By Karamoja–Turkana and the Community Research Team 

Ipoln the Karamoja and Turkana border regions of Uganda and Kenya, there is widespread violence including armed robbery, rape, and human rights abuses, yet community complaints about failures of governance remain largely unaddressed. This Policy Briefing highlights how different insecurities reinforce one another in ways exacerbated by the international border. It stresses the need for fulfilment of the two governments’ commitments to cross-border solutions, and suggests that international policy actors can help communities gain leverage with governments towards building trustworthy and effective peace and security institutions.

IDS Policy Briefing 214,

Brighton, UK: Institute of Development Studies, 2023. 4p.

By Jacob Bor, Atheendar S Venkataramani, David R Williams, Alexander C Tsai

Background Police kill more than 300 black Americans—at least a quarter of them unarmed—each year in the USA. These events might have spillover effects on the mental health of people not directly affected. Methods In this population-based, quasi-experimental study, we combined novel data on police killings with individual-level data from the nationally representative 2013–15 US Behavioral Risk Factor Surveillance System (BRFSS) to estimate the causal impact of police killings of unarmed black Americans on self-reported mental health of other black American adults in the US general population. The primary exposure was the number of police killings of unarmed black Americans occurring in the 3 months prior to the BRFSS interview within the same state. The primary outcome was the number of days in the previous month in which the respondent’s mental health was reported as “not good”. We estimated difference-in-differences regression models—adjusting for state-month, monthyear, and interview-day fixed effects, as well as age, sex, and educational attainment. We additionally assessed the timing of effects, the specificity of the effects to black Americans, and the robustness of our findings. Findings 38 993 (weighted sample share 49%) of 103710 black American respondents were exposed to one or more police killings of unarmed black Americans in their state of residence in the 3 months prior to the survey. Each additional police killing of an unarmed black American was associated with 0·14 additional poor mental health days (95% CI 0·07–0·22; p=0·00047) among black American respondents. The largest effects on mental health occurred in the 1–2 months after exposure, with no significant effects estimated for respondents interviewed before police killings (falsification test). Mental health impacts were not observed among white respondents and resulted only from police killings of unarmed black Americans (not unarmed white Americans or armed black Americans). Interpretation Police killings of unarmed black Americans have adverse effects on mental health among black American adults in the general population. Programmes should be implemented to decrease the frequency of police killings and to mitigate adverse mental health effects within communities when such killings do occur.

Lancet 2018; 392: 302–10 

By The International Labour Association

Occupational Safety and Health (OSH) measures are key to building an inclusive, integrated and gender-responsive approach to preventing and eliminating violence and harassment in the world of work, a new International Labour Organization (ILO) report finds. According to the report more than one-in-five people in employment have experienced violence and harassment. This issue can affect all types of workplaces and can also occur during commutes, work-related trips, events, digital communications, social activities and in home-based offices. The report emphasizes that OSH frameworks tackle root causes of violence and harassment by addressing underlying risks such as inadequate work organization, factors related to specific tasks (e.g. working alone or constantly interacting with third parties), and working conditions that produce high stress levels that in turn lead to violence and harassment. Occupational safety and health frameworks that are based on workplace cooperation and social dialogue, mobilize both employers and workers to create working environments free from violence and harassment, the analysis says

Geneva, SWIT: ILO, 2024. 5p.

By Lucia Bird Ruiz Benitez de Lugo, Mouhamadou Kane, Jason Eligh and Lyes Tagziria

Across Africa, the GI-TOC has documented the proliferation of synthetic drugs, the resulting transformation of drugs markets and the escalation of drug-related harm. The nature of synthetic drug markets – with their low barriers to entry and flexible supply chains – makes them attractive to criminal actors and difficult to respond to. The response in Africa is further hampered by a dearth of evidence regarding the scope and scale of the synthetic drug market. This report explores how synthetic drug markets respond to programming seeking to disrupt them. Tramadol is used as a lens through which to consider existing response frameworks to synthetic drugs in the ECOWAS region and more broadly.

ENACT Africa, 2024.

