Event-Level Analysis of Antecedents to Firearm Violence Among Drug-Using ED

Carter, P. M., Walton, M. A., Epstein-Ngo, Q., Austic, E. A., Zimmerman, M., Blow, F., Chermack, S., Buu, A., & Cunningham, R. M. (2015). Event-Level Analysis of Antecedents to Firearm Violence Among Drug-Using ED Youth. Drug and Alcohol Dependence100(156), e38.


Aims: To examine/compare antecedents (substance use, motivations) of firearm violence (FV) and non-weapon (NFV) peer violence events among drug-using ED youth utilizing an event-level analysis.

Methods: 14–24-y/o youth screening positive for past 6-mo drug use and seeking ED care for assault (AIG) or as part of a proportionally sampled comparison group (non-assault injured) were enrolled (n = 599) in a 2-year longitudinal study. TLFB substance use/aggression modules were completed at baseline, 6, 12, 18 and 24-mos. FV (aggression/victimization; threats/use) and NFV events were combined across timepoints and analyzed cross-sectionally. Generalized linear mixed modeling (GLMM) using event-level data, nested by individual/timepoint, analyzed antecedents of FV events as compared to NFV events.

Results: 139 youth (mean age = 19.7; 82% male; 78% African-American; 73% public assistance; 84% AIG) reported 196 FV events and 243 youth (mean age = 19.9; 57% male; 61% African-American; 73% public assistance; 65% AIG) reported 592 NFV events. 24% of FV events involved aggression/93% victimization, with 37% of youth in FV events endorsing firearm possession (90% illegally). Most common motivation for firearm aggression was retaliation (53%), while “personal belongings” (25%) and “got shot for no reason” (30%) were the most common reasons for firearm victimization. 38% of FV events were preceded (within 3 h) by marijuana use, 17% by alcohol use, 10% by binge drinking. 61% of FV events resulted in injury requiring medical care. GLMM identified male gender (OR = 4.63), African-American (OR = 3.49), AIG (OR = 4.32), marijuana (OR = 2.22), retaliation (OR = 3.75) and personal belongings (OR = 2.79) as more likely correlated with FV when compared to NFV.

Conclusions: Drug-using youth have high rates of FV events with differential motivations and types of drug/alcohol use proceeding the event. Tailored interventions specifically addressing marijuana use and retaliation as precursors to FV may decrease high firearm violence rates among drug-using youth.

Keywords: Youth intervention, marijuana use and firearm violence, emergency department youth