentCrimesforNewHavenandConnecticutoverallcanbeseeninFigure

34.Between1990and2000therateofviolentcrimesdeclinedconsiderablyinNewHaven,fromapproximately

30crimesto15crimesper1,000residents.From2000to2007,theannualnumberofviolentcrimesinNew

Havenappearstohaveincreasedalthoughnottopre-2000levels4.Thisupturnstartingin2000wasnotseenin

Connecticut4orintheUnitedStatesasawhole.

5Thereissomesuggestionofadecreaseinviolentcrimessince

2007.Similarpatternscanbeseenforrobberyandaggravatedassault(Figure4)4

.

Murders.From2005-2009,thenumberofmurdersoccurringinNewHavenwere16,24,13,23and12,

respectively,withabout17reportedwithinthefirstthreequartersof2010.Theannualizedincidenceofmurder

forthe5yearperiodfrom2005-2009was14.2per100,000NewHavenresidents(95%confidenceinterval:11.4-

17.5)4.TheannualizedincidenceofmurderforthisperiodinCT3.1per100,000CTresidents(95%confidence

interval:2.9-3.4)4.

UseofFirearms.Duetothepotentialforinjury,

communitiesoftenhaveheightenedconcerns

abouttheuseoffirearmstocommitcrimes.In

2008inNewHaven,firearmsweredischargedor

displayedin87%ofthemurders,81%ofthe

aggravatedassaultsand66%oftherobberies

reportedintheUniformCrimeReport6.

UnauditedNHPDdatafromtheNewHaven

IndependentCrimeLogonfirearmcrimescanbe

seeninTable1.Between2006and2009,the

annualnumberofassaultswithafirearm(non-fatalshootings)wasbetween117and140.Inthefirst10months

of2010therewere78assaultswithafirearmreportedinNewHaven.Thisappearstobetrackingtowardsa

lowertotalthaninpreviousyears.Thenumberofstreetrobberieswithafirearmrangedfrom217to259inthe

years2006to2009,with119reportedduringthefirst10monthsof2010.Alowertotalthanforpreviousyears

mayalsobeseenforstreetrobberieswithafirearmin2010.From2006to2009,therewerebetween480and610unlawfuldischargesofafirearm(dischargeofafirearmthatdoesnotresultinashooting),with473

reportedthroughOctober20107.

NewHavenIndependentcrimeLogsuggeststhatinthefirst10monthsof2010,roughly70%ofthe119

reportedstreetrobberiescommittedwithafirearmoccurredbetween7PMand4AM.

Arrestees.Arrestsforviolentcrimesaremostcommonamongyoungadultsandmen.InNewHavenin2008,

100%ofthosearrestedformurderwereunder35years,andhalfwereunder25.Incasesofrobbery,77%were

under35,and64%wereunder25.Sixty-fivepercentofthosearrestedforaggravatedassaultswereunder35,

and41%wereunder25.Allmurderarresteesweremale,aswere91%ofthosearrestedforrobberyand65%of

thosewhocommittedaggravatedassault6.Datafromvictimizationsurveyssuggestthispatternofageandsexis

trueforallperpetrators,notjustarrestees 8.

NeighborhoodData.MappingoftheUCRPart1datawithinNewHavendemonstratesthattheriskofexposure

toviolentcrimeisnotevenlydistributedacrossareasofthecity.Figure59showsthatthehighestviolentcrime

ratesper1,000residentsbetween2000and2009occurredincensustractsinDixwelll,Newhallville,Wooster

Square/MillRiverandportionsofDowntown,FairHavenandtheHill.Therateofviolentcrimewasalso

elevatedinDwight,Edgewood,WestRiver,LongWharfandotherpartsoftheDowntown,EastRock,FairHaven

andtheHill.


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Overthistime

period,Westville,

ProspectHill,East

Rock,FairHaven

Heights,EastShore

andaportionof

Downtownhadthe

lowestrateof

violentcrime.

ThedatainFigure

5arecrimerates

thatarecalculated

toallow

comparisonof

neighborhoodsof

differentsizes.A

crimerateisthenumberofcrimes

committedina

neighborhood

dividedbythe

numberof

neighborhood

residents.

However,crime

ratescanbe

misleadingsince

crimesmaybecommittedagainst

non-residents.This

may,inpart,

explainthehigh

crimeratesshown

within

neighborhoods,

suchasDowntown,

thathavealarge

daytime

(commuterand

visitor)population

relativetothetotal

numberofresidents.


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Whenexaminingandcomparingneighborhoods,itisimportanttonotethattheviolentcrimeratemaynotbe

uniformwithinagivenneighborhoodbutrathermaybeconcentratedinspecificareasorevenonspecificcity

blocks.Also,althoughmostcensustractscorrespondtoaneighborhoodarea,therearesomevariationsin

theseboundaries(forexample,EastRockandFairHavensharepartofthesamecensustract).

4.TheHealthEffectsofViolence-PhysicalinjuryDeathfromassault.Inordertobetterunderstandtheburdenofviolenceonaparticularcommunity,weoften

beginbylookingatthespecificcircumstancesofeachcrime.Deathcertificatesthatrecordassaultasacauseof

deathofNewHavenresidentsareanimportantsourceofinformationaboutmurder.Methodsforidentifying

thesedeathcertificatescanbeseeninAppendix1.

