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J Urban Health. 2017 Oct;94(5):619-628. doi: 10.1007/s11524-016-0121-2.

Preparing for Disaster: a Cross-Sectional Study of Social Connection and Gun Violence.

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Division of Critical Care, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2005, Cincinnati, OH, 45229-3039, USA.
Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Indian Health Service, Chinle Comprehensive Health Care Facility, Chinle, AZ, USA.
Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA.
Trauma Injury Prevention, Community Outreach & Research Department, Yale-New Haven Hospital, New Haven, CT, USA.
Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
West River Community Resilience Team, New Haven, CT, USA.
Transitions Clinic Network, New Haven, CT, USA.
Newhallville Community Resilience Team, New Haven, CT, USA.
African American Affinity Group, Yale University, New Haven, CT, USA.
Project Longevity New Haven, New Haven, CT, USA.
School of Public Health, Yale University, New Haven, CT, USA.
New Haven Family Alliance, New Haven, CT, USA.
Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, CT, USA.


Living in communities with persistent gun violence is associated with negative social, behavioral, and health outcomes, analogous to those of a natural disaster. Taking a disaster-preparedness approach may identify targets for community-based action to respond to on-going gun violence. We assessed the relevance of adapting a disaster-preparedness approach to gun violence and, specifically, the relationship between perceived collective efficacy, its subscales of social cohesion and informal social control, and exposure to gun violence. In 2014, we conducted a cross-sectional study using a community-based participatory research approach in two neighborhoods in New Haven, CT, with high violent crime rates. Participants were ≥18 years of age and English speaking. We measured exposure to gun violence by adapting the Project on Human Development in Chicago Neighborhoods Exposure to Violence Scale. We examined the association between perceived collective efficacy, measured by the Sampson Collective Efficacy Scale, and exposure to gun violence using multivariate modeling. We obtained 153 surveys (51% response rate, 14% refusal rate, and 35% non-response rate). Ninety-five percent reported hearing gunfire, 58% had friend or family member killed by gun violence, and 33% were physically present during a shooting. In the fully adjusted model, one standard deviation higher perceived collective efficacy was associated with lower reported exposure to gun violence (β = -0.91, p < 0.001). We demonstrated that it is possible to activate community members and local officials to engage in gun violence research. A novel, community-based approach adapted from disaster-preparedness literature may be an effective framework for mitigating exposure to gun violence in communities with persistent gun violence.


Collective efficacy; Community resilience; Disaster; Gun violence; Social cohesion

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