By Alessia Rossi

Organised crime is one of the most important threats to the functioning of the rule of law and democracy. This research will analyse why the ‘ndrangheta, with its structure, ranks among the most powerful mafias. Specifically, consideration will be paid to cocaine trafficking, which is their most profitable supply channel. One of their main strengths is having ‘ndrine located all over the world, especially in Latin America. There, brokers manage to contract with key organisations, such as the Urabeños. Moreover, to carry out operations mainly via containers, they have trusted corrupt accomplices in the ports. In the latter, the ‘ndrangheta may not only have influence but even be embedded, as in the case of the port of Gioia Tauro. Finally, it will be examined not only the transnational approach but also the need for a national response of increasing port security in limiting the infiltration of the Calabrian mafia.  

Fiesole FI, Italy:  Transnational Governance of the European University Institute, 2023. 43p.

By TRAFFIC

The research, conducted by a team of experts, focused on Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan. It began with an in-depth examination of social media platforms, where illegal wild species trade activities often thrive.

While these countries have made efforts to align their legal systems with international conventions and treaties, the study identified noticeable gaps and weaknesses in the enforcement of these laws. Ambiguous definitions, inadequate penalties, and shortcomings in regulating online trade were among the key issues identified.

The current legal frameworks in Central Asia are not effectively addressing the challenges posed by illegal wild species trade. To ensure the long-term success of sustainable trade, it is crucial to address these gaps and strengthen enforcement mechanisms.

The study provides a set of recommendations to address the identified shortcomings. These include clarifying definitions, enhancing penalties for offenders, and improving regulations for online trade. By implementing these recommendations, Central Asian countries can take significant steps towards curbing illegal wild species trade and promoting sustainable economic growth.

The findings of this study must urge policymakers to prioritise the enforcement of laws to stop steep declines of biodiversity in their countries. Sustainable and legal trade can only thrive when supported by robust and effective legal frameworks.

Cambridge, UK: TRAFFIC International, 2024. 101p.

By Serene C.L. Chng, Salman Saaban, Anongrakh Wechit, Kanitha Krishnasamy

Although the Oriental Magpie-robin Copsychus saularis is still a commonly seen species in many parts of Malaysia, high demand for it as a cage bird domestically and in neighbouring countries has resulted in trapping and smuggling of Malaysian populations. Analysis of seizure data for this species, as it implicated Malaysia, shows an escalation of international trafficking in recent years to feed the persistent demand for the pet trade. Overall, at least 26,950 Oriental Magpie-robins were seized from 44 incidents that implicated Malaysia from January 2015–December 2020, averaging at least 613 birds per seizure. These seizures took place in Indonesia, Malaysia and Singapore. Of these, Malaysian and Indonesian authorities definitively reported that 17,314 (64%) birds were being smuggled from Malaysia to Indonesia. This points to Malaysian populations of the Oriental Magpie-robin being increasingly targeted to feed demand in neighbouring countries, particularly Indonesia. At least 17,736 (66%) of all birds were confiscated in just 2020, signifying a current and possibly growing problem. This could be due to an increase in enforcement effort, coupled with dwindling populations in parts of Indonesia to supply birds for trade. A total of 23 seizures occurred in Malaysia, all were confined to the states of Johor, Melaka, Sarawak and Sabah involving a total of 17,997 birds. Most incidents in the first three states pointed to cross-border smuggling (the case in Sabah was a confiscation on premises). In eight of the Malaysian seizures, where birds were being trafficked to Indonesia, at least 16 Indonesian nationals were arrested, strongly suggesting networks of smugglers moving birds between the two countries. Many of these were reported to be illegal immigrants, indicating an additional national security concern.

TRAFFIC, Southeast Asia Regional Office, Petaling Jaya, Selangor, Malaysia: 2021. 20p.

By David Bright and Simone J Deegan 

Outlaw motorcycle gangs (OMCGs) are often reported to be disproportionately involved in crime. Debate continues about the relationship between the organisational structure of these groups and the extent and types of criminal activities undertaken by group members. A systematic review of the existing literature was conducted to examine the organisational structures that underpin the criminal activity of OMCGs. The available empirical research, though scant, supports the notion that, at least in some clubs or chapters, the structure of OMCGs facilitates criminal activities by individuals or small cliques, sometimes in collaboration with non-members. 

Australia.. Australian Institute of Criminology. Trends & issues in crime and criminal justice no. 621. March 2021. 16p

By Josef Job G. Raymundo, Emerson Y. Sy, and Serene C.L. Chng

The Philippines has a rich hornbill diversity, but many species are found in a restricted range and threatened by habitat loss, hunting for wild meat and cultural objects, and the live bird trade.