In2007and2008,assaultwaslistedasacauseofdeathfor30NewHavenresidents:11in2007and19in2008.

Assaultwaslistedastheprimarycauseofdeathfor29ofthese,whichisequivalenttoanannualizedincidence

rateof12per

100,000NewHaven

residents.

Firearmswerethe

mechanismofassault

for87%(26/30),

equivalenttoan

annualizedincidence

rateof10per

100,000NewHaven

residents.Similarly,

firearmswerethe

mostcommon

methodofhomicide

orlegalintervention

deathsinthe16US

statesmonitoredby

theUSNational

ViolenceDeath

ReportingSystemin

2007.Theyaccounted

for66%ofmurders

(72%ofmalesand

46%offemales).

Adescriptionofthefirearmsdeathsin

NewHavencanbe

seeninTable1.Sixty-

twopercentofthose

murderedwereBlack

and38%where

Hispanic.The


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majorityweremalesandundertheageof29.Theoldestwereintheirforties.Abouthalfwerehighschool

graduates,while36%didnotgraduatehighschool.Occupationinformationwasnotavailablefor7people.It

isnotclearifthisisbecausetheywereunemployedorthedataweremissingforsomeotherreason.Three

weresmallbusinessproprietors/contractors,2werestudentsandonewasreportedasdisabled.Otherswere

primarilyemployedinconstruction,manufacturingandserviceindustries.Thevastmajorityofassaults

occurredoutside,inthestreet,onthesidewalkorinaparkinglot(81%).Thedeathsdidnotshowaclear

seasonalitybutwereclusteredintime.Halfofthedeathsoccurredin3one-monthperiods:6inJune2007,3

inApril2008and4inSeptember2008.

TheleadingcausesofdeathtoNewHavenresidentsfor2007and2008combinedcanbeseeninTable3.In

2007and2008,assaultwastheprimarycauseofonlyasmallproportionofallthedeathsthatoccurredtoNewHavenresidents(29/1685=1.7%).Itaccountedfor3.3%ofthedeaths(27/816)amongmales.Forsome

populationgroups,assaultwasamuchmorefrequentcauseofdeath.Itwastheleadingcauseofdeathfor

Males15to39.Inthisgroup,itaccountedfor31%ofdeaths(23/75).ForBlackandHispanicmales15to39it

accountedfor38%ofdeaths(23/60).

Giventhatmostmurdervictimswereyoungmenwhowouldotherwiselikelyhavemanyyearsoflifeaheadof

them,assaultwasanimportantcauseofprematuredeathinNewHavenin2007-2008(Table3).Although


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assaultisarelativelyuncommoncauseofdeathforresidentsofthecityasawhole,itaccountedfor1,063years

ofpotentiallifelosttoage65,almostasmanyasformalignantneoplasms(cancer),heartdisease,andaccidents

(unintentionalinjury).

ThedatapresentedherestronglysuggestthatassaultisanimportantcauseofprematuredeathinNewHaven

particularlyamongBlackandHispanicmenandthatmostofthedeathsresultfromgunfire.However,the

resultsshouldbeinterpretedwithsomecaution.Giventherelativelysmallnumberofdeathsfromassaultinthe

citythedatamayvaryfromyeartoyear.

EmergencyDepartmentvisitsforassault.Dataondeathsfromassaultonlyprovideapartialpictureofthe

physicalinjurycausedbyviolence.Manymorepeoplesuffernon-fatalthanfatalinjuriesfromviolence.Hospital

emergencydepartmentsareonesourceofinformationonfatalandnon-fatalassaults.Theannualizedincidence

rateofemergencydepartmentvisitsforassaultamongNewHavenresidentsfrom2000-2004was669per

100,000residents(95%CI:648-689).ThisiscomparedtotheratesinStamford,Bridgeport,Waterburyand

Hartfordof302,723,731and1134,respectively10.

DataontheageandsexofNewHavenresidentsgoingtotheEmergencyDepartmentforassaultarenot

available.However,datafortheStateaffirmthatinjuryfromassaultlikefromfatalinjuryismorecommonformen,theyoung,andpeoplewhoareBlackorHispanic.Thehighestassaultrateswereinthose20-24.The

assaultratewas86%higherformalesthanfemales,and5timeshigherfornon-Hispanicblacksand4times

higherforHispanicsthanforWhitenon-Hispanics10.

Informationonemergencyroomvisitsforassaultisintendedtorepresentmoresevereinjuryfromviolence.

However,itislikelytoalsoincludelesssevereinjuriesforpeoplewhousetheemergencyroomforprimarycare.

Thiscouldaccountforsomeofthevariationbetweencitiesanddemographicgroups.

Although87%ofmurdersinNewHavenwerecausedbygunfirein2008,asdescribedabove,mostoftheinjuries

fromassaultseenwithintheseemergencyroomvisitsdonotappeartobeasaresultofwoundsfromgunfire.

TheConnecticut-wideemergencydepartmentvisitdatashowthatthemostcommonmechanismofinjuryby

assaultwasunarmedfightorbrawl(48%ofallassaults,71%withaknownmechanismofinjury).Firearmsaccountedforonlyaverysmallproportionofthese(1%ofallassaults,2%withaknownmechanismofinjury)

10.

