Jay, J., Pino, E., Georges, M., Courtepatte, A., Harris, J., Gause, E., Abaya, R., Rothman, E. F., & Goldstick, J. (2026). Effects of a hospital based violence intervention program on community violence in Boston, Massachusetts: A target trial emulation. Annals of Internal Medicine. https://doi.org/10.7326/ANNALS-25-01678
Abstract
Background:
Hospital-based violence intervention programs (HVIPs) are widespread, but their effectiveness for violence prevention is unclear.
Objective:
To determine the effects of Boston Medical Center’s HVIP on future violence outcomes among violently injured young adults.
Design:
Target trial emulation using observational data.
Setting:
Boston, Massachusetts.
Participants:
Young adults aged 16 to 34 years who survived a shooting or stabbing.
Intervention:
Target trials of 2 treatment strategies using the same eligibility criteria, time zero, and control group were emulated: 1) any treatment: engaging with the HVIP within 1 month of injury and 2) sustained treatment: initiating within 1 month and engaging more than 4 of the first 8 weeks.
Measurements:
Combined measure of violent reinjury or violence perpetration at 1, 2, and 3 years, using hospital and police data.
Results:
1328 patients met criteria; 565 (42.5%) initiated within 1 month. Of these, 58 (10.2%) sustained engagement. In the any-treatment analysis, estimated cumulative incidence was roughly equal between the treatment and control strategies at 1, 2, and 3 years. In the sustained engagement analysis, treatment was associated with considerably lower cumulative incidence (4.5% [95% CI, 1.1% to 9.3%] at 1 year; 5.1% [CI, 1.1% to 9.3%] at 2 years; 6.4% [CI, 1.4% to 12.9%] at 3 years) versus the control strategy (8.7% [CI, 6.6% to 10.0%] at 1 year; 12.3% [CI, 10.2% to 14.5%] at 2 years; 14.3% [CI, 11.8% to 16.6%] at 3 years), with corresponding risk reductions of 47.6% (CI, −19.8% to 86.7%), 58.5% (CI, 21.6% to 91.2%), and 55.3% (CI, 4.9% to 90.2%). Confidence intervals were wide.
Limitation:
Despite our target trial emulation approach, results could be confounded by unmeasured factors associated with program engagement.
Conclusion:
Although HVIPs can improve long-term violence outcomes, these effects seem to require intensive participant engagement.
Primary Funding Source:
Fund for a Safer Future.