Article 1
Predicting and Preventing Gun Violence: An Experimental Evaluation of READI Chicago. Bhatt MP, Heller SB, Kapustin M, Bertrand M, Blattman C. The Quality Journal of Economics. 2024 Feb;139(1):1-56.
This study published in the Quarterly Journal of Economics evaluates a targeted community violence intervention (CVI), the Rapid Employment and Development Initiative (READI) Chicago, a program that works in five of Chicago’s highest-violence neighborhoods. The READI intervention offered men at high-risk of firearm related injury an 18-month subsidized and supported employment program, combined with cognitive behavioral therapy (CBT). At risk men were identified using a machine learning algorithm based on (1) administrative arrest and victimization records, (2) referrals from local outreach workers and (3) screening among those leaving prison and jail. 2,456 men from five of Chicago’s most violent communities were randomized to either a READI offer or a control group free to pursue other community-based services. The main outcome was violent-crime associated events, measured by shooting and homicide victimization, arrest or other serious violent-crime arrests (robbery, battery).
Participants in the intervention experienced very high rates of firearm-related violence, with 11 shootings and homicide victimizations for every 100 people in the control group. While the differences in violent crime across all three categories were not statistically different between the two groups, there was a 65% relative reduction in suicide and homicide-related arrests. In addition, participants referred by outreach workers, such as the HVIP specialists many of us have at our trauma centers, had the greatest decrease in serious violence involvement compared to matched controls. This translated into cost savings between $182,000 and $916,000 per participant and the authors estimated the benefit-cost ratio of READI to be least 4 to 1 and as high of 18 to 1, making this an incredibly valuable intervention.
This article published in a high impact economics journal highlights the challenges with evaluating community- and hospital-based violence intervention programs (HVIPs). Identifying appropriate individuals and outcomes to evaluate the efficacy of community violence work is complicated. Additionally, interventions that focus on individual behavioral modification without addressing the environments out of which interpersonal violence evolves may be unsurprisingly limited. In its own guidelines, EAST makes “no recommendations with respect to adult-focused HVIP interventions.” The mission of trauma centers to eliminate preventable deaths must extend to primary prevention. Moving efforts upstream to address the root causes of violent injury is both feasible and cost-effective as this study demonstrates. Identification of individuals at unacceptably high risk of socially costly firearm-related outcomes coupled with targeted interventions can effectively engage extremely disconnected and underserved population.
Article 2
Penalizing underage alcohol use is associated with lower mortality for young drivers: Use/lose laws and their association with motor vehicle collision mortality. Shin GJ, Zogg CK, Rice W, Xu R, Castillo-Angeles M, Swain S, Agarwal SK, Haines KL. J Trauma Acute Care Surg. 2025 Feb 1;98(2):212-218.
Unintentional injury remains the leading cause of mortality in children and adolescents, and motor vehicle accidents are the second most common cause of preventable deaths in children. Various laws introduced over the prior two to three decades have seen a decrease in driving while intoxicated, and by 1998 all states have adopted zero tolerance laws where if any underage driver with a BAL >0.02 g/dL must have their license suspended or revoked. Other laws known as use/lose laws result in license suspension after underage purchase, possession, or consumption of alcohol, but these laws vary by state. This study looked at the association between the revocation of such mandatory use/lose laws and MVC mortality involving young drivers (aged 15-20) at the state level. Data from the Fatality Analysis Reporting System and the Centers for Disease Control and Prevention’s Wide-ranging ONline data for Epidemiologic Research were used. Seven states had revoked such laws (SD, IN, GA, OR, PA, DE, IL) since 2010. A difference-in-difference model was used to help control for temporal changes and confounders. This included 3 years pre- and post-change in the law (where possible) relative to a national average from all other states without law changes. For all 7 states, mortality significantly increased anywhere from 5.4 to 45.4 excess deaths per million.
This population-based study has demonstrated a correlation between revoking one or more mandatory use/lose laws and young driver associated MVC mortality at the state level. The range of extra deaths per million is rather wide, and each state’s laws are different. There remain several potential confounding factors, such as other drug use and regulation (cannabis, narcotics), young people’s understanding and interaction with state laws, as well as how well these laws are enforced. These factors perhaps explain the wide-range of excess deaths per million between the 7 states, but the positive association between revoking mandatory use/lose laws for underage drinking and increased deaths of young people in MVCs involving a young driver is strong evidence to support reimplementation of these laws. At very least, this study points to the fact that research should be done prior to any change in legislation.
Article 3
US Medical-Legal Partnerships to Address Health-Harming Legal Needs: Closing the Health Injustice Gap. Johnson DY, Asay S, Keegan G, Wu L, Zietowski ML, Zakrison TL, Muntz N, Tung EL. J Gen Intern Med. 2024 May;39(7):1204-1213.
Addressing health-related social needs has been shown to improve health outcomes and reduce violent injuries. Health-harming legal needs (HHLNs), such as access to public benefits and housing, are a subset of health-related social needs that require coordination of both healthcare and legal services. Medical-legal partnerships (MLPs) work to address HHLNs by integrating the expertise and services of healthcare and legal professionals. The more than 450 MLPs across the United States have assisted 75,000 patients and have gained support from both governmental and professional organizations.
Using a database review of the last 15 years of literature, the authors expanded upon a 2023 scoping review showing positive outcomes of MLPs. This narrative review focuses on the structure and function of existing MLPs, screening and referral processes, services provided, and various outcomes. While MLPs team structures vary, the need for an interdisciplinary approach has led to a broad range of team members including physicians, lawyers, social workers, nurses, medical students, paralegals, law students, project coordinators, case managers, psychologists, dietitians, and business students. Many MLPs are housed within trauma centers, but others are using innovative strategies such as mobile vans or integrating into schools. Building legal needs screening into the electronic health record is a common approach for integrating screening into existing workflows. Common areas of MLP legal support include insurance registration, incorrect medical billing, acquiring government benefits, housing issues, and family law. Clinician training differs across MLPs and is not standardized. Evidence shows that nearly 90% of MLP cases led to positive outcomes, nearly 90% of patients felt they benefited from the services, enrolled patients reported fewer days with poor physical or mental health, participating clinicians felt more empowered to advocate for their patients, and hospital systems had a 319% return on investment based on recovered Medicaid dollars.
Not only does this review reinforce the numerous ways MLPs improve health outcomes and costs but also provides an overview about how MLPs function. MLPs are especially important for trauma surgeons who treat survivors of violence and other injuries. Addressing HHLN among this population is an especially important aspect of their recovery to ensure survivors can live safe and healthy lives after their injury.