Circumstanceoffatalassaults.InformationislimitedonthecircumstancesofassaultsinNewHaven.Brief

descriptionsofthefatalassaultsofNewHavenresidentsin2008aspresentedintheNewHavenmediaoutlets

aresummarizedinTable411,12,13.Thesedescriptionssuggestmanyofthedeathsweretheresultsofdisputes

betweenpeoplewhokneworknewofeachother.In2008onlyoneoftheNewHavendeathswasaresultofa

straybullet11.

MostshootingsthatresultedinfatalinjuryamongNewHavenresidentsin2007and2008occurredoutdoors.

81%(21/26)happenedinthissetting:10onthesidewalk,4inaparkinglotand7inthestreet.Theremainder

offirearminjuriesoccurredinaresidence(2),abar(1),avehicle(1)andanunspecifiedsetting(1).


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5.TheEffectsofViolenceBeyondPhysicalInjury

Asdemonstratedabove,prematuredeathfromviolenceresultsinmanypotentialyearsoflifelostinNew

Haven.Eachprematuredeathrepresentsatragedy.Moreover,violencecanpotentiallyhaveeffectsonhealth

andwellbeingthatgofarbeyondthephysicalorpsychologicalinjuriestothosewhowereassaulted.

Psychologicalmorbidityandbereavement.Exposuretocrimecancausepsychologicalaswellasphysicalharm.

Childrenwhoarevictimsofcommunityviolenceareatincreasedriskofpost-traumaticstressdisorder14.

Availableliteraturealsosuggeststhatchildrenwhoarevictimsofviolenceareatincreasedriskofdepression

andanxiety.Witnessingviolentcrimecanalsohavepsychologicalramifications.Childrenwhowitnesscriminal

victimizationalsoappeartobemorepronetodepressionandanxiety14.Violentexposurecanbeinterpreted

byachildtomean,notonlythathis/herworldisunsafe,butalsothathe/sheisunworthyofbeingkeptsafe.

Thissituationcancontributetonegativeselfperceptionsanddepression14.

Whenaviolenteventoccursinacommunityitisoftendiscussedwidely.Margolinetalsuggestthateven

childrenwhodonotdirectlywitnesscommunityviolenceoftenhearrepeatedaccountsofaspecificincidentandmayformtheirownmentalimage

14.Insupportofthisidea,Horowitzetalfoundthatamongurbanadolescent

girlsPostTraumaticStressDisorder(PTSD)wasassociatedwithhearingaboutviolentcrime15.Youthlivingin

violentcommunitiesmayexperiencepsychologicaladaptationsincludinghopelessnessanddesensitizationto

violence16.

Dataonthementalhealthconsequencesofexposuretocommunityviolenceinadultsarescarce17.Inasample

ofwomen,Kilpatricketalfoundthatexperiencingacompletedrape,lifethreatorsustainedinjurypredicted


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PTSD18.ThefindingsofBordeauxetalsuggestthatwomenrarelysufferPTSDaloneasaresultofcriminal

victimization.AsaresultofthePTSDtheysufferotherpsychologicaldisordersincludingmajordepression.

Clarketalfoundwitnessingcommunityviolenceinurbanneighborhoodsincreasedthelikelihoodofclinically

significantanxietyanddepressioninagroupofWhitewomenandLatinasintheNortheasternUnitedStates17.

Finally,bereavementforfamiliesandlovedoneswhoaredirectlyimpactedbyviolencehasbeenshowntobe

particularlytraumatic.Onestudyfoundthattwiceasmanymothersandfatherswhosechildrenweremurdered

metPTSD(fulldiagnostic)criteriawhencomparedwithaccidentandsuicidebereavement19.

Safetyandphysicalactivity .Peopleconcernedabouttheirsafetymaynotfeelcomfortablegoingoutdoors

withintheirneighborhoodsandthereforemaygetlessphysicalactivity.Limitedphysicalactivityisamongthe

contributorstothenationsgrowingproblemofobesity.

Twomajorsurveyeffortsofover2,400NewHavenresidents,the2009CAREsurveyandthe2010Community

ManagementTeamsNeighborhoodQualityofLifeSurvey,includedquestionsaboutneighborhoodsafety.

Thesesurveysdemonstratedthat66%and61%ofresidents,respectively,eitherstronglyorsomewhatagreed

thattheyfeltunsafetowalkintheirneighborhoodatnight;31%and15%,respectively,feltunsafetogoon

walksduringtheday.Perceptionsthatresidentsneighborhoodswerefreeofdrugs,gangsandprostitutionrangedfrommorethan80%intheEastShoreandEastRockneighborhoods,tolessthan50%inDixwell,Dwight,

andFairHaven.

