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Using Data to Stem the Tide of Gun Violence in the U.S.

This article original appeared on Psychology Today.

Gun violence and firearm-related deaths have been increasing in the U.S. since 2020. This paradoxically may lead some people to think that owning a gun is a good idea—and indeed, gun sales in the U.S. have also been surging since the coronavirus pandemic began. Most gun owners in the U.S. say they own their guns for protection and that they make them feel safer.


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The data on gun ownership actually show quite the opposite. Numerous studies have demonstrated that the presence of a gun in the home increases the risk that a household member will die by firearm-related suicide or homicide. A new study published in April in the Annals of Internal Medicine found that homicides were twice as high among people who lived in households with a gun owner as those who lived in households without guns. The concluding statement from the paper is important:

Homicides and suicides account for 97 percent of the nearly 40,000 firearm-related deaths in the United States each year. It is implausible that gun access decreases suicide risk, and every rigorous study that has examined this relationship has found a positive association. Nonetheless, if firearm ownership enhanced personal safety in other ways, as many gun owners reportedly believe, tolerating some elevated risk for suicide might be considered a worthwhile tradeoff. This study adds to mounting evidence that no such tradeoff exists, because a gun in the home is associated with higher—not lower—risk for fatal assault. People who do not own handguns but live with others who do bear some of that risk, and the amount they bear appears to be substantial.

More Policing Not Correlated with Violent Crime Reduction

Believing that owning a gun offers protection could therefore be seen as a form of science denial, because the evidence we currently have is clear that it does not. Apparently, owning a firearm does exactly the opposite of what most gun owners believe: It increases the risk that the gun will be used to harm owners themselves or their families. Another belief that many people have is that more policing is a potential solution to stemming the rising tide of gun violence. A recent Brookings Institute report helps us consider if there is evidence to support that claim.

The report indicates that there is little correlation between increasing police funding and decreasing crime. Even if there were, the report notes that municipalities would still have “to weigh the negative effects that accompany adding more police officers, such as increasing arrests for low-level crimes which contribute to mass incarceration and disproportionately affect Black communities. Exposure to the criminal justice system itself can perpetuate underlying issues that contribute to violent crime and recidivism, such as low socioeconomic status and unemployment, homelessness, and poor mental health.”

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According to the Brookings report, “One of the most evident social factors correlated with violent crime is mental health.” High levels of poor mental health at the community level in aggregate, reflected by measures like overall community levels of depression and anxiety, are correlated with increased rates of violence. Efforts to improve community-level mental health may reduce violent crime. The report notes that “An estimated 20 percent of police calls are for mental health and substance use crises.” 

This of course does not mean that most individuals with mental illness are prone to commit violent acts; we know that even though overall people with mental illness are somewhat more likely to commit violent acts than people without mental illness, the great majority of people with mental illness are not violent. Rather, it suggests that poor overall community mental health and lack of access to mental health care increase the risk for violent crime, including gun-related violence. Furthermore, it begs the question of whether most police officers are properly trained and prepared to deal with the staggering number of calls that involve mental health disturbances.

Police Are Not Prepared for Mental Health Emergencies

These data suggest that owning a gun is clearly not a solution to dealing with increasing gun-related violence in the U.S. Nor is simply spending more money on policing likely to address the problem.

In addition to stricter gun control legislation and addressing the social factors that increase the risk for gun violence, the data indicate that improving access to mental health care facilities may have an impact. Also, we need to develop and evaluate alternatives to standard police responses to mental health emergencies. We have heard people scoff at the idea of “having a social worker respond to a police call,” but in fact, there is little evidence to suggest that having police officers respond to calls that involve a person in the midst of a mental health crisis is an effective intervention. Whether police officers can be better trained to respond to mental health emergencies or in fact we should be deploying behavioral health professionals for these calls is an empirical question that critically needs exploring.

Scientific data alone cannot be the basis for all public policy decisions; these require careful consideration of social needs, politics, and economic realities. But we believe that public policymakers should always ask if there are data relevant to their decisions or if more studies could be useful. Available data tell us that liberalizing gun ownership laws and spending more money on policing are unlikely to lead to meaningful and acceptable reductions in gun violence in the U.S. Rather, we need to consider factors that are known to increase the likelihood of gun violence and design interventions to address them.

