Understanding the burden of gun violence among youth is a public health imperative. While most estimates are based on direct and witnessed victimization, living nearby gun violence incidents may be consequential too. Yet detailed information about these broader experiences of violence is lacking. We use data on a population-based cohort of youth merged with incident-level data on deadly gun violence to assess the prevalence and intensity of community exposure to gun homicides across cross-classified categories of exposure distance and recency, overall and by race/ethnicity, household poverty, and neighborhood disadvantage. In total, 2–18% of youth resided within 600 m of a gun homicide occurring in the past 14–365 days. These percentages were 3–25% for incidents within 800 m and 5–37% for those within a 1300-m radius. Black and Latinx youth were 3–7 times more likely, depending on the exposure radius, to experience a past-year gun homicide than white youth and on average experienced incidents more recently and closer to home. Household poverty contributed to exposure inequities, but disproportionate residence in disadvantaged neighborhoods was especially consequential: for all racial/ethnic groups, the difference in the probability of exposure between youth in low vs high poverty households was approximately 5–10 percentage points, while the difference between youth residing in low vs high disadvantage neighborhoods was approximately 50 percentage points. Given well-documented consequences of gun violence exposure on health, these more comprehensive estimates underscore the importance of supportive strategies not only for individual victims but entire communities in the aftermath of gun violence.

Drug overdose is a leading cause of injury-related death in the United States, responsible for more than 70 000 fatalities, or approximately 200 deaths per day, in 2017. Fatal drug overdoses have increased markedly during the past 2 decades in large part because of overdoses involving opioids, including prescription opioids and illegal opioids, such as heroin and illicitly manufactured fentanyl. Between 2001 and 2017, the age-adjusted mortality rate for opioid-related overdoses more than quadrupled, from 3.3 to 14.9 per 100 000 standard population. In 2017, more than two-thirds of all drug overdose fatalities (47 600 deaths) involved an opioid.¹ Although overdose mortality may have stabilized in the past year, rates remain inordinately high.

Ambient air pollution is a well-known risk factor of various asthma-related outcomes, however, past research has often focused on acute exacerbations rather than asthma development. This study draws on a population-based, multigenerational panel dataset from the United States to assess the association of childhood asthma risk with census block-level, annual-average air pollution exposure measured during the prenatal and early postnatal periods, as well as effect modification by neighborhood poverty. Findings suggest that early-life exposures to nitrogen dioxide (NO₂), a marker of traffic-related pollution, and fine particulate matter (PM_2.5), a mixture of industrial and other pollutants, are positively associated with subsequent childhood asthma diagnosis (OR = 1.25, 95% CI = 1.10–1.41 and OR = 1.25, 95% CI = 1.06–1.46, respectively, per interquartile range (IQR) increase in each pollutant (NO₂ IQR = 8.51 ppb and PM_2.5 IQR = 4.43 µ/m³)). These effects are modified by early-life neighborhood poverty exposure, with no or weaker effects in moderate- and low- (versus high-) poverty areas. This work underscores the importance of a holistic, developmental approach to elucidating the interplay of social and environmental contexts that may create conditions for racial-ethnic and socioeconomic disparities in childhood asthma risk.

In the United States in 2018, there were nearly 68 000 violence-related deaths.¹ An additional 3.3 million people reported having been victims of nonfatal violent crime.² Most deaths (57%) and nearly 471 000 nonfatal violent victimizations involved a firearm.^1,2 Black, Indigenous, Latinx, and other communities of color endure a disproportionate share of this burden.^3-5 It is reasonable to expect that the emergence and progression of the coronavirus disease 2019 (COVID-19) pandemic—with more than 11 million confirmed cases and more than 270 000 deaths nationally as of December 2, 2020⁶—combined with the social, psychological, and economic fallout associated with efforts to lessen its spread, have intensified violence-related harms and inequities therein.

Objective To describe the prevalence of and factors associated with firearm ownership; the types, subtypes and quantity of firearms owned; and when, where and why firearms were acquired in California. Methods A cross-sectional analysis of a state-representative, probability-based, internet survey of California adults was conducted in September–October 2018 (n=2558; completion rate 49%). Household firearm ownership was ascertained for all respondents; personal firearm ownership was ascertained only among respondents who reported living in a home with firearms; and information on the types and quantity of firearms owned and details about recently acquired firearms came from firearm owners only. Findings Roughly one in four (25%, 95% CI 22% to 28%) California adults live in a home with a firearm, including 4.2 million adults—14% (95% CI 13% to 16%) of the adult population—who personally own a firearm. These owners collectively own an estimated 19.9 million firearms (8.9 million handguns). Approximately half (48%, 95% CI 34% to 61%) of the firearm stock in California is owned by the 10% (95% CI 6% to 14%) of owners who own 10 or more firearms, though more than half (54%, 95% CI 47% to 62%) of owners in the state own only one or two firearms. Most (69%, 95% CI 63% to 75%) owners purchased their last firearm from a firearm retailer, usually a handgun purchased primarily for protection against people. Conclusion This study provides the most detailed and up-to-date information available on firearm ownership and acquisition in California. Results can inform firearm violence prevention efforts and public health, safety and policy development in California and nationally.

This essay establishes a conceptual framework to understand how direct, secondar and community exposures to gun violence converge to influence population health. Our framework asserts that persistent gun violence in structurally disadvantaged communities enacts broad consequences for mental, physical and behavioural health, operating as a key driver of racial and socioeconomic health disparities. We discuss the applications of this framework for research and improved data collection with a focus on establishing timely and accurate measures of gun violence alongside individual and community health measures. We then address the policy implications of the framework, emphasising the need for long-term, institutional investment in gun violence prevention and intervention, survivor service provision and evidence-based policies at all levels of government.