Somestudieshavefoundanassociationbetweenneighborhoodsafetyandphysicalactivitybutthefindings

havenotbeenentirelyconsistent.Gomezfoundthatamong7thgradeMexican-Americangirlslivinginbarrios

inSanAntonio,Texas,violence(perceivedandobjectivelyassessed)wereassociatedwithdecreasedoutdoor

physicalactivity.This,however,wasnotthecaseforboys20.Inanationallyrepresentativesampleof

adolescentsingrades7to12,thosewholivedinneighborhoodswithhighlevelsofcrimeweresomewhatless

likelytoparticipateinfrequentmoderatetovigorousphysicalactivity.Twootherstudiesofperceived

neighborhoodviolenceandphysicalactivitydidnotfindanassociation(amongadolescentgirlsinurban

BaltimoreandadultsinurbanSt.Louis,MOandSavannah,GA21,22).Itisnotcleartheextenttowhichthemixed

resultsseenareafunctionofthesubstantialchallengesofmeasuringbothviolenceandphysicalactivity.

However,safetyconsiderationsdoappeartoaffectparents'decisionstoallowtheirchildrentoplayandwalk

outside23.Also,withaslightlydifferentwayoflookingatthetopic,Fishetalreportedthat,inasampleofadults

inLosAngeles,perceivingyourneighborhoodasunsafewasassociatedwithahigherself-reportedbodymass

index24.

Initsrecommendationstoreduceobesity,theCDCresearcherscitedabove suggestmonitoringthenumberof

abandonedbuildingswithinneighborhoodstodevelophyper-localindicatorsofneighborhoodsafetyand

walkability.Theypointoutthatinterventionstoimprovesafetycouldincludeincreasingpolicepresence,

decreasingthenumberofabandonedbuildingsandhomes,andimprovingstreetlighting.Othercitieshave

developedpedestrianenvironmentalqualityindices(PEQI)thatcantargetspecific,block-by-block

improvementstogeneralenvironmentalconditionsandsafetyforthecitysmanyresidentswhochoosetowalk.

Insomecases,safetyfearshaveledneighborhoodstoconductsuccessfulcommunityorganizingcampaigns,for

example,forimprovedlightingorpolicepresenceonbridgesreferredtoasmuggingalleys25.Relatedtothe

issueofunsafewalkingcorridors,dozensofcommentsonSeeClickFixinwhichresidentsdetailtheirneighbors

ortheirownexperiencesbeingmuggedwithinblocksoftheirhomes,onaformerlydarkbridge,areaclear

indicationofthelevelofconcern26.


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ResidentcommentsonVisioningaHealthierNewHavensurvey.TheNewHavenHealthEquityAlliance

recentlyconductedacampaignaskingresidentshowtheywouldenvisionahealthiercity.Urbanenvironmental

quality(e.g.,cleansidewalks,walkability)andpublicsafetywerethetwomostcommonthemesamongthe

approximately800writtensurveyresponsesand50video-recordedinterviews.Creatingthelinkbetweenliving

inaviolentenvironmentandstress,oneNewHavenresidentwrotethatahealthyNewHavenwouldlook:

morecivil,withfewergangbangertypes.Thestressoflivinginsuchacoarseenvironment,withsomuch

"frontin'"isgoingtogivemeaheartattack(notkidding--bloodpressurehasrisensignificantlysince

movinghere).Toomanymuggings,toomuchdisrespectbetweenandwithincommunities.

AnotherpersonwhoworksinNewHavenandhasthoughtaboutlivinginthecitywrote:

It'sagreatcitybuteverytimeIthinkaboutmovingintodowntown,there'sanotherincidentofrobberyor

worse.Fearofcrimeisatremendoussourceofstress.And,stressisnotgoodforhealth.

Anothermadethelinkbetweenviolenceandreducedphysicalactivitybysaying:

Therearesomegreatresourcesinthecityforoutdoorrecreation-EastRockPark,EdgewoodPark,

streetswithgreatsidewalkslikeWhitneyandProspect.ButwhenIgooutforarunin

Dixwell/Newhallville,thesidewalksareinpoorshape;I'veranafewtimesintheDwightneighborhood,

butit'spoorlylitatdawn/duskandIdon'tfeelsafe.IthinkthatahealthierNewHavenneeds(1)abetter

infrastructureforpeoplewhowanttobephysicallyactive,and(2)bettersafetymeasures,likelighting

andthoseblueboxesyoucancallinanemergency,tomakethosepeoplewhoareoutsidefeelsafe.

AnotherwroteofavisionforahealthyNewHavenbysayingthat:

AHealthyNewHavenhascleanandsafeparkswherekidscanplayandattendnatureandsports

activitieswithoutfear.

6.RiskandProtectiveFactorsforBeingInvolvedinViolence

Publichealthseekstoimprovecommunitysafetybyimplementingstrategiestopreventinjuryandother

adversehealtheffectsofcommunityviolence.Thedevelopmentofthesestrategiesshouldberootedinan

understandingofthefactorsthatincreasetheriskoforprotectagainstinvolvementinviolence.Thissectionwill

considercommunity-andsociety-levelcharacteristicsoftheenvironmentofNewHavenandothersimilarurban

Americanenvironmentsthatmayperpetuateviolence.

AsshowninFigure2,riskandprotectivefactorsmayoccurontheindividual,relationship,communityand

societallevel.Individualriskfactorsforcommittingviolenceincludeahistoryofviolentvictimization,substance

useantisocialbeliefs/attitudes.Protectivecharacteristicsincludedoingwellinschool,havingapositivesocial

orientationandbeingreligious.Relationship-levelriskfactorsthathavebeenidentifiedincludelowlevelof

parentalinvolvementandpeersthatareinvolvedinviolence.Protectivefactorsonthislevelinclude

connectednesstofamily,commitmenttoschoolandinvolvementinconstructivesocialactivities27.