One of those factors seems clearly to be poor community mental health. Thus, any attempt to reduce gun violence in the U.S. should consider the evidence and include an approach that addresses our police and overall community responses to mental health needs.

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This Might Hurt a Little: Finding Common Ground in Vaccine Hesitancy

This article originally appeared on Mediawell.

A common adage among people who study the concept of vaccine hesitancy is that vaccines are “a victim of their own success.” In other words, vaccines have been so successful at eliminating infectious diseases that people’s ability to assess the risk associated with these diseases has been muted. Lacking any access to a first-hand understanding of the devastation of diseases like measles and polio, people have effectively ceased to view them as a risk and in many cases have begun to view the vaccines as at best unnecessary and at worst too risky to accept.

Or so the argument goes. In the midst of the Covid-19 outbreak, as it became clearer and clearer—in part because of our failure to change the course of the disease by consistently adopting social distancing and other measures—that the success of the US response to the pandemic depended heavily on the robust uptake of a vaccine, there was suddenly a lot of speculation from researchers and journalists about how people traditionally labeled as “anti-vaxxers” would react to a novel vaccine for a virus that was very much alive and well. Unlike vaccines for diseases like diphtheria and tetanus, with which most people do not tend to come into too much contact, the threat of Covid-19 was, and is, very real. Would so-called anti-vaxxers change their tune and accept the vaccine for an illness that was much more salient? Of course, if we accept the notion that vaccine hesitancy is largely caused by a kind of collective amnesia about the dangers of largely extinct diseases, it would seem that a vaccine for an illness that is currently ravaging the population would be more acceptable.

This is, however, not quite what has happened. Skepticism of Covid-19 vaccines has been vibrant. In a December study, about 40 percent of Americans said they would not get a vaccine due to a variety of concerns about safety and efficacy. The fact that there are actually multiple vaccines complicates communications about their safety and efficacy even further. At points, opposition to vaccines has become mired in politics, such as when those advocating “anti-vaccine” views started showing up at anti-lockdown protests and demanding their freedom be restored. Conspiracy theories about microchips being put into the vaccine by Bill Gates to track the population have also been advanced, although these fringe ideas are less commonly cited as a primary barrier to vaccination.

So what went wrong with the many predictions that the Covid-19 vaccine would be more acceptable to people than vaccines against diseases that have faded into the background? Before answering this question, it’s worth looking at a historical example in which our predictions about acceptance of a new vaccine were wrong. In 2006, Gardasil, a vaccine that prevents human papilloma virus (HPV) infection, was approved for medical use in the US. In the years following, more and more medical entities recommended universal vaccination for both boys and girls, not least because the vaccine prevents several types of cancer. Given the cancer risk of HPV infection and the good efficacy and safety profile of the vaccine, no one expected any pushback, despite the fact that we were dealing with a sexually transmitted illness in the teenage population and that anti-vaccine sentiment was on the rise. Merck, the manufacturer of Gardasil, aggressively marketed the vaccine with no qualms about general distrust of big pharma in the population.

What followed was a major public health failure. Uptake of Gardasil is still abysmally low in the US despite repeated efforts on the part of public health agencies, physician groups, and others to convince people to get the vaccine. In 2016, Merck even came out with new ads featuring child actors asking their parents if they knew about the Gardasil vaccine with voiceovers revealing that these children later developed cancer due to HPV. The campaign met with anger from some viewers.

So what went wrong with Gardasil? The story is very similar to what is going wrong with our predictions about the population’s acceptance of the coronavirus vaccine. Public health officials and policymakers are assuming a monolithic, homogeneous population and a single category of anti-vaccine attitudes rather than the complex patchwork that actually makes up a variety of reasons why people become hesitant to vaccinate themselves or their children. In this essay, I will discuss what happens when we oversimplify the world of vaccine hesitancy and how to better understand this patchwork and speak to the variegated audiences of people who fall into vaccine-hesitant beliefs. There are obvious implications here for how we message around the new Covid-19 vaccines, which could make a significant difference in the proportion of the population that agrees to get the shot. Equally important is to consider the question: If we stop viewing everyone with some level of vaccine hesitancy as a virulent anti-vaxxer, might we start to see more common ground?

What’s in a name?

