Harvard University Project Descriptions
David Hemenway, PhD
Harvard University
School of Public Health
677 Huntington Avenue
Boston, MA 02115
Phone: 617 432 4493
Fax: 617 432 4494
E-mail: hemenway@hsph.harvard.edu
Project Title: Evaluation of State-level Firearms Policies
Project Period: 08/01/98-07/31/06
Description: The project consists of a systematic program for
evaluating public policies, technological innovations, and violence
prevention strategies involving firearms. Specific aims 1 through 4 pertain
to the initial focus on concealed gun carrying laws.
Aim 1: Extend and improve earlier work examining the effect of
concealed carry firearm regulations on aggregate categories of violent and
property crime, including murder, rape, aggravated assault, robbery,
burglary, and motor vehicle theft, using cross-sectional time series data
for the 50 United States for 1979 through 1997.
Aim 2: Evaluate the effect of permissive concealed carry regulations
on specific subcategories of crime, victims, and perpetrators. For a given
outcome, such as homicide, we will identify subgroups of the population for
whom concealed carry laws are expected to have an effect and 'control'
groups for whom such legislation is unlikely to have a material effect. For
example, middle-age white men are more likely than older black women to
obtain concealed carry permits and they are also more likely to be victims
of homicide outside the home. Homicide rates among middle-age white men
should thus be influenced more by changes in carry laws than are homicide
rates among older black women. Similarly, outcomes such as homicides by
strangers (which generally occur outside the home), might be affected by
passage of concealed carry laws, while such laws should have little effect
on homicides by family members (which generally occur inside the home).
Aim 3: Explore how well the observed patterns of associations between
concealed carry regulations and various crimes conform to various predictive
models from the criminology, economic, and public health literatures.
According to these predictive models, “shall issue” laws may produce effect
via four prime mechanisms: (1) deterring crime, (2) thwarting crime, (3)
increasing exposure to firearms, and )4) causing criminals to arm themselves
(arms race). For example, if concealed carry regulations deter criminals
from attacking victims who might be carrying a gun, homicides committed by
strangers (who would not know whether or not a victim was likely to be
carrying a gun) should decrease. If, however, concealed carry laws compel
criminals to better arm themselves (as in an arms race), homicides committed
by strangers and the percentage of such homicides due to handguns should
increase.
Aim 4: Examine the relationship between permissive concealed carry
regulations and noncriminal outcomes (e.g., the rates of suicide and firearm
accidents) using parsing strategies analogous to those described for crime
outcomes. To the extent that “shall issue” laws result in changes in firearm
carrying, concealed carry regulations change the exposure of individuals
(both carriers and those they encounter) to firearms. For example, the
proportion of suicides committed with a gun might increase for suicides that
occur out of the home but not for suicides that occur inside the
homeespecially among men.
Aim 5: Following evaluation of permissive concealed carry
regulations, evaluate the effect of child access prevention laws along with
at least one other firearm policy (e.g., waiting period regulations,
one-gun-a-month laws, design modification requirements, local rights or
preemption laws, secondary sales laws). To this end, a legislative history
for these laws will be compiled. In addition, using a ranking system like
that created by the Open Society Institute, a composite variable measuring
the overall permissiveness or restrictiveness of states' firearm-related
policies will be created, and this index will be used as an independent
variable in analyses. The resultant compendium of legislative
histories—drawing from National Rifle Association, Handgun Control, the
Bureau of Alcohol, Tobacco, and Firearms, and legal research—will be made
publicly available.
Project Title: Low-dose Alcohol, Cold Medications, and Maritime Safety
Project Period: 08/01/98-07/31/06
Description: Low doses of alcohol or therapeutic doses of
over-the-counter (OTC) cold medications may be important, but relatively
unexplored, sources of injury and error in the workplace. Although
impairment from these low-level exposures may pose small risks to
individuals, their aggregate effects might be considerable because of the
prevalence of exposures. Our research has shown significant decreases in
performance in simulated merchant operation when maritime academy cadets
were dosed with alcohol at levels between 0.04 and 0.05 g% blood alcohol
concentration (BAC). Since 0.04 g% BAC is by federal regulation the level
for intoxication for operation of several types of commercial vehicles
(trains, merchant ships, and aircraft), and nuclear power plants, our
previous findings raise the question of whether decreased performance would
occur at lower BACs. Research by others suggests that therapeutic doses of
OTC cold medications have impairing effects comparable to low doses of
alcohol.
In this project, we will conduct a dose-response, placebo-controlled trial
testing the effects of low-dose alcohol exposure (0.02, 0.03, 0.04 g% BAC)
on occupational performance. As with our previous research, the occupational
model will be merchant ship operation as measured by ship training
simulators. We will also conduct trials using the same research design to
measure the effects of first generation antihistamines and a non-sedating
OTC remedy. This will allow us to assess the risks associated with very
low-dose alcohol exposure and OTC cold medications and to compare directly
these effects. Secondary hypotheses will explore whether family history
mitigates the effects of alcohol on performance and whether a psychomotor
vigilance test detects low-level impairment and correlates with simulator
performance scores.