EconomicOpportunity.DatafromtheHealthEquityIndex(HEI)showthatmeasuresofeconomicwellbeingare

poorforNewHavenwhencomparedtotheStateofConnecticutasawhole2.Sinceeconomicopportunityhas

beenidentifiedasariskfactorforviolence27,thismaybecontributingtothechallengeofviolenceinNew

Haven.


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Table5presentstheHealthEquityIndexeconomicwellbeingscoreforNewHavencomparedtotherestofthe

State.Compositescoresforeconomicsecurity,employmentandeducationwouldallbeconsideredpoor.

Thesescoressuggestthatopportunitiesforfulltimejobs,

orotherlegitimatewaysofmakingalivingandeducation

arelimitedcomparedtootherpartsofthestate.These

dataalsosuggestthatavailablejobsmayhavelimited

potentialforeconomicadvancementandsecurity.Food

serviceworkersrepresentahigherpercentageofthe

totalworkforceinNewHaventhaninConnecticut

overall,whereasmanagementworkersrepresenta

smallerpercentageoftheworkforce.Foodservicejobs

areamongthelowestpaidpositionswhenrankedbyannualearningsandoftencomewithminimalbenefits

andlittlejobsecurity.

DatafromtheHealthEquityIndex2alsodemonstrate

thatpooreconomicwellbeingisspecifictocertain

neighborhoodswithinNewHaven.Moreover,itappears

thatareasofthecitywithhighlevelsofviolentcrime,as

presentedinFigure5,alsotendtobeareaswithlowersocioeconomicstatus.Figures6-8presentmapsofthe

percentoftheadultswithabachelorsdegree,laborforceparticipationandmedianowneroccupiedhouse

value.ThesemapscomparesocioeconomicstatusofcensusblockgroupswithinNewHaven.

Figure 6


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Limitedeconomicopportunityandviolence. ThefindingsofaphotovoiceprojectconductedbytheRobert

WoodJohnsonClinicalScholarsProgramandtheNewHavenFamilyAlliancemayshedsomelightonhowalack

ofeconomicopportunitymayleadtoinvolvementinviolence.Theprojectusedacommunity-based

participatoryresearchmethodtoidentifytherootcausesofgunviolenceforNewHavenyoungpeople.The

photovoicemethodusedgaveparticipants(19peopleaged14-19years)camerasandaskedthemto

photographscenesfromtheircommunityrelevanttodifferentaspectsofviolenceanditsrootcausesintheir

community.Theseimageswereusedasthestimulusfor

focusgroupdiscussions.Thecontentsofthesefocus

groupswereanalyzedtoidentifythemesconcerningthe

rootcausesofgunviolence28.

Adolescentsandyoungadultsseektofindrespectanda

placeofstatusintheworld.Animportantthemeto

emergefromthephotovoiceprojectsisthattheyoung

peopleinvolvedsawlimitedlegitimateopportunityfor

establishingthatrespectandstatus.Insomecases,youth

viewedtheeconomicsystemwithsuspiciondueto

discriminationagainsttheirparents,cheatingorwhitecollarcrime.Inthiscontext,someyoungpeopleturnto

TheGame(illegaldrugtradeandgangs)toachieve

respect.Thereforethelackofopportunityencouraged

youthtoparticipateinactivitiesassociatedwithviolence.

Sincestatusandrespectcanbeconsideredaprotection

againstviolence,thesituationisselfperpetuating.Onefocusgroupparticipantwrote:

Itslike,OK,ifImoutinsociety,youknow,workingandstuff,OK,Idratherhaverespectthanfear...

Whenyououtsideonthestreets,youdratherbefearedthanrespected.Youdratherbefearedthan

respectedinthestreets,butinsociety,ofcourse,youwouldwantrespect.

Anothersaid:

Kidsturntothestreetsfortworeasons:one,itseasytogetthemoney.Youdontneedajob

application,youjustneedalittlecashandyoucanstarthustling.Two,theyrescaredtofail.Theydont

seerolemodelswhoaresucceedingoffthestreet,andtheyarescaredthatiftheymovepasttheir

comfortzone,theywontgetanywhere.

Violenceandtheneighborhoodenvironment.InNew

Haven,thePoliceDepartmenthasexaminedneighborhood

levelfactorsthatareassociatedwithviolentcrime.

Departmentanalyseshavefoundthatacombinationof

infrastructureservices(conveniencestores,

restaurants/cafes,bars,liquorestablishments,gasstations,

banks,etc),residencesofparoleesandreleasedprisoners,

drugmarketsandlocationsofdrugviolationsincertain

localitieshavestrongspatialrelationshipstoviolentcrime.

Basedonthisanalysis,about20%oftheareaofNew

Havenisconsideredhighriskforviolentcrimes.Inthe

Figure 7

Figure 8


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years2003to2010atleast75%oftheviolentcrimesthatoccurredintheCityhappenedintheseareas.

