1. Violence Brian Ladds, M.D.

2. Violence Introduction Epidemiology/Trends –U.S vs. elsewhere –last 50 years vs. last decade Etiology/Risk Factors –Environmental –Biological

3. Introduction Medicine has undergone a paradigm shift –population health emphasis in health care delivery Violence is a ‘public health’ problem Role of physicians and specialists Place in medical education Surveys of doctors

4. Definition 4 major types of ‘violent crime’ –assault –robbery –rape –homicide

5. Homicide: Trends Among top 10 leading causes of death –‘Years of potential life lost’ (YPPL) –disproportionately affects young Homicide rate in US (~ 7/100,000) much higher than other ‘developed’ countries 1960-1990 dramatic increase 1990-2000 dramatic decrease

6. Causes of Violence Nature vs. nurture –controversies –newer model: dynamic interaction –example: low birth weight baby

7. Environmental factors Socio-economic –Absolute poverty –Economic inequality –Racial inequality and discrimination –‘Sub-cultures’ –Family disruptions Race Guns

8. Developmental Factors Physical abuse Witnessing domestic violence Media

9. Biological Factors Genetic: no –congenital, peri-natal? Gender Age

10. Biological Factors Neurologic dysfunction –Focal –Diffuse Neuro-chemistry Hormones Alcohol and illicit substances Mental disorders?