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BACKGROUND: Homicide is the leading cause of death among young people in Latin America, one of the world's most violent regions. Poverty is widely considered a key cause of violence, but theories suggest different effects of poverty, depending on when it is experienced in the life-course. Longitudinal studies of violence are scarce in Latin America, and very few prospective data are available worldwide to test different life-course influences on homicide. METHODS: In a prospective birth cohort study following 5914 children born in southern Brazil, we examined the role of poverty at birth, in early childhood, and in early adulthood on violence and homicide perpetration, in criminal records up to age 30 years. A novel Structured Life Course Modelling Approach was used to test competing life-course hypotheses about 'sensitive periods', 'accumulation of risk', and 'downward mobility' regarding the influence of poverty on violence and homicide. RESULTS: Cumulative poverty and poverty in early adulthood were the most important influences on violence and homicide perpetration. This supports the hypothesis that early adulthood is a sensitive period for the influence of poverty on lethal and non-lethal violence. Results were replicable using different definitions of poverty and an alternative outcome of self-reported fights. CONCLUSION: Cumulative poverty from childhood to adulthood was an important driver of violence and homicide in this population. However, poverty experienced in early adulthood was especially influential, suggesting the importance of proximal mechanisms for violence in this context, such as unemployment, organized crime, drug trafficking, and ineffective policing and justice systems.
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Homicídio , Pobreza , Violência , Humanos , Homicídio/estatística & dados numéricos , Brasil/epidemiologia , Pobreza/estatística & dados numéricos , Masculino , Feminino , Violência/estatística & dados numéricos , Adulto , Estudos Prospectivos , Adolescente , Criança , Adulto Jovem , Pré-Escolar , Coorte de Nascimento , Fatores de Risco , Fatores Socioeconômicos , Lactente , Estudos LongitudinaisRESUMO
BACKGROUND: Globally, Mexico is one of six countries with the highest level of firearm mortality. While previous studies have examined firearm mortality in Mexico before 2015, increases in violence since then highlight the need for an updated analysis. In this study, we examined changes in firearm-related deaths in Mexico from 2015 to 2022 and described these deaths by key demographic groups, incident location, and state of occurrence. Data came from Mexico's Instituto Nacional de Estadistica y Geografia (INEGI), a federal agency that collects and reports national population data. We used descriptive statistics to analyze rates, proportions, and percentage changes in firearm mortality, and we displayed temporal trends using time plots and special trends using maps. RESULTS: Firearm deaths increased in Mexico from 2015 to 2018 but slightly decreased from 2018 to 2022. Homicides presented the highest increase and the highest proportion of firearm-related deaths from 2015 to 2022. Victims were primarily males but rates among women increased at a higher proportion (99.5% vs 53.5%). One third of victims were 20-29y but rates among children and adolescents (10-9y) increased at a higher proportion. Most firearm-related deaths occurred in streets or public spaces but the percentage of incidents occurring in households have increased. State-level rates and percentage changes varied significantly. States with higher rates of firearm mortality coincide with those involving conflict among organized criminal organizations. CONCLUSION: Firearm mortality in Mexico is a major public health burden. The epidemiology of firearm-related deaths in Mexico varies by intent, demographics, location, and states. To mitigate this challenge, multiple solutions are required.
