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Reducing Urban Violence: A Contrast of Public Health and Criminal Justice Approaches

Cerdá, Magdalenaa; Tracy, Melissab; Keyes, Katherine, M.c

doi: 10.1097/EDE.0000000000000756
Psychosocial epidemiology

Background: Cities are investing millions in Cure Violence, a public health approach to reduce urban violence by targeting at-risk youth and redirecting conflict to nonviolent responses. The impact of such a program compared with criminal justice responses is unknown because experiments directly comparing criminal justice and public health approaches to violence prevention are infeasible with observational data. We simulated experiments to test the influence of two interventions on violence: (1) Cure Violence and (2) directed police patrol in violence hot spots.

Methods: We used an agent-based model to simulate a 5% sample of the New York City (NYC) adult population, with agents placed on a grid representing the land area of NYC, with neighborhood size and population density proportional to land area and population density in each community district. Agent behaviors were governed by parameters drawn from city data sources and published estimates.

Results: Under no intervention, 3.87% (95% CI, 3.84, 3.90) of agents were victimized per year. Implementing the violence interrupter intervention for 10 years decreased victimization by 13% (to 3.35% [3.32, 3.39]). Implementing hot-spots policing and doubling the police force for 10 years reduced annual victimization by about 11% (to 3.46% [3.42, 3.49]). Increasing the police force by 40% combined with implementing the violence interrupter intervention for 10 years decreased violence by 19% (to 3.13% [3.09, 3.16]).

Conclusions: Combined investment in a public health, community-based approach to violence prevention and a criminal justice approach focused on deterrence can achieve more to reduce population-level rates of urban violence than either can in isolation. See video abstract at,

From the aDepartment of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA; bDepartment of Epidemiology and Biostatistics, State University of New York at Albany, Albany, NY; and cDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.

Submitted October 12, 2016; accepted September 14, 2017.

Funding for this study was provided by K01DA030449, R21AA021909, 1R21DA041154-01.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Correspondence: Magdalena Cerdá, 2315 Stockton Blvd, Sacramento, CA, 95817. E-mail:

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