Wiebe, Douglas J.

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  • Publication
    Youth's Strategies for Staying Safe and Coping With the Stress of Living in Violent Communities.
    (2010-09-01) Teitelman, Anne M; McDonald, Catherine C; Wiebe, Douglas; McDonald, Catherine C; Thomas, Nicole; Guerra, Terry; Richmond, Therese S; Kassam-Adams, Nancy
    Youth living in urban environments of pervasive violence are exposed to a variety of violence-related stressors. This qualitative descriptive study sought to ascertain how community-dwelling youth perceived exposure to violence and how these youth identified and used available resources. The intent of this community-based participatory research study was to help inform the design of a youth violence prevention center intervention. Semi-structured interviews were conducted with a purposive sample of 18 youth ages 10-16. Youth reported high levels of exposure to neighborhood violence. A theme of identifying and navigating safe and unsafe places emerged. Other stressors were more proximal and included interpersonal issues and conflicts. Youth used neighborhood and individual resources to cope with stressors. Youth maintained a high level of vigilance and developed clear strategies to safely navigate violent neighborhoods. Implications for youth due to the constant vigilance and exquisite sensitivity to stressors of chronic neighborhood violence are discussed.
  • Publication
    Guns in the Home: Risky Business
    (2003-05-20) Wiebe, Douglas
    One in three U.S. households contains at least one firearm. Gun owners cite two main reasons for having a gun: hunting and self-protection. A majority of handgun owners believe that they are protecting their homes and families against violent assaults. But in a country where the majority of homicides and suicides involve a gun, it is reasonable to question whether access to a gun increases or decreases the risk of violent death. This Issue Brief describes case-control studies that investigate links between gun availability and gun death, and supports earlier findings that people with guns in their homes appear to increase their risk of being shot fatally (intentionally or unintentionally) or taking their own life with a gun.
  • Publication
    Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis
    (2016-10-24) Kaufman, Elinore; Rising, Kristin; Wiebe, Douglas; Ebler, David; Crandall, Marie; Delgado, M. Kit
    Key Findings: More than 11% of patients presenting to a hospital with a violent injury return to a hospital with another violent injury within two to three years. Recurrent violent injury is common and costly. Effective prevention programs should also target high-risk patients in non-trauma centers where most receive care.
  • Publication
    The Importance of Family to Youth Living in Violent Communities
    (2011-09-01) McDonald, Catherine C; Wiebe, Douglas; Guerra, Terry; Thomas, N; Richmond, T S
    The purpose of this study was to investigate family functioning in the relationship between community violence exposure and 1) self-esteem and 2) confrontational coping in a sample of urban youth. Adhering to the tenets of community based participatory research, academic and community partners collaborated on a cross-sectional study with 110 community dwelling urban youth, ages 10–16 living in a city located in the Northeastern United States. As part of a larger survey, this analysis included selected items on lifetime community violence exposure, family functioning, self-esteem and use of confrontational coping strategies in response to community violence. Over 90% of the youth reported some type of lifetime community violence exposure. Controlling for age and gender, older youth and those with healthier family functioning had higher self-esteem; community violence exposure was not associated with self-esteem. Healthier family functioning was associated with decreased use of confrontational coping, though increasing amounts of community violence exposure was still associated with increased confrontational coping. Family can be protective in violent environments. Results from this study directly informed an intervention aimed at youth violence prevention. This study highlights how psychiatric and mental health nurses may be able to address the complex interplay of factors for youth living in violent environments.
  • Publication
    Military Veteran Mortality Following a Survived Suicide Attempt
    (2011-01-01) Weiner, Janet; Richmond, Therese S; Wiebe, Douglas; Conigliaro, Joseph
    BACKGROUND: Suicide is a global public health problem. Recently in the U.S., much attention has been given to preventing suicide and other premature mortality in veterans returning from Iraq and Afghanistan. A strong predictor of suicide is a past suicide attempt, and suicide attempters have multiple physical and mental comorbidities that put them at risk for additional causes of death. We examined mortality among U.S. military veterans after hospitalization for attempted suicide. METHODS: A retrospective cohort study was conducted with all military veterans receiving inpatient treatment during 1993-1998 at United States Veterans Affairs (VA) medical facilities following a suicide attempt. Deaths occurring during 1993-2002, the most recent available year at the time, were identified through VA Beneficiary and Records Locator System data and National Death Index data. Mortality data for the general U.S. adult population were also obtained from the National Center for Health Statistics. Comparisons within the veteran cohort, between genders, and against the U.S. population were conducted with descriptive statistics and standardized mortality ratios. The actuarial method was used estimate the proportion of veterans in the cohort we expect would have survived through 2002 had they experienced the same rate of death that occurred over the study period in the U.S. population having the age and sex characteristics. RESULTS: During 1993-1998, 10,163 veterans were treated and discharged at a VA medical center after a suicide attempt (mean age = 44 years; 91% male). There was a high prevalence of diagnosed alcohol disorder or abuse (31.8%), drug dependence or abuse (21.8%), psychoses (21.2%), depression (18.5%), and hypertension (14.2%). A total of 1,836 (18.1%) veterans died during follow up (2,941.4/100,000 person years). The cumulative survival probability after 10 years was 78.0% (95% CI = 72.9, 83.1). Hence the 10-year cumulative mortality risk was 22.0%, which was 3.0 times greater than expected. The leading causes overall were heart disease (20.2%), suicide (13.1%), and unintentional injury (12.7%). Whereas suicide was the ninth leading cause of death in the U.S. population overall (1.8%) during the study period, suicide was the leading and second leading cause among women (25.0%) and men (12.7%) in the cohort, respectively. CONCLUSIONS: Veterans who have attempted suicide face elevated risks of all-cause mortality with suicide being prominent. This represents an important population for prevention activities.
