Poor Health and Violent Crime Hot Spots: Mitigating the Undesirable Co-Occurrence Through Focused Place-Based Interventions

Published:February 12, 2020DOI:


      The geographic overlap of violence and poor health is a major public health concern. To understand whether and how place-based interventions targeting micro-geographic places can reduce this undesirable co-occurrence, the study addresses 2 important questions. First, to what extent are deteriorated health conditions associated with living at violent crime hot spots? Second, through what mechanisms can focused place-based interventions break the association between living with violence and deteriorated health?


      This study used survey data from 2,724 respondents living on 328 street segments that were categorized as violent crime hot spots (181 segments with 1,532 respondents) versus non–hot spots (147 segments with 1,192 respondents) in 2013–2014 in Baltimore, Maryland. Propensity score analysis assessed whether individuals living at violent crime hot spots had lower general health perceptions than people living at non–hot spots. Marginal structural models estimated the proportion of total effects mediated by 3 theoretically informed intervening mechanisms. Analyses were conducted in 2019.


      Respondents living at violent crime hot spots had a lower level of self-rated general health (b= −0.096, 95% CI= −0.176, −0.015) and higher levels of health limitations (b=0.068, 95% CI=0.027, 0.109) and problems (OR=2.026, 95% CI=1.225, 3.349) than those living at non–hot spots. Enhanced perceptions of safety, collective efficacy, and police legitimacy may break the association between living in places with extremely high levels of violence and deteriorated health.