First, a note on language. In 2015, Jenny McCarthy, a celebrity and one of the foremost advocates of the debunked notion that vaccines cause autism, insisted in a PBS Frontline interview that people who hold this belief should not be called “anti-vaccine” but rather “pro-safe-vaccine-schedule.” While this name might not actually be the best representation of McCarthy and her followers’ views on vaccines, she raises an important point about framing. How we label people, especially people with whom we may disagree, is extremely important, not only to how they respond to us but also to how we go about approaching them in the first place. If we are “pro-vaccine” and we view everyone who doubts or questions vaccines as “anti-vaccine,” then our stance is immediately combative. Yet in many cases, this may not be an accurate reflection of the situation, and there may indeed be far more common ground than we think.

In a similar vein, in December 2019, a vaccine-skeptical group called “Crazymothers” released a statementrequesting that the media retire the use of the term “anti-vaxx” and replace it with the term “vaccine risk aware.” In their statement on Twitter, they claimed that the term “anti-vaxx” is “derogatory, inflammatory, and marginalizes both women and their experiences.” The problem with the proposed name “vaccine risk aware” is that it suggests both that vaccines are particularly risky, which they tend not to be, and that others, including those in the medical establishment, are by contrast somehow “unaware” of any risks associated with vaccines, which is also misleading and could cause diminished trust in health-care workers in the context of making vaccination decisions. Nonetheless, we once again see that names make a difference.

Many years of excessive focus on a group of people called “anti-vaxxers” has also led to a lack of focus on people who are mildly hesitant, are on the fence, or even accept vaccines now but may change their minds later if the circumstances around a particular vaccine cause a heightened perception of risk (as is the case with the Covid-19 vaccines—we will come back to this later). As a result, we spend much of our energy studying and trying to convince a very small number of people who are adamant that vaccines are dangerous and not nearly enough time understanding the underlying conditions that cause hesitancy to arise and what tools can be used to reinforce the safety and efficacy of vaccines even among people who currently do not view them as particularly risky. We in turn spend even less time addressing legitimate issues of trust in the health-care system, including in communities of color, in which distrust is even more understandable given ongoing patterns of systemic inequitiesand mistreatment of these populations in the health-care system.

Is there an anti-vaccine “movement”?  

One reason it may be difficult to figure out how to refer to people with high levels of skepticism about vaccines is a lack of clarity surrounding whether anti-vaccine and vaccine-hesitant sentiments constitute a “movement.” It is extremely common to see the phrases “anti-vaccine movement” and “pro-vaccine movement” in media coverage, including in headlines, as in “How pro-vaccine parents can help stop the rise of the anti-vaxxer movement” and “Why is the anti-vaxxer movement growing during a pandemic?

Despite the second headline’s insistence that the so-called movement is growing during the pandemic, it would seem that Covid-19 has actually called into question any sense of an organized, monolithic group of people driving anti-vaccine sentiment and vaccine hesitancy. For one thing, the “anti-vaxxers” are not behaving the way we thought they would. Instead of being humbled by the obvious need for a vaccine to control a raging epidemic, anti-vaccine sentiments have flourished in this environment. Among the American public more generally, people were much more skeptical of a potential Covid-19 vaccine than anticipated. The thought went that everyone would be so desperate for this crisis to end that they would rush to get vaccinated, but polls asking people about their plans once a vaccine became available did not bear this out. In every instance, researchers were very surprised to find that large quantities of people are either not planning to get the vaccine or want to significantly delay getting it.

The reality is that vaccine hesitancy is not that uncommon and encompasses a wide spectrum of views, from total acceptance to total rejection. Framing “anti-vaxxers” as a movement can actually help the cause of the most extreme vaccine skeptics by making them seem like a unified group. People feel comfortable when they join groups—it is a very socially desirable activity and helps make difficult decisions, like whether or not to get a brand-new vaccine whose long-term consequences have not been assessed, easier. Without meaning to, when we repeatedly refer to the “anti-vaxx movement,” we may be pushing people toward more extreme views rather than helping communities address the specific and varied concerns they might have. We are robbing ourselves of an opportunity to better understand a rich spectrum of views and instead focusing on a vocal fringe that is not going to engage with us much anyway.

Who are the “anti-vaxxers”? 

 If a monolithic view of the “anti-vaccine movement” is misguided, then who are the so-called anti-vaxxers? Who is most vulnerable to becoming “vaccine hesitant,” and how do we understand the different categories of people within this designation?

