Journal of Behavioral Medicine

, Volume 42, Issue 4, pp 635–645 | Cite as

Predictors of transitions in firearm assault behavior among drug-using youth presenting to an urban emergency department

  • Jason E. GoldstickEmail author
  • Patrick M. Carter
  • Justin E. Heinze
  • Maureen A. Walton
  • Marc Zimmerman
  • Rebecca M. Cunningham


Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals’ transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.


Firearms Violence Substance use Emergency department Transitions 



This work was funded by R03 AA025449 (PI: Goldstick), R01 DA024646 (PI: Cunningham), R01 DA035183 (PI: Cunningham), and R24HD087149 (PI: Cunningham).

Compliance with ethical standards

Conflict of interest

Jason E. Goldstick, Patrick M. Carter, Justin E. Heinze, Maureen A. Walton, Marc Zimmerman, and Rebecca M. Cunningham have no conflicts of interest to report.

Human and animal rights and Informed consent

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent (and parental consent with youth assent for participants under 18) was obtained from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Injury Prevention CenterUniversity of MichiganAnn ArborUSA
  3. 3.Youth Violence Prevention CenterUniversity of Michigan School of Public HealthAnn ArborUSA
  4. 4.Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA
  5. 5.Department of PsychiatryUniversity of Michigan School of MedicineAnn ArborUSA
  6. 6.University of Michigan Addiction CenterAnn ArborUSA
  7. 7.Department of Emergency MedicineHurley Medical CenterFlintUSA

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