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The Association Between Area-Level Gun Violence and Child and Adolescent General Health Status Across the United States, 2020 – 2022 Nandita Somayaji* Nandita Somayaji Emily Knapp Marie L. Churchill Cassandra Crifasi Judy L. Aschner Theresa M. Bastain Traci A. Bekelman Courtney Blackwell Patricia A. Brennan Carrie V. Breton Carlos A. Camargo, Jr. Nicholas Cragoe Lisa Croen Amy J. Elliott Assiamira Ferrara Jody M. Ganiban Rima Habre Theresa Herrera Alison E. Hipwell Kelly A. Hirko Zoe Baysdorfer Kaplan Margaret R. Karagas Barry M. Lester Leslie D. Leve Kristen Lyall Cindy T. McEvoy Kimberly S. McKee Richard K. Miller Hooman Mirzakhani Jenae Neiderhiser Thomas G. O’Connor Mike O’Shea Amy Padula Christina A. Porucznik Annemarie Stroustrup Aruna Chandran
The impact of gun violence on youth health in the United States is a vital public health issue. With gun violence data limitations and research policy restrictions, gaps remain in characterizing the population health burden. This study explores the association between area-level gun violence and general health status of youth nationwide leveraging individual-level data from the Environmental influences on Child Health Outcomes (ECHO) study. 12,902 youth aged 0-18 and parents reported general health status with the most recent reporting used for the study. Gun violence incidents, defined as any death or injury caused by a gun, were extracted from the publicly available Gun Violence Archive by county between 2020 and 2022. Counts of county-level gun violence incidents were categorized into tertiles: high ( ≥ 232), medium (27 – 231), and low (≤ 26). A generalized estimating equation logistic model with robust variance was used to estimate the association between binary general health status (good/fair/poor vs. excellent/very good) and county-level gun violence incidents adjusting for imputed individual and county-level sociodemographic covariates. In low gun violence counties, most participants identified as White (81%), followed by other races (12%) and Black (7.5%). Contrastingly, in counties with high gun violence, 42% reported White race, 37% Black, and 21% Other races. Odds of reporting excellent/very good general health was 35% higher in counties with low gun violence compared to those with high gun violence (OR = 1.35, 95% CI: 1.08, 1.70). Additionally, there were higher odds of reporting excellent/very good general health status in low compared to medium gun violence counties (OR = 1.22; 95% CI: 1.04, 1.43). Findings reiterate that higher levels of gun violence associate with poorer general health status in youth, even when adjusting for socioeconomic indicators. This data linkage will allow further research on the impact of gun violence across the life course.