This threat is reinforced by the discovery of 143 live hornbills from nine taxa for sale online from 2018-2022, reported in Farmers of the Forest in Cages: The Online Trade of Hornbills in the Philippines.

While the Luzon Tarictic Hornbill was the most recorded species in the study (73% of all individuals), five Endangered Visayas Tarictic Hornbill Penelopides panini were also offered for sale.

Two-thirds of traders recorded were in central Luzon and likely sourced wild hornbills within or from nearby provinces, said the report authors.

Seizure records during the same period showed a further 66 hornbills seized in 24 incidents.

TRAFFIC, Southeast Asia Regional Office, Petaling Jaya, Selangor, Malaysia, 2023. 24p.

By Bakytbek Tokubek uulu, Sanjar Kurmanov, Louisa Musing

Law enforcement agencies in Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan can greatly benefit from systematically collecting, analysing, and sharing data with neighbouring countries on illegal wild species traders, networks, and trade routes. By doing so, these agencies can effectively bring these criminals to justice.

The report comprises four main parts: Guidance on Illegal Wild species Trade Data Collection, Guidance on Illegal Wild species Trade Data Analysis, Guidance on Illegal Wild species Trade Data Sharing, and Training and Capacity Building Resources to Support Law Enforcement Agencies Tackling the Illegal Wild species Trade.

The Guidance also includes examples of best practices from other countries, including European Union Member States. Additionally, the report references existing resources such as the ICCWC Wild species and Forest Crime Analytic Toolkit and consolidates various tools and resources from initiatives like CITES, the World Customs Organisation (WCO), and the United Nations Office on Drugs and Crime (UNODC) websites.

The report acts as a guidance tool, urging law enforcement agencies to adopt best practices in combating illegal wild species trade. By understanding the intricacies of this criminal activity and leveraging data-driven approaches, agencies can significantly enhance their effectiveness in tackling this global issue.

Cambridge, UK: TRAFFIC, 2024. 36p.

By Bakytbek Tokubek uulu, Louisa Musing, Amy Woolloff, Kanaat Musuraliev, Sanjar Kurmanov, Stephanie von Meibom S

Central Asia boasts a remarkable array of ecosystems, harbouring a diverse range of animals, plants and fungi, from majestic Saker falcons to the slow Steppe Tortoises alongside the unique Saiga antelope and various wild species of Bovidae, including Argali Mountain sheep and Siberian Ibex and plants like liquorice root that is used in herbal remedies and teas globally. While the assessment primarily focuses on the trade in animal and plant species listed in CITES Appendices, it also encompasses information on nationally protected but non-CITES-listed species.

The report, part of a trio of Central Asia publications, identifies several species that frequently appear in country seizure records, indicating the need for regional collaboration to combat illegal trade.

Notably, the Saiga Antelope emerges as the most frequently reported species in seizure records from government agencies in Kazakhstan, with smaller records in Kyrgyzstan and Uzbekistan. The Saker Falcon also features prominently in seizure records from Kazakhstan, Kyrgyzstan, and Uzbekistan, with additional reports of live falcons seized upon import to the UAE from Tajikistan. Kazakhstan and Uzbekistan have seized several thousand live specimens of the Steppe Tortoise.

Beyond providing a comprehensive overview of wild species trade, the study aims to identify common challenges and propose solutions to assist national agencies in coordinating efforts to combat illegal trade while effectively managing and regulating legal wild species trade.

Cambridge, UK: TRAFFIC, 2024. 90p.

By Robby Roks & Lieselot Bisschop & Richard Staring

As an important gateway to Europe, the Port of Rotterdam is known for its high-quality facilities and efficiency, but also attracts organised crime groups who use the transatlantic legal trade flows to traffic cocaine. Based on a qualitative study, consisting of 73 interviews with public and private actors, an analysis of 10 criminal investigations and field visits to public and private organisations in the port, this article examines how organised crime groups involved in cocaine trafficking take advantage of or adapt to the socio-spatial relations in the Port of Rotterdam. First, we pay attention to which physical spaces in the port of Rotterdam provide opportunities for cocaine trafficking. Second, we examine how the occupational and legal environment in which people, private companies and law enforcement agencies in the port work and interact provide opportunities for cocaine trafficking. Our findings demonstrate that increased security measures by both public and private actors directed at physical spaces result in a displacement to new spaces in and around the port of Rotterdam. Furthermore, the current socio-spatial relations in the port of Rotterdam also make the role of people on the inside – referring to a whole range of public and private employees – increasingly indispensable. 