While the “categories” of people who tend toward hesitancy are by no means absolute, it is somewhat helpful to think of the different types of objections to vaccines if we want to be effective at targeting and correcting these views. While people who claim that vaccines are part of a vast government conspiracy may be the most visible and vocal, vaccine hesitancy consists of a wide array of concerns and barriers, many of which are actually quite mundane. This is important because if we always focus on the flashy phenomena such as conspiracy theories and direct all of our messages there, we will miss entire populations of people who may have more common, understandable concerns—concerns that we may be able to address with respectful and constructive dialogue. That’s why a careful assessment of different kinds of vaccine-hesitant sentiments is so important. And it’s also another reason why conceptualizing a monolithic “anti-vaccine movement” is so counterproductive.

A recent study suggested four different “types” of so-called anti-vaxxers, which the authors called the four Cs: complacency, convenience, lack of confidence, and utility calculation. Complacency refers to a sense that the diseases against which vaccines protect are not really a threat; convenience refers to the kinds of structural barriers, such as time and cost, that might keep people from prioritizing and following through with a vaccine; lack of confidence refers to what we most commonly think of when we hear the term “anti-vaxxer”—that is, a sense that the safety of the vaccine is in question; and utility calculation refers to the notion that people may not bother getting vaccinated because they think they are protected by others in the population who are immune. Other studies have suggested similar formulations of hesitancies.

Is coronavirus vaccine hesitancy different?

 While it is too soon to fully understand how hesitancy around Covid-19 vaccines will play out, there is still some basis to speculate on how it might compare to the kind of vaccine hesitancy we have been seeing over the past few decades. On the one hand, there are a lot of similarities between Covid-19 vaccine hesitancy and hesitancy surrounding other vaccines. We often hear a lot of the same arguments meant to discredit the need to get a vaccine, including the supposed superiority of natural immunity over vaccine-acquired immunity, the idea that the pharmaceutical industry is pushing something unnecessary and potentially unsafe for its own benefit, and the argument, which comes up a lot around the seasonal flu vaccine, that the disease is not that bad.

On the other hand, hesitancy around Covid-19 vaccines is actually quite different from hesitancy around established vaccines. In some ways, the argument is less polarized, as some trepidation around a new vaccine is quite logical. There are understandable concerns, although they are probably ultimately unfounded, about the speed with which Covid-19 vaccines have been developed. It is not completely unreasonable for people to be nervous about a new vaccine when we have no longer-term information on how it might affect people. Against a backdrop of decreasing trust in government authorities, which is also understandable given many of the actions of the current outgoing administration, hesitancy around a new vaccine developed with hefty support from the government is not exactly surprising or even wholly unwarranted.

How hesitancy around Covid-19 vaccines will ultimately play out is going to function as an interesting natural experiment on how vaccine hesitancy develops and flourishes. In this case, researchers and policymakers actually have the opportunity to watch hesitancy unfold as the vaccines are developed and distributed in real time. Hopefully, if we pay enough attention, we will learn something about which efforts and messages work and don’t work to convince people that the vaccines are safe and effective and to reach reasonable levels of population immunity.

Where do we go from here?

Vaccine hesitancy is certainly not a one-size-fits-all phenomenon, and if anything it has only become more complex with the new threat of Covid-19 and accompanying vaccines. As we struggle to keep hesitancy at bay in the coming months and years, it’s essential to continue to search for common ground. One of the best ways to find it is to fully embrace the fact that vaccine hesitancy is a heterogeneous phenomenon. This understanding will undoubtedly have implications for how we actually address vaccine hesitancy and look to persuade people to accept vaccines for Covid-19 and other diseases. But no matter what method of persuasion and behavior change we choose, it is fair to say that the way we conceptualize vaccine hesitancy has a significant impact on how we respond to it. If we are going to be successful at vaccinating the public against this novel threat, we need to reframe both our language and our concept of the so-called “anti-vaxxer.”

