Date: Sat, 16 Apr 1994 05:08:45 -0400 (EDT) From: "Gary N. Greenberg, MD" Subject: MMWR: Homocide < 18 y/o, Georgia Resent-to: occ-env-med-l-expand@mc.duke.edu To: List OccEnvMed Errors-to: eoccmed@mc.duke.edu Reply-to: occ-env-med-l@mc.duke.edu Resent-message-id: <01HB8C4DRT0Y003QKP@mc.duke.edu> Message-id: X-VMS-To: IN%"occ-env-med-l-forward@mc.duke.edu" "List OccEnvMed" MIME-version: 1.0 Content-type: TEXT/PLAIN; charset=US-ASCII Content-transfer-encoding: 7BIT Comments: Occupational & Environmental Medicine This is broadcast from the Occ-Env-Med-l Mail-list, which originates at Duke University Medical Center. Readership is intended to be clinicians and other health professionals interested in the medical and preventive aspects of occupational and environmental health. To subscribe, send a single line message to mailserv@mc.duke.edu Subscribe OCC-ENV-MED-L "your-name" Questions to Gary Greenberg: green011@mc.duke.edu To reply or post to the list, use occ-env-med-L@duke.mc.edu Current Trends Homicides of Persons Aged Less Than or Equal to 18 Years -- Fulton County, Georgia, 1988-1992 Homicide is a major cause of death among persons aged less than or equal to 18 years in the United States; among black males aged 15-24 years, homicide is the leading cause of death (1). Most efforts to characterize homicide among persons aged less than or equal to 18 years have used databases at the national level (2-5) rather than at the state or local level or have been restricted in scope to specific types of homicides (e.g., gang-related homicide [2]). This report summarizes an epidemiologic study of homicides that occurred among persons aged less than or equal to 18 years in Fulton County (Atlanta), Georgia (1990 population: 648,951), from 1988 through 1992. All known or suspected homicides occurring in Fulton County are reported to the Fulton County Medical Examiner (FCME) for investigation of the cause, manner, and circumstances of death. FCME death investigation data for 1988 through 1992 were reviewed to identify cases of homicide among persons aged less than or equal to 18 years that resulted from an intentional act of commission or omission by another person regardless of the perpetrator's degree of intent. Information analyzed included the decedent's demographic characteristics, the circumstances and cause of death, toxicologic findings, the involvement of firearms in the death, and, when available, demographic data about the perpetrator(s). A person was classified as a perpetrator on the basis of police reports and district attorney records indicating that that person was a primary suspect or was arrested or charged with the homicide. During the 5-year period, FCME certified 141 homicides of persons aged less than or equal to 18 years, accounting for 12% of all homicides in the county. Of the 141 homicides, 107 (75%) occurred among adolescents aged 13-18 years; eight (6%), among children aged 7-12 years; and 26 (19%), among children aged less than or equal to 6 years. The overall homicide rate for persons aged less than or equal to 18 years was 14.1 per 100,000, compared with 37.8 per 100,000 for persons of all ages; the rate for males (20.0 per 100,000) was more than threefold higher than for females (5.8 per 100,000). Rates were highest among adolescents aged 13-18 years (35.7) and among infants (i.e., children aged less than 1 year) (17.4) and higher among black persons aged less than or equal to 18 years (24.5) than persons of other races (2.5). Of the 141 homicides, 110 (78%) resulted from the use of firearms. Firearms accounted for 98 (92%) of the 107 homicides among adolescents aged 13-18 years, compared with six (75%) of the eight deaths among children aged 7-12 years, five (33%) of the 15 deaths among children aged 1-6 years, and one (9%) of 11 deaths among infants. Deaths resulting from blunt-force injury accounted for 16 (11%) of the deaths, and the proportion of deaths from blunt force was higher among younger decedents: such deaths accounted for seven (64%) of the homicides among infants, seven (47%) among children aged 1-6 years, and two (2%) among those aged 7-18 years. Eight (6%) deaths were caused by sharp force (including stabbing and cutting), and seven (5%) resulted from other causes (e.g., asphyxia). Of the 110 firearm-associated deaths, 58 (53%) resulted from the use of handguns. Investigative findings suggested that 14 (13%) other homicides may have resulted from the use of handguns. Six (5%) of the firearm-associated deaths resulted from the use of a rifle (including one assault rifle) and four (4%) from the use of a shotgun. In 28 (25%) deaths, bullets were not recovered or records did not indicate bullet or gun type involved. Overall, 86 (61%) of the homicides occurred outdoors. Homicides occurred indoors at home for 19 (73%) of 26 children aged less than or equal to 6 years, three (38%) of eight children aged 7-12 years, and 12 (11%) of 107 adolescents aged 13-18 years. Of the 86 homicides that occurred outside and away from home, 48 (56%) occurred in a "parking lot," on a "sidewalk," or "on the street"; three occurred at school; and nine involved victims who were in vehicles. Nineteen of the homicides occurred on a Monday; 23 on a Tuesday; 19 on a Wednesday; 17 on a Thursday; 15 on a Friday; 28 on a