Trends in Organized Crime (2021) 24:171–188 

By Sarah S. Shin, Kate LaForge, Erin Stack, Justine Pope, Gillian Leichtling, Jessica E. Larsen, Judith M. Leahy, Andrew Seaman, Daniel Hoover, Laura Chisholm, Christopher Blazes, Robin Baker, Mikaela Byers, Katie Branson & P. Todd Korthuis

Background

Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade.

Methods

We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes.

Results

PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers.

Conclusion

PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

Harm Reduction Journal volume 19, Article number: 76 (2022)

By C.J. Valaseka , Samantha A. Streuli a, Heather A. Pines , Steffanie A. Strathdeec , Annick Borquez , Philippe Bourgois , Tara Stamos-Buesige , Carlos F. Verac , Alicia Harvey-Verac , Angela R. Bazzi

Background: People who use drugs (PWUD) in the San Diego, USA and Tijuana, Mexico metroplex face high overdose risk related to historic methamphetamine use and relatively recent fentanyl introduction into local drug supplies. The personal overdose experiences of PWUD in this region are understudied, however, and may have been influenced by the COVID pandemic. Methods: From September-November 2021, we conducted 28 qualitative interviews among PWUD ≥18 years old sampled from an ongoing cohort study in the San Diego-Tijuana metroplex. Interviews explored overdose experiences and changes in the drug supply. Thematic analysis of coded interview transcripts explored overdose experiences, perspectives on drug supply changes, interactions with harm reduction services, and naloxone access. Results: Among 28 participants, 13 had experienced an overdose. Participants discussed rising levels of fentanyl in local drug supplies and increasing overdose incidents in their social networks. Participants discussed a general shift from injecting heroin to smoking fentanyl in their networks. Participants’ most common concerns included having consistent access to a safe and potent drug supply and naloxone. Conclusion: Participants prioritized adapting to drug supply changes and preventing overdose compared to other health concerns, such as HIV and COVID-19. Efforts to address overdose in this region could benefit from drug checking services and expanded, equitable delivery of naloxone.

Volume 7, June 2023, 100154, Drug and Alcohol Dependence Reports

By Lauren J. Tanz, R. Matt Gladden, Amanda T. Dinwiddie, Kimberly D. Miller, Dita Broz, Eliot Spector, Julie O’Donnell

Summary

What is already known about this topic?

More than 109,000 drug overdose deaths occurred in the United States in 2022; nearly 70% involved illegally manufactured fentanyls (IMFs). Data from the western United States suggested a transition from injecting heroin to smoking IMFs.

What is added by this report?

From January–June 2020 to July–December 2022, the percentage of overdose deaths with evidence of smoking increased 73.7%, and the percentage with evidence of injection decreased 29.1%; similar changes were observed in all U.S. regions. Changes were most pronounced in deaths with IMFs detected, with or without stimulant detection.

What are the implications for public health practice?

Strengthening and expanding public health and harm reduction services to address overdose risk with smoking and other noninjection routes might reduce deaths.

Preliminary reports indicate that more than 109,000 drug overdose deaths occurred in the United States in 2022; nearly 70% of these involved synthetic opioids other than methadone, primarily illegally manufactured fentanyl and fentanyl analogs (IMFs). Data from the western United States suggested a transition from injecting heroin to smoking IMFs. CDC analyzed data from the State Unintentional Drug Overdose Reporting System to describe trends in routes of drug use in 27 states and the District of Columbia among overdose deaths that occurred during January 2020–December 2022, overall and by region and drugs detected. From January–June 2020 to July–December 2022, the percentage of overdose deaths with evidence of injection decreased 29.1%, from 22.7% to 16.1%, whereas the percentage with evidence of smoking increased 73.7%, from 13.3% to 23.1%. The number of deaths with evidence of smoking increased 109.1%, from 2,794 to 5,843, and by 2022, smoking was the most commonly documented route of use in overdose deaths. Trends were similar in all U.S. regions. Among deaths with only IMFs detected, the percentage with evidence of injection decreased 41.6%, from 20.9% during January–June 2020 to 12.2% during July–December 2022, whereas the percentage with evidence of smoking increased 78.9%, from 10.9% to 19.5%. Similar trends were observed among deaths with both IMFs and stimulants detected. Strengthening public health and harm reduction services to address overdose risk related to diverse routes of drug use, including smoking and other non-injection routes, might reduce drug overdose deaths.

