Characteristics Associated With Community Violence Prevention Programs in US Hospitals: A Cross-Sectional Survey Analysis

Acad Emerg Med. 2026 Apr;33(4):e70300. doi: 10.1111/acem.70300.

ABSTRACT

BACKGROUND: Violence is a social determinant of health, and hospitals are well-positioned to promote patient well-being by addressing its root causes. Understanding factors associated with hospital engagement in community violence prevention can guide intervention development and capacity building.

OBJECTIVE: To examine hospital and county-level factors associated with the presence of community violence prevention programs (CVPPs) in U.S. hospitals.

METHODS: This cross-sectional study linked data from the 2022 American Hospital Association Annual Survey with county-level socioeconomic and demographic data from the US Census Bureau and all-cause homicide rates from the US Centers for Disease Control and Prevention. The sample included general medical and surgical hospitals with Medicare identification numbers. Survey-adjusted logistic regression assessed associations between hospital CVPP presence and all-cause homicide. Our response variable was whether or not the hospital had a CVPP, and our explanatory variable was county-level all-cause homicide rates. We adjusted for hospital characteristics and county-level socio-demographics.

RESULTS: Of 4,374 hospitals, 990 (22.6%) reported having CVPPs. Compared to those without CVPPs, hospitals with CVPPs were more likely to be nonprofit (85.0% vs. 62.9%), large (> 500 beds; 16.9% vs. 4.7%), have more annual ED visits (51,873.9 vs. 26,224.5), and be urban (81.1% vs. 51.8%) (all p < 0.001). They also more frequently offered outpatient psychiatric (86.1% vs. 46.9%), substance use (74.4% vs. 23.2%), and pain management (93.1% vs. 65.2%) services. In adjusted models, homicide rates were not associated with CVPP presence (aOR = 1.01, 95% CI [0.99, 1.04]). CVPP presence was independently associated with nonprofit ownership, larger size, trauma designation, and lower social deprivation in urban counties.

CONCLUSIONS: Hospital and community characteristics, rather than homicide rates, predict CVPP presence. CVPPs are concentrated in larger, urban, well-resourced hospitals rather than in areas with the highest homicide rates, highlighting potential misalignment between program placement and community need.

PMID:42050826 | DOI:10.1111/acem.70300