James Macinko

Gun-related violence in the U.S. threatens public health and strains the healthcare system. Prior work suggests that self-protection is a key driver of gun prevalence in the U.S., whereby Americans seek to acquire a gun when they fear that they themselves or their loved ones may be at risk of violence. The more the gun homicides take place in a city, the stronger the tendency to own a gun by its residents. While it is tenable that economic conditions may modulate the strength of this association, we know little about how economic hardship shapes gun ownership in the U.S. Leveraging mutual information and time-series symbolization, and considering suicides with firearms as a proxy of gun prevalence, we examine how economic indicators modify the association between gun homicides and gun prevalence using a cross-sectional comparison of 884 metropolitan/micropolitan statistical areas in the U.S. and a temporal analysis of national monthly trends. Across these areas, gun prevalence rises roughly twice as fast with gun homicides in high income-inequality settings. Nationally, gun homicide–gun prevalence association emerges only when Economic Policy Uncertainty changes are sufficiently large. These findings suggest that reducing inequality and elevating economic confidence past a critical threshold may dampen gun prevalence and help mitigate public-health impacts of gun violence.

Objective. To evaluate the extent to which the world's largest and most well established Conditional Cash Transfer (CCT) program, the Bolsa Família Program (BFP), reduced health inequities in the incidence of AIDS, tuberculosis (TB), and child mortality in Brazil. Design. Health impact evaluation within a large-scale cohort study. Setting. Brazil, from January 1 2004 to December 31 2015. Participants. We use three cohorts totaling 92,382,204 million individuals: i) Cohort 1: 22,788,997 individuals aged 13 and older from 2007 to 2015 for the analysis of AIDS incidence; ii) Cohort 2: 54,759,252 individuals from 2004 to 2015 for the analysis of TB incidence; iii) Cohort 3: 14,833,955 children under the age of 5 from 2004 to 2015 for the analysis of child mortality. Interventions. We began by assessing the excess incidence and mortality attributable to poverty severity. To estimate the reduction in health inequities associated with the BFP, we applied multiple inequality indices. We then conducted impact evaluations of BFP’s effects across wealth deciles, employing Inverse Probability Treatment Weighting (IPTW) multivariable Poisson regressions adjusted for all relevant socioeconomic, demographic, and health variables at the individual, household, and municipal levels. Main outcome measures. Incidence of AIDS, incidence of TB, and child mortality Results. Receiving BFP benefits eliminated the excess incidence and mortality associated with extreme poverty, significantly reducing the Gini, Theil, and Concentration Index values. Among the extremely poor, BFP was associated with reductions in the incidence of AIDS by 49%(RR: 0.51;95%CI:0.48-0.54), TB by 51%(RR:0.49;95%CI:0.48-0.50), and child mortality by 70%(RR:0.30;95%CI:0.28 0.32). These effects diminished progressively as beneficiaries’ poverty levels decreased. Over the past two decades, BFP is estimated to have prevented 99,083 cases of AIDS, 235,489 of TB, and 200,627 child deaths. Conclusions. Conditional Cash Transfer programs can significantly alleviate the burden of AIDS, tuberculosis, and child mortality, with the most pronounced impacts observed among the poorest populations. Their effectiveness follows a gradient aligned with levels of individual vulnerability and can substantially reduce health inequities in low- and middle-income countries.

Background: Amenable mortality, deaths preventable through timely and effective healthcare, is a widely used indicator of health system performance, yet evidence is lacking on its individual-level determinants in Brazil. Methods: We used data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative cohort of adults aged 50 and older. Deaths were classified as amenable using both the Brazilian and the Pan American Health Organization’s definitions. Semi-parametric competing risks regression modeled the hazard of amenable death while accounting for non-amenable death as a competing event and adjusting for covariates. Results: Among 872 deaths during follow-up, 30% to 39% were classified as amenable, with rates ranging from 2.5 (50–59 yrs) to 32.3 (80+) per 1,000 person-years. Older age, male sex, unpartnered status, lower income, multi-morbidity, and tobacco use were associated with higher risk of amenable mortality. Conclusions: Amenable mortality constitutes a substantial and inequitably distributed share of deaths among older Brazilians.