WhatexplainsthefindingsoftheNewHavenPoliceDepartmentonneighborhoodfactors,thanwhentaken

together,predisposeanareatocrime?Itiswellestablishedthatillegaldruguseanddrugtraffickingfuelviolent

crimeinmanycities29.Figure8showsthedistributionofnarcoticincidentsforSeptember2010asreportedin

theHavenIndependentCrimeLog.

Thegeographicaldistributionis

similartothedistributionofviolent

crimeratesasshowninFigure5.

Anumberofecologicalstudieshave

foundanassociationbetween

violenceandthedensityof

businessesthatsellalcohol30.

Gruenewaldetal30examinedthe

relationshipbetweenneighborhood

characteristicsandtherateof

hospitaldischargeforviolentassaultin1,637zipcodesinCalifornia.

Assaultsweremorelikelyindensely

populatedpoorminorityareaswith

unstableresidentialpopulations.

Aftercontrollingfortheeffectsof

thesepowerfulfactors,assaultswere

stillmorelikelyasthedensityofoff-

premisesalcoholoutletsincreasedin

anarea.Bars,however,wereonly

associatedwithanincreaseinthe

riskofassaultinparticularlypoorunstableneighborhoods.

Branasetal31identifiedallshootings

inPhiladelphiafrom2003to2006

andthenexaminedthe

characteristicsofeachpersonand

theplaces/hewasshot.They

matchedeachpersonwhowasshot

withacontrolwhowasnotshotandalsostudiedthatpersonandhis/herlocationatthetimeoftheshooting.

Theyalsoobservedthatbeinginaplacewithahighdensityofoutletsthatsoldliquorforconsumption

elsewhere(e.g.liquorstores,conveniencestores)doubledtherisk.Peoplewhowerebothheavydrinkersand

wereinareaswithahighdensityofoff-premisesliquoroutletshadover9timestheriskofbeingshot.Barswere

notfoundtoincreasetherisk.

Ahighdensityofalcoholoutletscouldincreasethelevelofviolencebecausealcoholismoreavailableinthese

areas.Alcoholappearstodisinhibitaggressionincreasingthelikelihoodthatsomeonewillcommitanassault30.

Intoxicationcouldalsoincreasetheriskofbeingassaultedifitreducesapersonsawarenessofapotentially

violentsituationorincreaseshis/herlikelihoodtoinstigateviolenceorover-reacttoaperceivedthreat31.If

intoxicatedpeoplecongregatenearliquorstoresthismayincreasethelikelihoodofviolenceinthearea.The


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tendencytowardviolencemaybeaccentuatediftheoutletsareinareasofweakersocialguardianship30asa

resultoflimitedpoliceinvolvement,retailconcentrationand/orneighborhoodinstabilitycausedbyillegal

activitiessuchasthedrugtradeandeconomicdisadvantage.

Finally,ahistoryofpriorcrimesorarrestsisariskfactorforcommittingafuturefelony.Amongfelony

defendantschargedwithviolentoffensesinlargeurbancountiesin2006,71%hadapriorarrest,62%prior

multiplearrests,53%atleastonepriorconviction,41%priormultipleconvictionsand35%priorfelony

convictions.Athirdofviolentcrimedefendantswereinvolvedwiththecriminaljusticesystematthetimeof

theirarrest(8%onprobation,11%onpretrialrelease,3%onparoleand6%other)32.

In2007,over1,200peoplewerereturnedfromtheConnecticutDepartmentofCorrectionstoNewHavenon

paroleorotherformofearlyreleaseandover2,800probationerslivedinNewHaven33.InNewHaven,

recidivismamongex-offendersisalargecontributingfactortocrimeinNewHaven.In2008,aboutthree

quartersofhomicidevictimsandsuspectsinNewHavenhadatleastonepriorfelonyconviction34.

Certaincharacteristicsareassociatedwithanincreasedlikelihoodofrecidivism.Amongthosereleasedfrom

DepartmentofCorrectionsinCTin2005greatersubstanceabuseproblemsandmentalhealthneedspredicted

anincreasedlikelihoodofrecidivismwithin3yearsofrelease.AboutaquarterthosereleasedinCTin2005hadreachedtheendofsentenceanddidnotreceiveanysupervisionfromparoleorprobation

35.Thisgroupwas

morelikelytorecidivatethanthosewhodidreceivecommunitysupervision.Recidivismcanbereducedby

initiativesthatassistex-offenderswithreentryintothecommunity.Theinitiativesincludefacilitatingaccessto

jobtraining,addictiontreatmentandidentificationcards34.

7.ConclusionsandNextSteps

ViolencetakesalargetollonthehealthandqualityoflifeofNewHavenresidents.Itisacity-widepublichealth

issuethatrequirestheattentionofall.However,theexperienceandeffectsofviolencearenotequallymanifest

acrossthecity.

Fatalinjurybyassaultisanimportantcauseofprematuremortalityinthecity.AmongNewHavenresidentsin

2007and2008,almostasmanypotentialyearsoflifetoage65werelosttomurderastocancer,heartdisease

andaccidents.Murderwasaleadingcauseofdeathfrommen15to29yearsofage.Mostofthefatalinjuries

werecausedbygunfireandoccurredinoutdoorspaces(street,sideways,parkinglots).Therewasalsoa

substantialburdenofinjuryfromassaultthatdidnotprovetobefatal.

