Lauren A. Magee

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https://hdl.handle.net/1805/35563

The Hidden Consequences of Exposure to Firearm Violence

Dr. Lauren Magee's interdisciplinary research intersects the fields of public health and criminal justice and focuses on how social determinants of health, poverty, and neighborhood dynamics influence violence and other health outcomes among adolescents and young adults. Her research takes a mixed-methods approach by leveraging police and health care data linked at the individual level and through qualitative interviews with victims to identify opportunities for intervention, with specific emphasis on individuals with mental illness, substance use disorders, and those involved in firearm violence.

Firearm injuries surpassed vehicle-related accidents as the leading cause of death among children and youth in the US in 2020. Little research has focused on nonfatal firearm injuries, despite being four times more prevalent than firearm fatalities. Individuals who survive a firearm injury experience increases in adverse mental health outcomes, such as posttraumatic stress disorder, anxiety disorder, and depression disorder. Beyond the survivor, family members also suffer increased subsequent mental health needs and communities more broadly are affected. This research examines mental health outcomes among family members of firearm injury survivors and explores engagement with mental health services among survivors.

Dr. Magee's translation of research into establishing resources for the victims of gun violence and their family members is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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    Patterns of adolescent gun carrying and gun-related crime arrests in Indianapolis, Indiana over an 11-year time period
    (Elsevier, 2020-10) Magee, Lauren A.; Dir, Allyson L.; Clifton, Richelle L.; Wiehe, Sarah E.; Aalsma, Matthew C.; Pediatrics, School of Medicine
    Adolescent males are disproportionately affected by homicide as both victims and offenders. Indianapolis has seen increases in youth homicides over the past few years; gun carrying increases an individual's risk for involvement in firearm violence. It is unclear how often youth are arrested for gun carrying and gun-related crimes. Examining these patterns may identify an opportunity for intervention. This study is a descriptive epidemiology analysis that examines patterns of gun carrying and gun-related crime arrests among justice involved youth in Marion County (Indianapolis), Indiana. We accessed juvenile court records from January 1, 2006 to December 31, 2016 on all individuals arrested for a gun carrying offense (i.e., illegal possession of a firearm or gun; n = 711) and all individuals arrested for a gun-related crime (i.e., homicide, robbery, aggravated assault; n = 150). Data were analyzed in fall 2019. Proportions of juvenile arrests for both gun carrying (47.0 per 1000 arrests) and gun-related crime (25.4 per 1000 arrests) have substantially increased compared to ten-years ago (4.5 per 1000 arrests and 2.0 per 1000 arrests, respectively). Of those arrested, 27.7 per 100,000 population were arrested for a repeated gun-related offense; of which 21.5 per 100,000 were first arrested for gun carrying and 6.2 per 100,000 were arrested for a gun-related crime. The majority of gun-related repeat offenders were first arrested for gun carrying; therefore, these gun-carrying arrests may be an opportunity to intervene on an individual level by providing treatment, other needed resources, and discussing safe firearm storage with families and communities.
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    Understanding Victim Cooperation in Cases of Nonfatal Gun Assaults
    (Sage, 2019-12) Kroovand Hipple, Natalie; Thompson Garrity, Kristina; Huebner, Beth M.; Magee, Lauren A.; School of Public and Environmental Affairs
    Victims play a central role in criminal case processing, but research suggests many victims do not report crimes to police or cooperate in a police investigation. This study extends the literature on victim cooperation by examining the effect of incident-level variables and neighborhood characteristics on victim cooperation in nonfatal shooting incidents. The sample includes 1,054 nonfatal shooting victims from two Midwestern cities. Results using binary logistic regression suggest that incident and victim characteristics are significantly associated with cooperation, but race conditions the effect of injury severity and motive on cooperation. The willingness to cooperate among Whites is contingent on injury severity while non-White victims do not become markedly more cooperative when confronted with serious injury. Race also moderates the relationship between crime motive and cooperation. This work demonstrates the need to incorporate nonfatal firearm violence into studies of victim cooperation and gun crime more broadly.
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    Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth
    (Elsevier, 2020-11) Dir, Allyson L.; Clifton, Richelle L.; Magee, Lauren A.; Johnson-Kwochka, Annalee V.; Wiehe, Sarah E.; Aalsma, Matthew C.; Psychiatry, School of Medicine
