Bridging the Response to Mass Shootings and Urban Violence: Exposure to Violence in New Haven, Connecticut

Alycia Santilli, Yale School of Public Health
Kathleen O’Connor Duffany, Yale School of Public Health
Amy Carroll-Scott, Drexel University Dornsife School of Public Health
Jordan Thomas, Yale School of Public Health
Ann Greene, Yale School of Medicine
Anita Arora, Yale School of Medicine
Alicia Agnoli, Yale School of Medicine
Geliang Gan, Yale School of Public Health
Jeannette R. Ickovics, Department of Social and Behavioral Sciences, Yale School of Public Health


We have described self-reported exposure to gun violence in an urban community of color to inform the movement toward a public health approach to gun violence prevention.

The Community Alliance for Research and Engagement at Yale School of Public Health conducted community health needs assessments to document chronic disease prevalence and risk, including exposure to gun violence. We conducted surveys with residents in six low-income neighborhoods in New Haven, Connecticut, using a neighborhood-stratified, population-based sample (n = 1189; weighted sample to represent the neighborhoods, n = 29 675).

Exposure to violence is pervasive in these neighborhoods: 73% heard gunshots; many had family members or close friends hurt (29%) or killed (18%) by violent acts. Although all respondents live in low-income neighborhoods, exposure to violence differs by race/ethnicity and social class. Residents of color experienced significantly more violence than did White residents, with a particularly disparate increase among young Black men aged 18 to 34 years. While not ignoring societal costs of horrific mass shootings, we must be clear that a public health approach to gun violence prevention means focusing on the dual epidemic of mass shootings and urban violence.

Gun violence is one of the most pressing public health issues of our time; it has galvanized the nation’s attention since the 1999 Columbine High School shooting, which was followed by many other mass shootings, including the most recent shootings in Orlando, Florida, in June 2016 and Dallas, Texas, in July 2016. In 2015, there were 332 mass shootings, defined as shootings in which four or more people are killed with firearms at one time.

Although the media focuses on mass shootings, 88 Americans die every day from gunshot wounds as a result of suicide or homicide. Gun violence consistently ranks as a top-five leading cause of death for those aged 1 to 44 years; more than 30 000 people die from a firearm-related injury in the United States annually, accounting for one in six injury deaths.

Gun violence disproportionately occurs in communities experiencing social and economic inequities, including residential racial segregation and concentrated poverty. In 2015, 369 people died in mass shootings in the United States; that same year, nearly 6000 Black men were murdered with guns. Although Black men make up only 6% of the population, they represent more than one half of gun homicide victims.

The impacts of gun violence extend far beyond the victim, resulting in long-term adverse effects on community well-being. More than 20% of injured trauma survivors have symptoms consistent with a diagnosis of posttraumatic stress disorder even after acute care or inpatient hospitalization. Among children, witnessing community violence is a risk factor for substance abuse, aggression, anxiety, depression, and antisocial behavior. These behaviors contribute to the cycle of violence, as adolescent delinquency and substance use are predictive of violent offenses and substance use in adulthood. These adverse events also have been associated with other negative health risks and outcomes in adulthood such as smoking, physical inactivity, sexual risk taking, and suicide attempts.

Research has demonstrated that urban violence is associated with neighborhoods characterized by social disorder, such as less social cohesion and collective efficacy among residents, and by physical deterioration of urban landscapes, such as vacant lots and buildings, abandoned cars, and graffiti. It is theorized that this lack of informal social control leads to a sense that violence and crime are tolerated, which results in poorer quality of life for all residents; further breakdown of social cohesion and collective efficacy to address these behaviors; and the cyclical perpetuation of violence, neighborhood stigma, and socioeconomic and health inequities.

Since 2009, the Community Alliance for Research and Engagement at the Yale School of Public Health has conducted a triennial community health needs assessment in the six lowest-income New Haven, Connecticut, neighborhoods to document chronic disease prevalence and risk, including neighborhood violence in 2015. The Community Alliance for Research and Engagement’s goal is to use data to inform, develop, and build community support for neighborhood-focused prevention efforts.

New Haven has nearly 130 000 residents with substantial wealth and health disparities. Racial/ethnic composition includes 33% Black, 32% White, and 27% Hispanic/Latino. Forty-nine percent of the population is low-income (i.e., household income is < 2 times the federal poverty level), compared with 24% in Connecticut. In the six lowest-income neighborhoods in New Haven—where most residents are people of color—11% are unemployed, compared with 7% citywide (US Census, American Community Survey, 2010–2014).

Crime statistics indicate that rates of violent crime in New Haven far exceed the national average and are threefold higher than the average for cities of comparable population. A well-known limitation of crime incident data is that they capture only violence that results in police reports and do not take into account all individuals affected by the violent act. Therefore, these statistics underestimate violence exposure. We have described self-reported exposure to gun violence among residents in a population-based sample to inform the movement toward a public health approach to gun violence prevention.