TherearesignificantdisparitiesinNewHaven,withcertainneighborhoods,communitiesofcolor,andyoung

peoplebearingahugelydisproportionateburdenofthecosts.TheimpactonyoungBlackandHispanicmalesis

particularlypronounced.In2007and2008,murderaccountedfor39%ofthedeathsofBlackandHispanic

malesage1529.AllthosekilledbygunfireduringthatperiodwereBlackorHispanicmales.Theincidenceof

non-fatalinjuryfromviolencewasalsohigherforBlacksandHispanicsandformales.

Itisincreasinglyrecognizedthatwhereweliveisanimportantdeterminantofourhealthstatus,moresothan

manyotherfactors.ThisholdstrueinNewHaven.Intheyears2003to2010atleast75%ofviolentcrime

occurredin20%oftheareaofthecity.Areasofthecitywithhighratesofviolentcrimealsohavelow

economicstatusincludingpoorjobopportunitiesasindicatedbylowlaborforceparticipation.Morelimited

economicopportunity,inparticular,isaknownriskfactorforviolence.Reversingthepreponderanceofviolence


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intheseneighborhoodswillthereforerequireadecidedfocusontheunderlyingsocialandeconomicconditions

thatleadtoinstabilityandconflict.

Examplesofprogramstoreduceviolence.BlueprintsforViolencePreventionisaprojectthatidentifies

evidence-basedyouthviolenceanddrugpreventionprograms.Todate,ithasassessedmorethan800programs

fromwhichelevenmodelviolenceprogramshavebeenidentified.Theseprogramsaddressviolenceprimarily

ontheindividual-andrelationship-levelthroughtechniquessuchasschool-basedcurricula,individualandfamily

therapy,youthmentoringandhomevisits.Forexample,theBigBrother/BigSisterprogrammentorsyouth

typicallyfromsingleparenthomes.TheNurseFamilyPartnershipprovideshomevisitstoat-riskpregnant

women.TheFunctionalFamilyTherapyprogramprovidescounselingtothefamiliesofyouthwithmaladaptive

andacting-outbehaviors36.

Thereisadearthofresearchontheeffectivenessofcommunity-andsociety-levelinterventionsonviolence

prevention37.Inoneexample,theRANDCorporationevaluatedtheimpactofbusinessimprovementdistricts

(BIDs)onyouthviolenceinLosAngeles37.TheBIDswereself-organizinglocalpublic-privateorganizationsthat

collectedassessmentsandinvestedinlocal-areaserviceprovisionsandactivitiessuchasplacepromotion,street

cleaningandpublicsafety.Whiletheinterventiondidappeartodecreaserobberyratesithadonlyamarginal

effectonreducingthetotalviolentcrimerate.

TheCeaseFireChicagoprogramisanexampleofaviolencepreventionprogramthatincludesindividual-,

relationship-andcommunity-levelcomponents38.Theprogramfocusesonidentifyingasmallnumberof

individualswhowereathighriskofshootingorbeingshot.Outreachworkersprovidecounselingandservice

referralstotheindividuals.Otheroutreachworkers,referredtoasviolenceinterrupters,usetheirknowledge

ofthecommunitytoidentifyconflictsandprovidemediation.Muchoftheirtimeisspentworkingtoprevent

retaliatoryviolence.Additionally,theprojecthadcommunitymobilizationandpubliceducationcomponents

thataimatchangingcommunitynormsconcerningtheacceptabilityofusingviolencetoresolveconflicts.The

interventionactivelyinvolvesthepoliceintheoutreachandcommunitymobilizationefforts.Theevaluationof

thisprogramhasconcludedthatitdoessignificantlydecreasetheincidenceofshootingsandtheintensityof

shootinghotspots.However,anevaluationoftheOneVisionOneLifeprograminPittsburgh,whichwasmodeledaftertheCeaseFireChicagoproject,didnotfindittobeeffectiveinreducingviolence.

39

WorkingtowardaHealthierNewHaven:NextSteps.TheHealthEquityAllianceandHealthMatters!seekto

identify,developandadvancepoliciesthataddresstherootcausesofviolence.However,asdescribedabove

bestpracticesincommunity-andsociety-levelchangeshavenotbeenidentified.Inthiscontext,thisissuebrief

pointstonumerousareasforpolicychangeandstructuralinterventionthatareworthyofexploration:

Policiestoexpandjobopportunitiesforyouthandadultsandcontinuededucationopportunitiestoenablepeopletoaccessbetterpayingandsaferlessstressfuljobs;

PoliciestosupportphysicalimprovementstosectionsoftheCity,includingretailareas,experiencinghighincidenceofviolencesuchasbetterstreetlighting,reducedblightandimprovementstotransportation

facilities(sidewalks,busstops).Also,policiestoincreasecommunitystewardshipintheseareassuchasthe

expansionofcommunitypolicingprograms.

Policiesthatenableaccesstopositivesocialactivitiesforyouthandadultsbyopeningupschoolsandotherlocalvenuesforcommunityuse.


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Increasingdeterrenttohandgunuseinthecommissionofcrime.

Furtherenhancementofprisonerreentryprograms.