    Background Substance use is prevalent among justice-involved youth and given the risk of recidivism and other poor outcomes associated with substance use, justice systems have implemented efforts to improve substance use screening and connection to treatment. Although many justice systems use drug screening to monitor substance use, research on patterns of substance use based on drug screen records is lacking. The current study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. We also examined differences in these patterns of use and treatment referral and completion by race, ethnicity, and gender. Method We examined court records for N = 3440 youth with records of positive oral drug screen (ODS) between 2011 and 2016 to assess patterns of ODS results (e.g., number and of positive screens), court-ordered referrals to substance use treatment, and rates of treatment completion. Results Of 3440 youth with a positive ODS, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode; black youth ( OR = 0.54, p < .01) were less likely to have history of completing substance use treatment. Conclusion Our results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services. Additional research should identify barriers to substance use treatment completion among this population.
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    Sexually transmitted infections in association with area-level prostitution and drug-related arrests
    (Wolters Kluwer, 2020-12-15) Magee, Lauren A.; Fortenberry, J. Dennis; Nelson, Tammie; Roth, Alexis; Arno, Janet; Wiehe, Sarah E.; School of Public and Environmental Affairs
    Objectives: Examine the mediators and moderators of area-level prostitution arrests and sexually transmitted infections (STI) using population level data. Methods Using justice and public health STI/HIV data in Marion County (Indianapolis), Indiana, over an 18-year period, we assessed the overall association of area-level prostitution and drug-related arrests and STI /HIV, and mediators and moderators of the relationship. Point-level arrests were geocoded and aggregated by census block group. Results: Results indicate a positive relationship between numbers of prostitution arrests and area-level STI rates. There was a dose-response relationship between prostitution arrests and STI rates when accounting for drug-related arrests. The highest quintile block groups had significantly higher rates of reported chlamydia (IRR: 3.29, 95% CI: 2.82, 3.84), gonorrhea (IRR: 4.73, 95% CI: 3.90, 5.57), syphilis (IRR: 4.28, 95% CI: 3:47, 5.29), and HIV (IRR: 2.76, 95% CI: 2.24, 3.39) compared with the lowest quintile. When including drug arrests, the second (IRR: 1.19, 95% CI: 1.03, 1.38) and the third (IRR: 1.20, 95% CI: 1.02, 1.41) highest quintile block groups had lower IRR for reported rates of chlamydia, indicating that drug arrests mediated the prostitution arrest effect. Conclusions: These findings inform public health agencies and community-based organizations that conduct outreach in these areas to expand their efforts to include harm reduction and HIV/STI testing for both sex workers and individuals experiencing substance use disorder. Another implication of these data is the importance of greater collaboration in public health and policing efforts to address overlapping epidemics that engage both health and legal intervention.
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    The Extent and Nature of Gang Crime
    (Oxford UP, 2018) Magee, Lauren A.; Melde, Chris; School of Public and Environmental Affairs
    The purpose of this chapter is to review the evidence on the association between gangs, gang members, and crime, and to describe whether or not there is anything unique about the nature of offending attributable to gangs.
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    The Difference Between Living and Dying: Victim Characteristics and Motive Among Nonfatal Shootings and Gun Homicides
    (Springer, 2017-12-01) Hipple, Natalie Kroovand; Magee, Lauren A.; School of Public and Environmental Affairs
    Using both official and unofficial data sources, researchers examined nonfatal (n = 617) and fatal shooting (n = 159) victim characteristics over an 18-month period in Indianapolis. This research revealed that the typical shooting victim was male, non-White, almost 29 years old, had been arrested prior to inclusion in this study, and had been shot more than once. Interestingly, this research supports the notion that nonfatal shooting and homicide victims are different, especially as they relate to victim age, gunshot wound severity, and shooting motive. It highlights the need for better gun violence data collection beyond what currently exists. Striving for improved, more comprehensive cross-sector data collection has implications beyond just police policy and practice to include public health and prevention efforts.
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    Identifying victims of firearm assault in Indianapolis through police and clinical data
    (BMJ, 2020-05-01) Magee, Lauren A.; School of Public and Environmental Affairs
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    Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees
    (BMC, 2021) Magee, Lauren A.; Fortenberry, J. Dennis; Rosenman, Marc; Aalsma, Matthew C.; Gharbi, Sami; Wiehe, Sarah E.; School of Public and Environmental Affairs
    Background Individuals with mental illness and co-occurring substance use disorders often rapidly cycle through the justice system with multiple arrests. Therefore, is it imperative to examine the prevalence of mental health and substance use diagnoses among arrestees and repeat arrestees to identify opportunities for intervention. Methods We linked police arrest and clinical care data at the individual level to conduct a retrospective cohort study of all individuals arrested in 2016 in Indianapolis, Indiana. We classified arrestees into three levels: 1 arrest, 2 arrests, or 3 or more arrests. We included data on clinical diagnoses between January 1, 2014 and December 31, 2015 and classified mental health diagnoses and substance use disorder (SUD) based on DSM categories using ICD9/10 diagnoses codes. Results Of those arrested in 2016, 18,236 (79.5%) were arrested once, 3167 (13.8%) were arrested twice, and 1536 (6.7%) were arrested three or more times. In the 2 years before the arrest, nearly one-third (31.3%) of arrestees had a mental health diagnosis, and over a quarter (27.7%) of arrestees had an SUD diagnosis. Most of those with a mental health or SUD diagnosis had both (22.5% of all arrestees). Arrestees with multiple mental health (OR 2.68, 95% CI 2.23, 3.23), SUD diagnoses (OR 1.59, 95% CI 1.38, 1,82), or co-occurring conditions (1.72, 95% CI 1.48, 2.01) in the preceding 2 years had higher odds of repeat arrest. Conclusions Our findings show that linked clinical and criminal justice data systems identify individuals at risk of repeat arrest and inform opportunities for interventions aimed at low-level offenders with behavioral health needs.