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Ebola has Taught us a Crucial Lesson about our Views of “Irrational” Health Behaviors

This post originally appeared here

As Ebola rears its ugly head in the U.S., there has been a lot of discussion about how afraid we really should be. While health officials have remained relatively calm, insisting in a tense congressional hearing that there is no need to panic, some members of the American public have gone in the opposite direction, proclaiming a state of emergency on social media channels such as Twitter and Facebook. Donald Trump has been an especially noisy voice on the topic on Twitter, demanding that Obama stop all flights to and from West Africa and proclaiming that Ebola is actually much more contagious than the CDC says it is. At the end of September, with the announcement of the first suspected case of Ebola in the U.S., Trump expressed panic on Twitter, writing:

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Trump’s comments suggest not only a distrust of health authorities but also a kind of hysteria, with the use of the word “plague,” that is reminiscent of the infectious disease panic seen in many other outbreaks in American history, including SARS in 2003 and bubonic plague in 1924, the latter an outbreak that famously led to the frantic firing of thousands of Latino workers and destruction of homes in low-income Latino neighborhoods because they were seen as the “source” of the disease.

At the same time, a good deal of the coverage of the Ebola crisis in West Africahas focused on the “irrationality” and “ignorance” of West Africans, choosing to visit traditional healers instead of doctors and ignoring warnings from health officials that traditional burial rituals can hasten the spread of the disease. Indeed, this “lack of faith in Western medicine” is now being addressed by local and foreign health officials who are running educational programs in places like Liberia and Sierra Leone in order to ensure that the people exposed to the illness have the correct scientific information.

But while certain cultural practices and lack of education have certainly played a role in the rapid spread of Ebola in West Africa, the amount of attention we have paid to the “ignorance” and “irrationality” of people living in these developing countries has not been balanced with an equal amount of attention to our own developed nations’ manifestations of similar irrational health beliefs. Are we really that much more knowledgeable and rational than our West African counterparts, or do our irrationalities and psychological missteps simply take different cultural forms? And do our ignorance levels and irrationalities have the potential to be just as dangerous to our health as seeking out a local healer instead of a trained healthcare professional in response to a life-threatening viral illness?

Some recent news articles have focused on the need for anthropologists in the response to the Ebola outbreak in West Africa. These anthropologists have noted that the response to any disease outbreak or epidemic is fundamentally social and cultural. In this same vein, our response here in the U.S. to Ebola (and likely in other developed nations) is similarly prone to social and cultural inflections, psychological influences, and misinformation.

For one thing, responses to “exotic,” novel infectious diseases seem to incur a kind of panic in the U.S. that is often out of proportion to the actual threat of the illness. This leads to a situation in which people worry about these illnesses to the exclusion of other, more serious threats, like the seasonal flu, a highly infectious airborne virus with no reliable cure that is known to cause many deaths every year. Misunderstanding the relative risks of Ebola and the flu is not only irrational but also misinformed. Because we are accustomed to the flu but not to Ebola there may be a temptation to think the former is less of a threat than the latter when in fact the opposite is the case.  What is the most effective treatment for Americans to protect themselves from early death by an infectious pathogen? A flu shot.

In the U.S., our responses to infectious disease outbreaks can also sometimes tap into embedded racial tensions. For example, the widow of the first American citizen to die of Ebola has noticed that many members of the sizeable Liberian community in the Twin Cities are being ostracized because of fears of the disease. One Liberian friend of the widow—an individual who had not had any contact with an infected person–even had a doctor refuse to examine her.  This kind of behavior among healthcare providers is not only irrational but also potentially dangerous, since it tends to foster distrust of the medical community.

Finally, distrust of government and a tendency toward conspiracy theories also seems to become a particularly popular trend in response to infectious disease in the U.S. In early October, a doctor strolled through the Atlanta airport wearing a hazmat suit reading “CDC is lying”. Needless to say the idea has gained traction and is now circulating around the internetoften alongside a series of other “lies” fed to us by the government. This is particularly dangerous, since it leads to a general erosion of the public’s trust in our nation’s public health authorities and it tends to spread false information. A recent survey by the Kaiser Family Foundation showed that 25% of Americans believe that Ebola can be transmitted through the air and 37% believe that Ebola can be transmitted by shaking hands with someone who has it but is still asymptomatic.

So are some of the views of West African citizens on Ebola irrational and misinformed? Yes, and this is a dangerous problem that needs to be rectified. Yet, and I would argue in many ways equally as dangerous, some of the views of people in developed countries such as the U.S. on Ebola are also irrational and misinformed. This is also a serious problem that needs to be rectified. Perhaps anthropologists are also key in the developed world’s fight against the Ebola virus.

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