About This Literature Summary
This summary of the literature on Crime and Violence as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note, the terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Incarceration literature summary.
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Any person can be affected by crime and violence either by experiencing it directly or indirectly, such as witnessing violence or property crimes in their community or hearing about crime and violence from other residents.1 While crime and violence can affect anyone, certain groups of people are more likely to be exposed. For example, the national homicide rate is consistently higher for Black adolescents and young adults than their White counterparts.2 Low-income neighborhoods are more likely to be affected by crime and property crime than high-income neighborhoods.3 Types of violence include, but are not limited to, child abuse and neglect, firearm violence, intimate partner violence, sexual violence, and elder abuse.4 In addition to the potential for death, disability, and other injuries, people who survive violent crime endure physical pain and suffering and may also experience mental distress and reduced quality of life.5,6 Specific examples of detrimental health effects from exposure to violence and crime include asthma, hypertension, cancer, stroke, and mental disorders.7
Individuals can experience different types of violence throughout the lifespan, and the negative health effects of violence can occur at any age. Decades of research has established a connection between adverse childhood experiences (ACEs) such as violence or abuse and lifelong health outcomes, including chronic disease and mental disorders.8 Children can be exposed to violence such as bullying or cyberbullying, abuse, or witnessing violence in a variety of settings, including at home or school, online, or in their neighborhoods.9 Children and adolescents exposed to violence are at risk for poor long-term behavioral and mental health outcomes, such as depression, anxiety, and post-traumatic stress disorder, regardless of whether they are victims, direct witnesses, or hear about the crime.10,11 Research has also shown an association between exposure to violence in childhood and an increased likelihood of experiencing intimate partner violence as an adult.12,13
In adulthood, exposure to violence can also lead to poor health outcomes. For example, women exposed to intimate partner violence have an increased risk of physical health issues such as injuries and mental disorders such as disordered eating, depression, and suicidal ideation.14 Older adults can also experience violence, including elder abuse or intimate partner violence.15 Evidence shows that older adults who experience elder abuse are more likely to experience increased stress and depression or develop fear and anxiety than those who do not experience elder abuse.16
There are serious short- and long-term health effects from exposure to crime and violence in one’s community. For example, one study found an association between gun-related violent crime in a neighborhood and a reduction in park use and park-based physical activity.17 Higher rates of neighborhood safety fears may lead to poorer self-rated physical and mental health.18 One study also found that higher rates of neighborhood crime were associated with increased odds for adverse pregnancy outcomes in Chicago.19 Community gun violence, which generally occurs in public spaces between non-related individuals, is a specific kind of violence that disproportionately affects Black and Hispanic/Latino communities.20 One study conducted in 4 U.S. cities found that people who were exposed to gun violence fatalities experienced higher levels of depression and suicidal ideation than those who were not exposed.21
Addressing exposure to crime and violence as a public health issue may help prevent and reduce the harms to individual and community health and well-being. Public health strategies to address crime and violence focus on building resilience and reducing susceptibility, building healthy gender norms, developing healthy relationships, and creating protective environments.7 The Community Preventive Services Task Force (CPSTF) recommends universal school-based programs that focus on skill-building related to emotional self-awareness and control, social problem-solving, and teamwork to reduce or prevent violent behavior among school-aged children. Besides schools, other places where violence interventions occur are hospitals. Hospital-based violence intervention programs that involve screening and intensive case management have been shown to be successful and cost-effective in reducing violent injury recidivism.22,23 Much of the evidence on strategies to prevent and reduce crime and violence focus on children and adolescents. Additional research and interventions are needed to address crime and violence throughout the entire life course.
Hartinger-Saunders, R. M., Rine, C. M., Nochajski, T., & Wieczorek, W. (2012). Neighborhood crime and perception of safety as predictors of victimization and offending among youth: A call for macro-level prevention and intervention models. Children and Youth Services Review, 34(9), 1966–1973.
Sheats, K. J., Irving, S. M., Mercy, J. A., Simon, T. R., Crosby, A. E., Ford, D. C., Merrick, M. T., Annor, F. B., & Morgan, R. E. (2018). Violence-related disparities experienced by black youth and young adults: Opportunities for prevention. American Journal of Preventive Medicine, 55(4), 462–469. doi: 10.1016/j.amepre.2018.05.017
Kang, S. (2016). Inequality and crime revisited: Effects of local inequality and economic segregation on crime. Journal of Population Economics, 29(2), 593–626.