  • Publication
    PhillydotMap: The Shape of Philadelphia
    (2009-10-01) Branas, Charles; Davitt, Joan K; Hillier, Amy; Cheetham, Robert; Cheetham-Richard, Rachel; Cohen, Rachel B; Decker, Joan; Heckert, Megan; Steinberg, Harris; Sullivan-Marx, Eileen; Hutchins, Jason; Tomlin, C. Dana; Kerman, Lucy; Volpe, Stella; Lechner, Zachary L; Wiebe, Douglas; McLarnon, Michael; Newlin, Heather; Scholssberg, Dina; Wormley, Diane-Louise
    This book is the outgrowth of a working group entitled, “Modeling Urban Environmental Impacts on Health, Development, and Behavior" sponsored by the University of Pennsylvania Institute for Urban Research. The purpose of the working gropu was to engage faculty from across campus and to encourage their collaborative use of GIS technology in the modeling of urban form and function. These ten chapters represent a wide range of GIS applications, from community-based social services to public history to social science research.
  • Publication
    Acute Alcohol Consumption, Alcohol Outlets, and Gun Suicide
    (2011-01-01) Branas, Charles; Richmond, Therese S; Ten Have, Thomas; Wiebe, Douglas
    A case-control study of 149 intentionally self-inflicted gun injury cases (including completed gun suicides) and 302 population-based controls was conducted from 2003 to 2006 in a major US city. Two focal independent variables, acute alcohol consumption and alcohol outlet availability, were measured. Conditional logistic regression was adjusted for confounding variables. Gun suicide risk to individuals in areas of high alcohol outlet availability was less than the gun suicide risk they incurred from acute alcohol consumption, especially to excess. This corroborates prior work but also uncovers new information about the relationships between acute alcohol consumption, alcohol outlets, and gun suicide. Study limitations and implications are discussed.
  • Publication
    Novel Linkage of Individual and Geographic Data to Study Firearm Violence
    (2008-08-01) Branas, Charles; Culhane, Dennis P; Richmond, Therese S; Wiebe, Douglas
    Firearm violence is the end result of a causative web of individual-level and geographic risk factors. Few, if any, studies of firearm violence have been able to simultaneously determine the population-based relative risks that individuals experience as a result of what they were doing at a specific point in time and where they were, geographically, at a specific point in time. This paper describes the linkage of individual and geographic data that was undertaken as part of a population-based case-control study of firearm violence in Philadelphia. New methods and applications of these linked data relevant to researchers and policymakers interested in firearm violence are also discussed.
  • Publication
    Predicting the Future Development of Depression or PTSD After Injury
    (2011-07-01) Richmond, Therese S; Ruzek, Josef; Wiebe, Douglas; Ackerson, Theimann; Winston, Flaura; Kassam-Adams, Nancy
    OBJECTIVE: The objective was to develop a predictive screener that when given soon after injury will accurately differentiate those who will later develop depression or posttraumatic stress disorder (PTSD) from those who will not. METHOD: This study used a prospective, longitudinal cohort design. Subjects were randomly selected from all injured patients in the emergency department; the majority was assessed within 1 week postinjury with a short predictive screener, followed with in-person interviews after 3 and 6 months to determine the emergence of depression or PTSD within 6 months after injury. RESULTS: A total of 192 completed a risk factor survey at baseline; 165 were assessed over 6 months. Twenty-six subjects [15.8%, 95% confidence interval (CI) 10.2-21.3] were diagnosed with depression, four (2.4%, 95% CI 0.7-5.9) with PTSD and one with both. The final eight-item predictive screener was derived; optimal cutoff scores were ≥2 (of 4) depression risk items and ≥3 (of 5) PTSD risk items. The final screener demonstrated excellent sensitivity and moderate specificity both for clinically significant symptoms and for the diagnoses of depression and PTSD. CONCLUSIONS: A simple screener that can help identify those patients at highest risk for future development of PTSD and depression postinjury allows the judicious allocation of costly mental health resources.
  • Publication
    Neighborhoods, Daily Activities, and Measuring Health Risks Experienced in Urban Environments.
    (2010-12-01) Richmond, Therese S; Basta, Luke A; Wiebe, Douglas
    Studies of place and health often classify a subject's exposure status according to that which is present in their neighborhood of residence. One's neighborhood is often proxied by designating it to be an administratively defined unit such as census tract, to make analysis feasible. Although it is understood that residential space and actual lived space may not correspond and therefore exposure misclassification may result, few studies have the opportunity to investigate the implications of this issue concretely. A population-based case-control study that is currently underway provides one such opportunity. Adolescent victims of assault in Philadelphia, Pennsylvania, USA, and a control sample of adolescents drawn randomly from the community are being enrolled to study how alcohol consumption and time spent nearby alcohol outlets - individual-level and environmental-level risk factors for violence, respectively - over the course of daily activities relate to the likelihood of being assaulted. Data from a rapport-building exercise consist of hand-drawn sketches that subjects drew on street maps when asked to indicate the area considered their neighborhood. The main data consist of self-reported, detailed paths of the routes adolescents traveled from one location to the next over the course of one full day. Having noticed interesting patterns as the data collection phase proceeds, we present here an analysis conducted with the data of 55 control subjects between 15 and 19 years old. We found that hand-drawn neighborhoods and activity paths did not correspond to census tract boundaries, and time subjects spent in close proximity to alcohol outlets during their daily activities was not correlated with the prevalence of alcohol outlets in the census tract of their residence. This served as a useful example demonstrating how classifying subjects as exposed based solely on the prevalence of the exposure in the geographic area of their residence may misrepresent the exposure that is etiologically meaningful.