Morbidity and Mortality Weekly Report; February 15, 2024

By R. Santamarina  D. Caldicott , J. Fitzgerald , J.L. Schumann 

Background : Illicit drug use is overrepresented in music festival attendees compared with the general population. Drug use often involves a wide range of substances with the potential to cause drug toxicity. Law enforcement-centred strategies intended to deter drug use and supply at these mass gatherings have been implemented throughout Australia. However, many have been criticised for their lack of effectiveness, with evidence suggesting that they can inadvertently increase the risk of drug harm. Drug deaths are often multifactorial, providing added challenges in the development of prevention strategies. This study aimed to determine the frequency of deaths involving alcohol and other drugs at music festivals in Australia and to identify potential risk factors that may inform future harm reduction strategies.

Methods : A descriptive case series study was conducted using the National Coronial Information System (NCIS) to investigate drug-related deaths at music festivals throughout Australia between 1 July 2000 (Queensland from 1 January 2001) and 31 December 2019, using a list of keywords comprising music festival names and terms.

Results : There were 64 deaths, of which most involved males (73.4%) aged in their mid-20s (range 15-50 years). Drug toxicity was the most common primary cause of death (46.9%) followed by external injuries (37.5%). The drug most commonly detected or reported as being used was MDMA (65.6%), followed by alcohol (46.9%) and cannabis (17.2%), with most cases reporting the use of two or more drugs (including alcohol) and 36% reporting a history of drug misuse in the coroner's findings. Most deaths were unintentional, with less than a fifth of cases (17.2%) involving intentional self-harm. Clinical intervention was involved in 64.1% of cases and most festivals occurred in inner city locations (59.4%).

Conclusions : The findings suggest that drug-related deaths at music festivals in Australia typically involve young people using multiple illicit substances in combination with alcohol. Most are unintentional and could potentially be prevented through the implementation of a range of harm reduction strategies, including mobile medical care, drug checking services, and increased consumer education and awareness.

International Journal of Drug Policy Volume 123, January 2024, 104274

By Kunal Madan  , Samantha Schmidt  , Raeiti Fouladi Chami  , Raymond Ho , Justin C. Lewis  , Dorie E. Apollonio

Background: As of June 2023, a majority of states had legalized the sale of cannabis, which past research has found to be associated with increased exposures. In 2018, a change in federal policy increased access to cannabidiol (CBD) and derived psychoactive cannabis products, but there has been limited study of reported exposures following this change. Methods: This observational retrospective study analyzed exposures involving synthetic cannabinoid receptor agonists (SCRAs) and derived cannabis products, including CBD, reported to the California Poison Control System (CPCS) from 2010 to 2022. We focused primarily on potential shifts in reported exposures before and after the implementation of the 2018 Farm Bill, which removed products derived from hemp from the Controlled Substances Act. We reviewed and hand-coded individual call records to assess reported exposures over time and their characteristics, and conducted interrupted time series analysis to assess whether exposure counts changed after policy interventions. Results: Reported CBD exposures significantly increased following the federal reclassification of hemp products. Exposure reports were most common among young children and for edibles. Exposure reports provided limited information about derived psychoactive cannabis products. Conclusions: Our findings suggest a need for improved data collection regarding derived psychoactive cannabis products, as well as potential public health value in modifying packaging regulations and in providing additional guidance to parents to help prevent CBD exposures.

International Journal of Drug Policy Volume 124, February 2024, 104313

By ENACT

Iboga, a plant native to Central Africa, has been used for centuries in religious rituals and traditional medicine. In recent years, it has gained notoriety for its potential to treat substance use disorders. However, its increasing commercialisation and global trade are having a negative impact on the plant and the communities that rely on it. Ibogaine, the psychoactive alkaloid found in iboga root, can cause a variety of effects, including stimulation, aphrodisia, trance, and hallucinations. At high doses, it can be toxic. Despite the risks, iboga is being used in unregulated therapeutic clinics around the world to treat addiction. The online market for iboga is thriving, and consumers often seek out Gabonese iboga due to its sacred properties. This has led to overharvesting and deforestation in Gabon, harming local communities and the environment. Criminal networks are involved in the illicit harvesting, trafficking and sale of iboga. These networks are composed mostly of nationals from Gabon and Cameroon with connections to Europe and North America. Iboga is sold online in a variety of formats, including root bark, root powder, capsules, and, less commonly, ibogaine powder or iboga seed.