Project Title: Outcomes of Elderly Patients Hospitalized with Injuries
Project Period: 08/01/98-07/31/06
Description: Rates of mortality from injury increase with advancing
age, and the elderly constitute a disproportionate fraction of patients
hospitalized with injuries. Measures to ensure the quality of care for this
increasingly large segment of the population have been identified as an
important area of research.
Medicare billing data will be used to identify patients over ages 65 who
have been hospitalized after injuries and to categorize them by type of
injury, severity of injury, and pre-existing health status. For a given
injury in a patient with a given state of health, the expected mortality
(short- and long-term), acute hospital length of stay, and total
institutional length of stay (including rehabilitation and skilled nursing
facilities) will be determined. Further variation in these outcomes
concerning age, sex, region, hospital volume, and physician experience will
be evaluated.
This project will apply methods for using Medicare data in outcome studies
that have been previously developed and standardized by the investigators
and others. It takes advantage of the nearly complete participation of the
elderly population in the Medicare program, a unique beneficiary number
enabling linkage of Medicare records across files and over time, and the
availability of associated files describing hospitals, physicians, and
regional demography. Previously validated methods to estimate co morbidity,
classify injuries, and measure injury severity using administrative data
will be evaluated in the elderly population. Health Resource Regions
previously described in the Dartmouth Atlas of Health Care will be used as
the unit of regional analysis.
Having controlled for injury type, injury severity, and co-morbidity,
excessive variation in the outcomes dependent upon patient age, sex, region,
hospital volume, or physician experience may represent variability in the
quality of care. Acquainting providers and policy makers with this
variability may improve or standardize hospital care for patients of all
ages, and particularly for the elderly.
Project Title: Intentional Injury among Urban Youth
Project Period: 08/01/98-07/31/06
Description: The project will study 5,000 males and females, ages 2,
5, 8, 11, 14, and 17, residing in 80 neighborhoods in Chicago. These
children and their caregivers will be assessed twice during home-based
sessions to determine the source, frequency, and severity of intentional
injury and the consequences of such injury on their physical, psychological,
social, and academic functioning. Participants will also be interviewed
about gun ownership (self and family), gun carrying, and reasons for gun
ownership. Information will be obtained through structured interviews with
subjects (ages 7 and older) and one primary caregiver. Data collected in
these domains will be embedded in an ongoing study of the neighborhoods,
schools, families, and personal risk factors of the study participants. The
resulting combined data set will enable an interdisciplinary group of
researchers to achieve the following aims.
Aim 1: Determine the prevalence of intentional injury and its
variation by age, gender, race/ethnicity, and socioeconomic status in a
probability sample of 5,000 children, ages 2 to 17, in the city of Chicago.
Aim 1a: Determine the prevalence of gun ownership by
children/adolescents and their family members and its variation by age,
gender, race/ethnicity, and socioeconomic status.
Aim 2: Examine cross-sectionally the correlates of intentional injury
at community, school, family, and individual levels. Pursuit of this
objective will be based on community data obtained from multiple,
independent sources, including official records, surveys, and personal
interviews.
Aim 2a: Examine cross-sectionally the correlates of gun ownership at
community, school, family, and individual levels.
Aim 3: Determine, cross-sectionally, the relative risk for
intentional injury associated with the presence of a gun in the home,
independent of and in interaction with neighborhood levels of violence and
neighborhood levels of gun ownership.
Aim 4: Replicate the findings of Aims 1and 3 in a second round of
cross-sectional analyses, using a final wave of data collection.
Aim 5: Examine longitudinally the relationship between intentional
injury and psychiatric symptoms and disorders, physical health status, and
associated impairments in the areas of academic and social functioning.
Aim 6: Examine longitudinally the antecedents and multiple pathways
resulting in intentional injury.
Aim 6a: Examine longitudinally the antecedents and multiple pathways
leading to youth gun possession and carrying.
Aim 7: Determine, longitudinally, the relative risk for intentional
injury associated with the presence of a gun in the home, independent of and
in interaction with neighborhood levels of violence and neighborhood levels
of gun ownership.
Project Title: Estimating the Cost of Employing Partner Violence
Perpetrators
Project Period: 08/01/03-07/31/06
Description: The purpose of this project is to develop a measurement
tool for use in occupational settings that will identify perpetrators of
intimate partner violence and assess productivity level. The project
involves conducting background research necessary for developing the survey
items, creating a pilot survey, administering the survey to workers, and
assessing the validity of the measure.