Finally,werecommendthat:

Asystematicreviewbeundertakenofcommunity-andsociety-levelviolencepreventionstrategiesimplementedinUScities.

TheCityofNewHavenadoptaprocess,suchashealthimpactassessment,tohelpguidedecisionsaroundthedesignanddevelopmentofneighborhoodsthatsupportsafeneighborhoodswithphysicallyactive

residents.

ThesearejustsomeexamplesofstepsthatNewHavenmightpursuetoeliminatedisparitiesforresidentswho

areundulyexposedtoviolenceintheirneighborhoods,andtoinstitutionalizepreventivemeasuresthatleadto

changedsocialnormsaroundviolence,andimprovedsocialandenvironmentalconditionsinallneighborhoods.

Someoftheseactionsarealreadyunderway,andlistedinAppendix2.Whatweneednextistoidentifythose

areasthatarestilllacking,andtotargetadditionalpolicyinterventionstoenhancetheworkthatispresently

occurring.

Ourcommunityseffortstoeliminateviolencewillnotonlyimpactoneofthemajorcausesofprematuredeath

inourcity,theywillalsoaddressabroadrangeofpublichealthconsequencesincludingthementalhealth

implicationsofexperiencingviolenceand/orlivinginanareathatisperceivedasunsafe,andthenegative

effectsoflivinginunsafeneighborhoodsonphysicalactivitylevelsofresidents.


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Appendix1.Methodsforidentifyingdeathsfromassault.

ConnecticutDepartmentofHealthsuppliesNewHavenHealthDepartmentwithdatasetsofelectronicdeath

recordsfromtheConnecticutDeathMasterFilesforNewHavenresidents.The2007and2008datasetswere

usedinthisanalysis.

DeathswithanICD10codeforassaultintheunderlyingcauseofdeathfieldoranyofthe20multiplecauseof

deathfieldswereconsideredassaultdeaths.ThesecodeswereX85toY09andY87.1.Ifoneofthesecodeswas

intheunderlyingcauseofdeathfieldassaultwasconsideredtheprimarycauseofdeath.


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Appendix2.ExistingPrograms&StrategiesinNewHaven.

Manyprogramshavebeendevelopedtoimprovecommunitysafety.School-basedandfamily-basedprevention

programsareabletoreduceyouthviolence.Programsinwhichformeroffendersmentoryouthathighriskfor

violencehaveshownsuccessinmanyurbanareas.Cognitivebehaviortherapymayreducethepsychological

harmthatchildrenendureduetoexposuretoviolence.Progressiveurbantrafficengineering,educationand

enforcementprogramshavereducedinjuriescausedbytrafficcollisions,whilegreatlyimprovingsafeaccessto

walking,masstransitandbicycling.Environmentaldesign(lighting,physicalcodeenforcement,improved

visibility,etc.)hasbeenshowntosignificantlyreduceopportunitiesforcriminalactivityandimprove

neighborhoodsenseofsecurity.

NewHavenPoliceDepartmentprograms

BlockWatchesandCommunityManagementTeams(CMTs)

LivableCityInitiative

Youth@Work

StreetOutreachWorkersProgram(CityofNewHaven/NewHavenFamilyAlliance)

NHPSSocialDevelopmentPrograms

NewHavenSafeStreetsCoalition

CityofNewHavenCompleteStreetsLegislation

NewHavenEarlyChildhoodCouncilFamilyEngagement

DomesticViolenceTaskForce

CitywideYouthCoalitionmemberprograms

CommunityMediation/PeerMediationinSchools

Mentoringprograms

NewHavenCollaborativeforYouth(behavioralhealth)

CommunityFoundationforGreaterNewHavenNeighborhoodsofChoice(e.g.,trafficcalminginChatham

Square)

YaleChildStudyCenterCommunityPolicingPartnershipandNationalCenterforChildrenExposedtoViolence

(NCCEV)

CliffordBeersGuidanceClinic

UnitedIlluminatingLighttheNight


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Appendix3.HealthEquityAlliance/NewHavenHealthDataWorkgroup

AmandaDurante,Epidemiologist,CityofNewHaven(Chairperson)

MarkAbraham,ExecutiveDirector,RegionalDataCooperativeofGreaterNewHaven(DataHaven)

ThomasButcher,ProjectDirector,RyanWhite,NewHavenHealthDepartment

BethComerford,DeputyDirector,Yale-GriffinPreventionResearchCenter

ShantaL.Evans,Director,NewHavenHealthEquityAlliance

LewisMadley,LaboratoryDirector,NewHavenHealthDepartment

ElaineOKeefe,ExecutiveDirector,OfficeofCommunityHealth,YaleSchoolofPublicHealth

JesseReynolds,DataAnalyst,Yale-GriffinPreventionResearchCenter

DavidSavage,Network for Community Engagement Coordinator,CommunityMediation,Inc.

ContactInformation

Aspartofthiswork,theHealthEquityAllianceactivelyseekscommunityfeedbackandquestionsaboutthe

informationwithinthisreport.Wealsowelcomeparticipationinourefforts.PleasecontactShantaEvans,the

HealthEquityAllianceDirector,[email protected](860)869-8779.

Creating a Healthy and Safe City

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