Lyon, France, INTERPOL, 2023. 31p.

Editor(s): D. Asher Ghertner, Hudson McFann, Daniel M. Goldstein

Security is a defining characteristic of our age and the driving force behind the management of collective political, economic, and social life. Directed at safeguarding society against future peril, security is often thought of as the hard infrastructures and invisible technologies assumed to deliver it: walls, turnstiles, CCTV cameras, digital encryption, and the like. The contributors to Futureproof redirect this focus, showing how security is a sensory domain shaped by affect and image as much as rules and rationalities. They examine security as it is lived and felt in domains as varied as real estate listings, active-shooter drills, border crossings, landslide maps, gang graffiti, and museum exhibits to theorize how security regimes are expressed through aesthetic forms. Taking a global perspective with studies ranging from Jamaica to Jakarta and Colombia to the U.S.-Mexico border ;Futureproof expands our understanding of the security practices, infrastructures, and technologies that pervade everyday life.

Contributors: Victoria Bernal, Jon Horne Carter, Alexandra Demshock, Zaire Z. Dinzey-Flores, Didier Fassin, D. Asher Ghertner, Daniel M. Goldstein, Rachel Hall, Rivke Jaffe, Ieva Jusionyte, Catherine Lutz, Alejandra Leal Martínez, Hudson McFann, Limor Samimian-Darash, AbdouMaliq Simone, Austin Zeiderman

Durham, NC: Duke University Press, 2020. 312p.

By Nanzi Zheng, Karen M. Abram,  Leah J. Welty; et alDavid A

Importance  Youths, especially Black and Hispanic males, are disproportionately affected by firearm violence. Yet, no epidemiologic studies have examined the incidence rates of nonfatal firearm injury and firearm mortality in those who may be at greatest risk—youths who have been involved with the juvenile justice system.

Objectives  To examine nonfatal firearm injury and firearm mortality in youths involved with the juvenile justice system and to compare incidence rates of firearm mortality with the general population.

Design, Setting, and Participants  The Northwestern Juvenile Project is a 25-year prospective longitudinal cohort study of 1829 youths after juvenile detention in Chicago, Illinois. Youths were randomly sampled by strata (sex, race and ethnicity, age, and legal status [juvenile or adult court]) at intake from the Cook County Juvenile Temporary Detention Center. Participants were interviewed at baseline (November 1995 to June 1998) and reinterviewed as many as 13 times over 16 years, through February 2015. Official records on mortality were collected through December 2020. Data analysis was conducted from November 2018 to August 2022.

Main Outcomes and Measures  Participants self-reported nonfatal firearm injuries. Firearm deaths were identified from county and state records and collateral reports. Data on firearm deaths in the general population were obtained from the Illinois Department of Public Health. Population counts were obtained from the US census.

Results  The baseline sample of 1829 participants included 1172 (64.1%) males and 657 (35.9%) females; 1005 (54.9%) Black, 524 (28.6%) Hispanic, 296 (16.2%) non-Hispanic White, and 4 (0.2%) from other racial and ethnic groups (mean [SD] age, 14.9 [1.4] years). Sixteen years after detention, more than one-quarter of Black (156 of 575 [27.1%]) and Hispanic (103 of 387 [26.6%]) males had been injured or killed by firearms. Males had 13.6 (95% CI, 8.6-21.6) times the rate of firearm injury or mortality than females. Twenty-five years after the study began, 88 participants (4.8%) had been killed by a firearm. Compared with the Cook County general population, most demographic groups in the sample had significantly higher rates of firearm mortality (eg, rate ratio for males, 2.8; 95% CI, 2.0-3.9; for females: 6.5; 95% CI, 3.0-14.1; for Black males, 2.5; 95% CI, 1.7-3.7; for Hispanic males, 9.6; 95% CI, 6.2-15.0; for non-Hispanic White males, 23.0; 95% CI, 11.7-45.5).

Conclusions and Relevance  This is the first study to examine the incidence of nonfatal firearm injury and firearm mortality in youths who have been involved with the juvenile justice system. Reducing firearm injury and mortality in high-risk youths and young adults requires a multidisciplinary approach involving legal professionals, health care professionals, educators, street outreach workers, and public health researchers.

JAMA Netw Open. 2023;6(4):e238902. doi:10.1001/jamanetworkopen.2023.8902