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AIMS: Previous epidemiological evidence identified a concerning increase in behavioural problems among young children from 1997 to 2008 in Brazil. However, it is unclear whether behavioural problems have continued to increase, if secular changes vary between sociodemographic groups and what might explain changes over time. We aimed to monitor changes in child behavioural problems over a 22-year period from 1997 to 2019, examine changing social inequalities and explore potential explanations for recent changes in behavioural problems between 2008 and 2019. METHODS: The Child Behaviour Checklist was used to compare parent-reported behavioural problems in 4-year-old children across three Brazilian birth cohorts assessed in 1997 (1993 cohort, n = 633), 2008 (2004 cohort, n = 3750) and 2019 (2015 cohort, n = 577). Response rates across all three population-based cohorts were over 90%. Moderation analyses tested if cross-cohort changes differed by social inequalities (demographic and socioeconomic position), while explanatory models explored whether changes in hypothesized risk and protective factors in prenatal development (e.g., smoking during pregnancy) and family life (e.g., maternal depression and harsh parenting) accounted for changes in child behavioural problems from 2008 to 2019. RESULTS: Initial increases in child behavioural problems from 1997 to 2008 were followed by declines in conduct problems (mean change = -2.75; 95% confidence interval [CI]: -3.56, -1.94; P < 0.001), aggression (mean change = -1.84; 95% CI: -2.51, -1.17; P < 0.001) and rule-breaking behaviour (mean change = -0.91; 95% CI: -1.13, -0.69 P < 0.001) from 2008 to 2019. Sex differences in rule-breaking behaviour diminished during this 22-year period, whereas socioeconomic inequalities in behavioural problems emerged in 2008 and then remained relatively stable. Consequently, children from poorer and less educated families had higher behavioural problems, compared to more socially advantaged children, in the two more recent cohorts. Changes in measured risk and protective factors partly explained the reduction in behavioural problems from 2008 to 2019. CONCLUSIONS: Following a rise in child behavioural problems, there was a subsequent reduction in behavioural problems from 2008 to 2019. However, social inequalities increased and remained high. Continued monitoring of behavioural problems by subgroups is critical for closing the gap between socially advantaged and disadvantaged children and achieving health equity for the next generation.
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Comportamento Problema , Gravidez , Humanos , Masculino , Feminino , Pré-Escolar , Brasil/epidemiologia , Estudos de Coortes , Fatores Socioeconômicos , Poder FamiliarRESUMO
Background: City-led interventions are increasingly advocated to achieve the UN's Sustainable Development Goal to reduce violence for all. We used a new quantitative evaluation method to examine whether a flagship programme, called the "Pelotas Pact for Peace" (the Pacto), has been effective in reducing violence and crime in the city of Pelotas, Brazil. Methods: We used synthetic control methodology to assess the effects of the Pacto from August 2017 to December 2021, and separately before and during the COVID-19 pandemic. Outcomes included monthly rates of homicide and property crime, and yearly rates of assault against women and school drop-out. We constructed synthetic controls (counterfactuals) based on weighted averages from a donor pool of municipalities in Rio Grande do Sul. Weights were identified using pre-intervention outcome trends and confounders (sociodemographics, economics, education, health and development, and drug trafficking). Findings: The Pacto led to an overall 9% reduction in homicide and 7% reduction in robbery in Pelotas. These effects were not uniform across the full post-intervention period as clear effects were only seen during the pandemic period. A 38% reduction in homicide was also specifically associated with the criminal justice strategy of Focussed Deterrence. No significant effects were found for non-violent property crimes, violence against women, and school dropout, irrespective of the post-intervention period. Interpretation: City-level interventions that combine public health and criminal justice approaches could be effective in tackling violence in Brazil. Continued monitoring and evaluation efforts are increasingly needed as cities are proposed as key opportunities for reducing violence for all. Funding: This research was funded by the Wellcome Trust [grant number: 210735_Z_18_Z].
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INTRODUCTION: Despite promising reductions in mortality from infectious diseases, premature death is a still major public health problem in Brazil. However, little is known about which diseases and injury mechanisms are the main causes of premature death. This paper aimed to detail the trends in leading causes of death among children and adolescents in Brazil. METHODS: Data were extracted from medical death certificates from the Brazilian Mortality Information System for children and adolescents aged 1-19 years for 2000-2020. The 10 leading causes of death for children and adolescents were defined using primary cause of death codes, grouped by death for diseases and mechanism for injury, according to the ICD-10. All analyses were completed in 2022. RESULTS: From 2000 through 2020, there was a total of 772,729 child and adolescent deaths in Brazil. Despite an overall 34% reduction in child and adolescent mortality from 2000 to 2020, improvements were less pronounced for injury-related deaths than for communicable diseases. Therefore, by 2020, over half of deaths were from injury-related causes. Firearm-related injury was by far the leading cause, accounting for 21% of all deaths. There was a 38% reduction in firearm deaths in the last 4 years against a previously increasing trend, and homicide accounted for over 90% of all firearm deaths because suicide by firearm was rare. CONCLUSIONS: Injury-related deaths among children and adolescents are a growing concern in Brazil, and firearms are the current leading cause of child and adolescent death.