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    Neighborhood variation in unsolved homicides: a retrospective cohort study in Indianapolis, Indiana, 2007–2017
    (BMC, 2020) Magee, Lauren A.; Fortenberry, J. Dennis; Tu, Wanzhu; Wiehe, Sarah E.; School of Public and Environmental Affairs
    Background Homicide is a widely acknowledged public health problem in the United States. The majority of homicides are committed with a firearm and have long-term health consequences for family members and entire communities. When left unsolved, violence may be perpetuated due to the retaliatory nature of homicides. Improving homicide clearance rates may help prevent future violence, however, we know little about the community-level social dynamics associated with unsolved homicides. Methods This study examines the individual-and-community-level social processes associated with low homicide clearance rates in Indianapolis, Indiana between 2007 and 2017. Homicide clearance is the primary outcome, defined as if a perpetrator was arrested for that homicide case between 2007 and 2017. Individual-level variables include the victim’s race/ethnicity, sex, and age. Community-level (i.e., census tracts) variables include the number of resident complaints against the police, resident complains of community disorder, income inequality, number of police interactions, and proportion of African American residents. Results In Indianapolis over a 11-year period, the homicide clearance rate decreased to a low of 38% in 2017, compared to a national clearance rate of 60%. Homicide case clearance was less likely for minority (OR 0.566; 95% CI, 0.407–0.787; p < 0.01) and male (OR 0.576; 95% CI, 0.411–0.807; p < 0.01) victims. Resident complaints of community disorder were associated with a decreased odds of case clearance (OR 0.687; 95% CI, 0.485–0.973; p < .01)., African American victim’s cases were less likely to be cleared in 2014–2017 (OR 0.640; 95% CI, 0.437–0.938; p < 0.05), compared to 2007. Conclusions Our study identified differences in neighborhood social processes associated with homicide clearance, indicating existing measures on these community factors are complex. Programs aimed at improving signs of community disorder and building community engagement may improve neighborhood clearance rates, lower violence, and improve the health of these communities.
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    A Solutions-Based Approach to Building Data-Sharing Partnerships
    (AcademyHealth, 2018) Wiehe, Sarah E.; Rosenman, Marc B.; Chartash, David; Lipscomb, Elaine R.; Nelson, Tammie L.; Magee, Lauren A.; Fortenberry, J. Dennis; Aalsma, Matthew C.; School of Public and Environmental Affairs
    Introduction: Although researchers recognize that sharing disparate data can improve population health, barriers (technical, motivational, economic, political, legal, and ethical) limit progress. In this paper, we aim to enhance the van Panhuis et al. framework of barriers to data sharing; we present a complementary solutions-based data-sharing process in order to encourage both emerging and established researchers, whether or not in academia, to engage in data-sharing partnerships. Brief Description of Major Components: We enhance the van Panhuis et al. framework in three ways. First, we identify the appropriate stakeholder(s) within an organization (e.g., criminal justice agency) with whom to engage in addressing each category of barriers. Second, we provide a representative sample of specific challenges that we have faced in our data-sharing partnerships with criminal justice agencies, local clinical systems, and public health. Third, and most importantly, we suggest solutions we have found successful for each category of barriers. We grouped our solutions into five core areas that cut across the barriers as well as stakeholder groups: Preparation, Clear Communication, Funding/Support, Non-Monetary Benefits, and Regulatory Assurances. Our solutions-based process model is complementary to the enhanced framework. An important feature of the process model is the cyclical, iterative process that undergirds it. Usually, interactions with new data-sharing partner organizations begin with the leadership team and progress to both the data management and legal teams; however, the process is not always linear. Conclusions and Next Steps: Data sharing is a powerful tool in population health research, but significant barriers hinder such partnerships. Nevertheless, by aspiring to community-based participatory research principles, including partnership engagement, development, and maintenance, we have overcome barriers identified in the van Panhuis et al. framework and have achieved success with various data-sharing partnerships. In the future, systematically studying data-sharing partnerships to clarify which elements of a solutions-based approach are essential for successful partnerships may be helpful to academic and non-academic researchers. The organizational climate is certainly a factor worth studying also because it relates both to barriers and to the potential workability of solutions.