Introduction: Public opinion on firearm legislation varies, though there is broader agreement on restricting guns in alcohol-serving venues. Methods: This study used a discrete choice experiment with 306 US adults in June 2025 to examine preferences for firearm restrictions across different conditions. Scenarios varied by who would be restricted (felons, currently intoxicated individuals, or those with prior alcohol-related offenses), venue size (small, medium, or large), and annual enforcement costs ranging from $0 to $300. Results: Results show that when no enforcement costs are included, a majority of the respondent sample weighted to voting-eligible Americans (56%-74%, depending on the restricted group and venue size) supports firearm restrictions, with support exceeding 65% for restrictions in large venues. However, introducing a $100 annual cost reduces support: significant majority support remains only for restricting combinations of felons, intoxicated people, or those with alcohol-related convictions and only in large venues. Support patterns differ by demographics: women show the strongest support regardless of political affiliation, Democratic men show moderate support, while Republican men and Independents are least supportive. Gun ownership did not independently affect preferences. Conclusions: While support for firearm restrictions in alcohol-serving venues is widespread, even modest implementation costs significantly reduce public backing.

Health inequities in Latin America are rooted in historical systems of oppression, including slavery, patriarchy, and colonialism, which disproportionately affect socially marginalized groups. Intersectionality theory offers a framework to examine how overlapping social markers interact to shape health outcomes. While HIV/AIDS research has explored the effects of individual markers, few studies have addressed their intersections. We conducted a retrospective cohort study using data from 28.3 million Brazilians aged ≥13 years. We examined associations between race/ethnicity, education, and wealth—individually and in combination—stratified by gender. Over nine years, AIDS incidence was 23.37 and 18.63 per 100,000 person-years among men and women, respectively; mortality rates were 8.06 and 5.81 per 100,000 person-years. Isolated markers of social difference were associated with increased risk, but combined markers revealed pronounced intersectional effects. Here we show that intersections of race/ethnicity, education, and wealth substantially amplify the risk of AIDS-related illness and death in Brazil, with greater effects among women. These findings underscore the necessity of incorporating intersectionality into public health research and policy, and of addressing structural racism, sexism, and poverty through coordinated intersectoral actions to reduce HIV/AIDS inequities.

Objective: This study describes alcohol involvement in violent deaths using the National Violent Death Reporting System (NVDRS) from 2015 to 2022 in 24 states where at least 90% of decedent records had available alcohol assessment data. Methods: Using a repeated cross-sectional design, we construct a composite alcohol-involvement measure from toxicology results and NVDRS coder assessments and estimate negative binomial regression models with state-year demographic population counts as offsets to evaluate the roles of alcohol, firearms, and their intersection in violent deaths. The analytic sample included 204,739 decedents. Results: Alcohol was present in roughly 27% of all violent deaths (27% in suicide and 25% in homicide deaths), with age- and sex-adjusted alcohol-involved mortality rates ranging from 1.6 per 100,000 in Virginia to 7.8 per 100,000 in North Dakota. Firearms and alcohol co-occurred in 19% of homicide and 14% of suicide deaths. Alcohol involvement was most common among men and younger adults (aged 20–39) with the highest rates observed for men aged 30–39 who died from suicide. There was a slight (6%) decrease in mean alcohol-involved violent death rates within a subsample of 18 states observed from 2016 to 2022, although Alaska saw a larger decrease (39%) and Oregon and Connecticut saw a near doubling of their alcohol-involved violent death rates over this period. Conclusions: These findings indicate that alcohol plays a substantial and complex role in violent deaths. This role differs between homicides and suicides, and varies by sex, age, state, year, and firearm involvement. Violence reduction efforts may benefit from interrupting the links between alcohol consumption and violent behaviors. Improved data collection and toxicology standardization across states would greatly enhance efforts to monitor and evaluate ongoing and future interventions.