TY  - JOUR
PY  - 2018//
TI  - Exposure to community violence and self-harm in California: a multi-level, population-based, case-control study
JO  - Epidemiology
A1  - Matthay, Ellicott C.
A1  - Farkas, Kriszta
A1  - Skeem, Jennifer L.
A1  - Ahern, Jennifer
SP  - 697
EP  - 706
VL  - 29
IS  - 5
N2  - BACKGROUND: Self-harm is a leading cause of morbidity and mortality. Exposure to community violence is an important and potentially modifiable feature of the social environment that may affect self-harm, but studies to date are limited in the samples and outcomes examined. <br><br>METHODS: We conducted a population-based, nested case-control study. Cases were all deaths and hospital visits due to self-harm in California, 2006-2013. We frequency-matched California resident population-based controls from the American Community Survey to cases on age, gender, race/ethnicity, and year of survey/injury. We assessed past-year community violence using deaths and hospital visits due to interpersonal violence in the community of residence. We estimated risk-difference parameters that were defined to avoid extrapolation and to capture associations between changes in the distribution of community violence and the population-level risk of self-harm. <br><br>RESULTS: After adjustment for confounders, setting past-year community violence to the lowest monthly levels observed within each community over the study period was associated with a 30.1 (95% CI: 29.6 to 30.5) per 100,000 persons per year lower risk of nonfatal self-harm, but no difference in the risk of fatal self-harm. Associations for a parameter corresponding to a hypothetical violence prevention intervention targeting high-violence communities indicated a 5% decrease in self-harm at the population level. In sensitivity analyses, results were robust. <br><br>CONCLUSIONS: This study strengthens evidence on the relationship between community violence and self-harm. Future research should investigate reasons for differential associations by age and gender and whether community violence prevention programs have meaningful impacts on self-harm.<p />  <p>Language: en</p>
LA  - en
SN  - 1044-3983
UR  - http://dx.doi.org/10.1097/EDE.0000000000000872
ID  - ref1
ER  -