Centers for Disease Prevention and Control. (2021, September 28). Violence prevention. https://www.cdc.gov/violenceprevention/
Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002). The world report on violence and health. Lancet, 360(9339), 1083–1088.
McCollister, K. E., French, M. T., & Fang, H. (2010). The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol Dependence, 108(1–2), 98–109. doi: 10.1016/j.drugalcdep.2009.12.002
American Public Health Association. (2018, November 3). Violence is a public health issue: Public health is essential to understanding and treating violence in the U.S. https://apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/28/violence-is-a-public-health-issue
Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141–149.
Moffitt, T. E., & Klaus-Grawe 2012 Think Tank. (2013). Childhood exposure to violence and lifelong health: Clinical intervention science and stress-biology research join forces. Development and Psychopathology, 25(4 Pt 2):1619–1634. doi: 10.1017/S0954579413000801
Jones-Webb, R., & Wall, M. (2008). Neighborhood racial/ethnic concentration, social disadvantage, and homicide risk: An ecological analysis of 10 U.S. cities. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 85(5), 662–676. doi: 10.1007/s11524-008-9302-y
Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A. J., & Baltes, B. B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology, 21(1), 227–259. doi: 10.1017/S0954579409000145
Beyer, K., Wallis, A. B., & Hamberger, L. K. (2015). Neighborhood environment and intimate partner violence: A systematic review. Trauma, Violence & Abuse, 16(1), 16–47. doi: 10.1177/1524838013515758
Raghavan, C., Mennerich, A., Sexton, E., & James, S. E. (2006). Community violence and its direct, indirect, and mediating effects on intimate partner violence. Violence Against Women, 12(12), 1132–1149. doi: 10.1177/1077801206294115
Stockman, J. K., Hayashi, H., & Campbell, J. C. (2015). Intimate partner violence and its health impact on ethnic minority women. Journal of Women’s Health, 24(1), 62-79.
Rosen, T., Makaroun, L. K., Conwell, Y., & Betz, M. (2019). Violence In older adults: Scope, impact, challenges, and strategies for prevention. Health Affairs (Project Hope), 38(10), 1630–1637. doi: 10.1377/hlthaff.2019.00577
Yunus, R. M., Hairi, N. N., & Choo, W. Y. (2019). Consequences of elder abuse and neglect: A systematic review of observational studies. Trauma, Violence & Abuse, 20(2), 197–213. doi: 10.1177/1524838017692798
Han, B., Cohen, D. A., Derose, K. P., Li, J., & Williamson, S. (2018). Violent crime and park use in low-income urban neighborhoods. American Journal of Preventive Medicine, 54(3), 352–358. doi: 10.1016/j.amepre.2017.10.025
Meyer, O. L., Castro-Schilo, L., & Aguilar-Gaxiola, S. (2014). Determinants of mental health and self-rated health: A model of socioeconomic status, neighborhood safety, and physical activity. American Journal of Public Health, 104(9), 1734–1741. doi: 10.2105/AJPH.2014.302003
Mayne, S. L., Pool, L. R., Grobman, W. A., & Kershaw, K. N. (2018). Associations of neighbourhood crime with adverse pregnancy outcomes among women in Chicago: Analysis of electronic health records from 2009 to 2013. Journal of Epidemiology and Community Health, 72(3), 230–236. doi: 10.1136/jech-2017-209801
Centers for Disease Prevention and Control. (2021, May 4). Firearm violence prevention. https://www.cdc.gov/violenceprevention/firearms/fastfact.html
Smith, M. E., Sharpe, T. L., Richardson, J., Pahwa, R., Smith, D., & DeVylder, J. (2020). The impact of exposure to gun violence fatality on mental health outcomes in four urban U.S. settings. Social Science & Medicine (1982), 246, 112587. doi: 10.1016/j.socscimed.2019.112587
Juillard, C., Cooperman, L., Allen, I., Pirracchio, R., Henderson, T., Marquez, R., Orellana, J., Texada, M., & Dicker, R. A. (2016). A decade of hospital-based violence intervention: Benefits and shortcomings. Journal of Trauma and Acute Care Surgery, 81(6), 1156–1161. doi: 10.1097/TA.0000000000001261
Juillard, C., Smith, R., Anaya, N., Garcia, A., Kahn, J. G., & Dicker, R. A. (2015). Saving lives and saving money: Hospital-based violence intervention is cost-effective. Journal of Trauma and Acute Care Surgery, 78(2), 252–258. doi: 10.1097/TA.0000000000000527