Saturday; and 20 on a Sunday. Most homicides (72 [51%]) occurred between 6 p.m. and midnight; 27 (19%), between midnight and 6 a.m.; 12 (9%), between 6 a.m. and noon; and 29 (21%), between noon and 6 p.m. In 20 (14%) cases, a motive was not apparent. Of the 121 homicides for which a motive was determined, 29 (21%) deaths involved illicit drug activity as a precipitating motive, 14 (10%) resulted when the perpetrator was attempting to kill someone else, 14 (10%) were caused by perpetrators who were allegedly "playing" with a gun, 14 (10%) occurred under circumstances indicating child abuse or neglect, 11 (8%) resulted from "drive-by shootings," 11 (8%) were caused by a family member, and 11 (8%) were associated with robbery. Toxicology testing of 131 decedents detected ethanol in 21 (16%), cocaine in 17 (13%), and marijuana in 11 (8%). At least one drug (including ethanol) was detected in 44 of the 101 decedents aged 13-18 years who were tested. The identity of a perpetrator was known to law enforcement officials when they began their investigation in 56 (40%) of the cases. As of February 28, 1993, records of the police and district attorney indicated that 100 suspects had been identified or arrested for 82 (58%) of the homicides. Of the 100 persons, 90 were of the same race as the victim, 82 were males of the same race as the victim, and 46 were aged less than or equal to 18 years. Reported by: R Hanzlick, MD, Dept of Pathology, Emory Univ School of Medicine; M Koponen, MD, Fulton County Medical Examiner's Office, Atlanta; V Floyd, MD, Maternal and Child Health Br, K Toomey, MD, State Epidemiologist, Div of Public Health, Georgia Dept of Human Resources. National Center for Injury Prevention and Control; Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC. Editorial Note: In Fulton County, a high percentage of homicides among persons aged less than or equal to 18 years were associated with firearms, a finding consistent with previous reports (2-4,6,7) describing homicide among children and young adults. Previous reports also have documented higher rates of homicide among infants and children of preschool age and adolescents (8). Based on the findings in Fulton County and previous reports, prevention strategies should recognize that younger children are more likely to be victimized indoors, at home, and by family members who use blunt force, shaking, or methods other than firearms (7), and homicides among adolescents occur away from home and outdoors and are perpetrated by nonfamily members using firearms (2,4,6). In Fulton County, black males were at highest risk for homicide; however, birth-, maternal-, or education-related risk factors were not evaluated. Race may be a marker for these and other potential risk factors for homicide (e.g., socioeconomic status) (9). The definition of perpetrator used in Fulton County was necessary because insufficient time had elapsed in some cases to allow for legal disposition of the case and because of other factors (e.g., difficulty in identifying a perpetrator because of plea bargaining and case complexity). However, nearly half of known or suspected perpetrators were aged less than or equal to 18 years, illicit drug activity was the suspected motive cited most commonly, and most decedents and perpetrators were of the same race. These findings suggest that programs to prevent homicide among persons aged less than or equal to 18 years could be integrated with drug-abuse prevention programs. The reduction of homicide among children and young adults is a national health objective for the year 2000 (objective 7.1) (10). Studies to characterize homicide at the local level--such as that in Fulton County--will be critical for developing local prevention and intervention strategies (3,4). Law enforcement, public health, criminal justice, and other agencies in Fulton County are developing programs to monitor homicide occurrence and plans to use that information to assist in reducing homicide in persons aged less than or equal to 18 years. References 1. CDC. Homicide among young black males--United States, 1978-1987. MMWR 1990;39:869-73. 2. Rogers C. Gang-related homicides in Los Angeles County. J Forensic Sci 1993;38:831-4. 3. Fingerhut LA, Ingram DD, Feldman JJ. Firearm homicide among black teenage males in metropolitan counties: comparison of death rates in two periods, 1983 through 1985 and 1987 through 1989. JAMA 1992;267:3054-8. 4. Fingerhut LA, Ingram DD, Feldman JJ. Firearm and non-firearm homicide among persons 15 through 19 years of age: differences by level of urbanization, United States, 1979 through 1989. JAMA 1992;267:3048-53. 5. Griffith EE, Bell CC. Recent trends in suicide and homicide among blacks. JAMA 1989; 262:2265-9. 6. Ropp L, Visintainer P, Uman J, Treolar D. Death in the city: an American childhood tragedy. JAMA 1992;267:2905-10. 7. Adelson L. Pedicide revisited: the slaughter continues. Am J Forensic Med Pathol 1991;12:16-26. 8. Sorenson SB, Richardson BA, Peterson JG. Race/ethnicity patterns in the homicide of children in Los Angeles, 1980 through 1989. Am J Public Health 1993;83:725-7. 9. CDC. Use of race and ethnicity in public health surveillance: summary of the CDC/ATSDR workshop. MMWR 1993;42(no. RR-10). 10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.