      Indicated or selective strategies are urgently needed to target micro-geographic locations with known increased risks, supplementing universal strategies applied to a broader community.
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        • Macintyre S
        • Ellaway A
        • Cummins S
        Place effects on health: how can we conceptualize, operationalize and measure them?.
        Soc Sci Med. 2002; 55: 125-139
        • Diez Roux AV
        • Mair C
        Neighborhoods and health.
        Ann N Y Acad Sci. 2010; 1186: 125-145
        • Braveman P
        • Egerter S
        • Williams DR
        The social determinants of health: coming of age.
        Annu Rev Public Health. 2011; 32: 381-398
        • Chen E
        • Miller GE
        Socioeconomic status and health: mediating and moderating factors.
        Annu Rev Clin Psychol. 2013; 9: 723-749
        • Sampson RJ
        The neighborhood context of well-being.
        Perspect Biol Med. 2003; 46: S53-S64
        • Krug EG
        • Mercy JA
        • Dahlberg LL
        • Zwi AB
        The world report on violence and health.
        Lancet. 2002; 360: 1083-1088
        • Sumner SA
        • Mercy JA
        • Dahlberg LL
        • Hillis SD
        • Klevens J
        • Houry D
        Violence in the United States: status, challenges, and opportunities.
        JAMA. 2015; 314: 478-488
        • Weisburd D
        • Groff ER
        • Yang SM
        The Criminology of Place: Street Segments and Our Understanding of the Crime Problem.
        Oxford University Press, Oxford, UK2012
        • Weisburd D
        The law of crime concentration and the criminology of place.
        Criminology. 2015; 53: 133-157
        • Sherman LW
        • Gartin PR
        • Buerger ME
        Hot spots of predatory crime: routine activities and the criminology of place.
        Criminology. 1989; 27: 27-56
        • Weisburd D
        • Eck JE
        • Braga AA
        • et al.
        Place Matters: Criminology for the Twenty-First Century.
        Cambridge University Press, New York, NY2016
        • Weisburd D
        • Mazerolle LG
        Crime and disorder in drug hot spots: implications for theory and practice in policing.
        Police Q. 2000; 3: 331-349
        • Weisburd D
        • Groff ER
        • Yang SM
        Understanding and controlling hot spots of crime: the importance of formal and informal social controls.
        Prev Sci. 2014; 15: 31-43
        • Wikström PH
        • Ceccato V
        • Hardie B
        • Treiber K
        Activity fields and the dynamics of crime.
        J Quant Criminol. 2010; 26: 55-87
        • Yuan Y
        • Dong B
        • Melde C
        Neighborhood context, street efficacy, and fear of violent victimization.
        Youth Violence Juv Justice. 2017; 15: 119-137
        • Browning CR
        • Cagney KA
        Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting.
        J Health Soc Behav. 2002; 43: 383-399
        • National Academies of Sciences, Engineering, and Medicine
        Proactive Policing: Effects on Crime and Communities.
        The National Academies Press, Washington, DC2018
        • Lum CM
        • Koper CS
        Evidence-Based Policing: Translating Research Into Practice.
        Oxford University Press, Oxford, UK2017
        • Weisburd D
        • Cave B
        • Nelson M
        • et al.
        Mean streets and mental health: depression and post-traumatic stress disorder at crime hot spots.
        Am J Commun Psychol. 2018; 61: 285-295
        • Holbrook AL
        • Krosnick JA
        • Pfent A
        • et al.
        The causes and consequences of response rates in surveys by the news media and government contractor survey research firms.
        in: Lepkowski JM Tucker C Brick JM Advances in Telephone Survey Methodology. John Wiley & Sons, Hoboken, NJ2008: 499-528
        • Idler EL
        • Benyamini Y
        Self-rated health and mortality: a review of twenty-seven community studies.
        J Health Soc Behav. 1997; 38: 21-37
        • Freyer-Adam J
        • Baumann S
        • Haberecht K
        • et al.
        Can brief alcohol interventions in general hospital inpatients improve mental and general health over 2 years? Results from a randomized controlled trail.
        Psychol Med. 2019; 49: 1722-1730
        • Sampson RJ
        • Raudenbush SW
        • Earls F
        Neighborhoods and violent crime: a multilevel study of collective efficacy.
        Science. 1997; 277: 918-924
        • Coffman DL
        • Zhong W
        Assessing mediation using marginal structural models in the presence of confounding and moderation.
        Psychol Methods. 2012; 17: 642-664
        • VanderWeele TJ
        Marginal structural models for the estimation of direct and indirect effects.
        Epidemiology. 2009; 20: 18-26
        • MacKinnon DP
        • Lockwood CM
        • Brown CH
        • Wang W
        • Hoffman JM
        The intermediate endpoint effect in logistic and probit regression.
        Clin Trials. 2007; 4: 499-513
        • Preacher KJ
        • Selig JP
        Advantages of Monte Carlo confidence intervals for indirect effects.
        Commun Methods Meas. 2012; 6: 77-98
        • Gordon Jr, RS
        An operational classification of disease prevention.
        Public Health Rep. 1983; 98: 107-109
        • Weisburd D
        • White C
        Hot spots of crime are not just hot spots of crime: examining health outcomes at street segments.
        J Contemp Crim Justice. 2019; 35: 142-160
        • Sherman LW
        • Weisburd D
        General deterrent effects of police patrol in crime “hot spots”: a randomized, controlled trial.
        Justice Q. 1995; 12: 625-648
        • Braga AA
        • Papachristos AV
        • Hureau DM
        The effect of hot spots policing on crime: an updated systematic review and meta-analysis.
        Justice Q. 2014; 31: 633-663
        • van Dijk AJ
        • Herrington V
        • Crofts N
        • et al.
        Law enforcement and public health: recognition and enhancement of joined-up solutions.
        Lancet. 2019; 393: 287-294
        • Branas CC
        • South E
        • Kondo MC
        • et al.
        Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear.
        Proc Natl Acad Sci U S A. 2018; 115: 2946-2951
        • Kondo M
        • Hohl B
        • Han S
        • Branas CC
        Effects of greening and community reuse of vacant lots on crime.
        Urban Stud. 2016; 53: 3279-3295
        • Kondo MC
        • Andreyeva E
        • South EC
        • MacDonald JM
        • Branas CC
        Neighborhood interventions to reduce violence.
        Annu Rev Public Health. 2018; 39: 253-271
        • South EC
        • Hohl BC
        • Kondo MC
        • MacDonald JM
        • Branas CC
        Effect of greening vacant land on mental health of community-dwelling adults: a cluster randomized trial.
        JAMA Netw Open. 2018; 1e180298
        • South EC
        • Kondo MC
        • Cheney RA
        • Branas CC
        Neighborhood blight, stress, and health: a walking trial of urban greening and ambulatory heart rate.
        Am J Public Health. 2015; 105: 909-913
        • Rees-Punia E
        • Hathaway ED
        • Gay JL
        Crime, perceived safety, and physical activity: a meta-analysis.
        Prev Med. 2018; 111: 307-313
        • Kim D
        Blues from the neighborhood? Neighborhood characteristics and depression.
        Epidemiol Rev. 2008; 30: 101-117
        • Won J
        • Lee C
        • Forjuoh SN
        • Ory MG
        Neighborhood safety factors associated with older adults’ health-related outcomes: a systematic literature review.
        Soc Sci Med. 2016; 165: 177-186
        • Sharkey PT
        Navigating dangerous streets: the sources and consequences of street efficacy.
        Am Sociol Rev. 2006; 71: 826-846
        • Sunshine J
        • Tyler TR
        The role of procedural justice and legitimacy in shaping public support for policing.
        Law Soc Rev. 2003; 37: 513-548
        • Nagin DS
        • Telep CW
        Procedural justice and legal compliance.
        Annu Rev Law Soc Sci. 2017; 13: 5-28
        • White C
        • Weisburd D
        A co-responder model for policing mental health problems at crime hot spots: findings from a pilot project.
        Policing J Policy Pract. 2017; 12: 194-209
        • Shepherd JP
        • Sumner SA
        Policing and public health—strategies for collaboration.
        JAMA. 2017; 317: 1525-1526
        • Shepherd JP
        Emergency medicine and police collaboration to prevent community violence.
        Ann Emerg Med. 2001; 38: 430-437
      1. Azrael D, Braga AA, O'Brien ME. Developing the capacity to understand and prevent homicide: an evaluation of the Milwaukee Homicide Review Commission; 2013. Accessed June 15, 2019.

      2. Dong B, Morrison CN, Branas CC, Richmond TS, Wiebe DJ. As violence unfolds: a space–time study of situational triggers of violent victimization among urban youth. J Quant Criminol. In press. Online June 25, 2019.

        • Dong B
        • Branas CC
        • Richmond TS
        • Morrison CN
        • Wiebe DJ
        Youth's daily activities and situational triggers of gunshot assault in urban environments.
        J Adolesc Health. 2017; 61: 779-785
        • Anderson E
        Code of the Street: Decency, Violence, and the Moral Life of the Inner City.
        W. W. Norton & Company, New York, NY2000