Garen J. Wintemute – Winner of the 2023 Jess Kraus Award

The Jess Kraus Award is given each year to the author of the best paper published in Injury Epidemiology, selected by the Editorial Board. Editor-in-Chief, Professor Guohua Li, chats with this year’s recipient, Dr. Garen J. Wintemute, about his award-winning study.

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BioMed Central
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Views of democracy and society and support for political violence in the USA: findings from a nationally representative survey - Injury Epidemiology

Background Current conditions in the USA suggest an increasing risk for political violence. Little is known about the prevalence of beliefs that might lead to political violence, about support for and personal willingness to engage in political violence, and about how those measures vary with individual characteristics, lethality of violence, political objectives that violence might advance, or specific populations as targets. Methods This cross-sectional US nationally representative survey was conducted on May 13 to June 2, 2022, of adult members of the Ipsos KnowledgePanel. Outcomes are weighted, population-representative proportions of respondents endorsing selected beliefs about American democracy and society and violence to advance political objectives. Results The analytic sample included 8620 respondents; 50.5% (95% confidence interval (CI) 49.3%, 51.7%) were female; and weighted mean (± standard deviation) age was 48.4 (± 18.0) years. Nearly 1 in 5 (18.9%, 95% CI 18.0%, 19.9%) agreed strongly or very strongly that “having a strong leader for America is more important than having a democracy”; 16.2% (95% CI 15.3%, 17.1%) agreed strongly or very strongly that “in America, native-born white people are being replaced by immigrants,” and 13.7% (95% CI 12.9%, 14.6%) agreed strongly or very strongly that “in the next few years, there will be civil war in the United States.” One-third of respondents (32.8%, 95% CI 31.7%, 33.9%) considered violence to be usually or always justified to advance at least 1 of 17 specific political objectives. Among all respondents, 7.7% (95% CI 7.0%, 8.4%) thought it very or extremely likely that within the next few years, in a situation where they believe political violence is justified, “I will be armed with a gun”; 1.1% (95% CI 0.9%, 1.4%) thought it very or extremely likely that “I will shoot someone with a gun.” Support for political violence and for the use of firearms in such violence frequently declined with increasing age, education, and income. Conclusions Small but concerning proportions of the population consider violence, including lethal violence, to be usually or always justified to advance political objectives. Prevention efforts should proceed urgently based on the best evidence available.

Editor-in-Chief, Guohua Li: Dr. Wintemute, congratulations on winning the Jess Kraus Award in Injury Epidemiology! Would you please briefly introduce yourself and your coauthors?  

Garen Wintemute: On behalf of the entire team, Dr. Li, thanks very much to you and the editorial board for the recognition.

 Here’s who we are: I am an emergency medicine physician,   director of the Violence Prevention Research Program, and lead investigator for our political violence survey work.   Sonja Robinson, PhD, is an epidemiologist and research data analyst with our group; Andrew Crawford, PhD, is a social psychologist and research data analyst with us; Daniel   Tancredi, PhD, is a faculty statistician at UC Davis; Julia   Schleimer, MPH, is a research analyst with us and doctoral student in epidemiology at the University of Washington;   Liz Tomsich, PhD, is a specialist in public policy analysis and another of our research analysts; Paul Reeping, PhD, is an epidemiologist and postdoctoral fellow with us; Aaron Shev, PhD, is a statistician and research analyst in our group; and Veronica Pear, PhD, senior author on the paper, is an epidemiologist on our faculty.

GL: Dr. Jess Kraus worked at UC Davis medical school in the 1970s.  What do you know about him and his pioneering work in Sacramento?    

GW: Dr. Kraus was a member of the department of community health at that time and one of very few injury epidemiologists in the country. His record in Pub Med goes back to 1969, when he was focusing on sports injuries. He led investigations of many types of injuries and collaborated on work involving suicide, brain and spinal cord injury, pesticide poisoning, and other important problems.

A personal anecdote: when I returned to California and joined the UC Davis faculty in 1983 after getting an MPH in injury prevention at Johns Hopkins, Professors Sue Baker and Steve Teret made clear that Dr. Kraus was someone I really needed to get to know. He was at UCLA by that time. In our first meeting there I sketched out a very rough idea for a descriptive study of the epidemiology of firearm death in California and sat astonished in a classroom as he quickly sketched out on the blackboard the design of the study and how best to present the findings. I felt like I was watching a wizard at work. He was a superb mentor and friend.

GL: In your award-winning paper, you made a compelling case for studying political violence.  Would you please tell us what has motivated you to forge into this important area of inquiry?  

GW: As the Covid 19 pandemic struck the United States in 2020, we expected a surge in firearm purchasing and a subsequent increase in violence and began monitoring both closely. Both occurred. But the purchasing surge did not abate in 2021 as we expected, and in mid-2021 I began looking for causes. What I found could be summed up in this statement by an expert on domestic violent extremism: “A lot of people want to see January 6 as the end of something. I think we have to consider the possibility that this was the beginning of something.” I wrote a commentary about the growing potential for political violence, which was published in Injury Epidemiology in November 2021, and we began planning our first survey soon thereafter. The data in the paper were collected by that survey in mid-2022.

GL: In your study, political violence is defined as “use of physical force or violence to advance political objectives”. This definition seems rather broad.  According to this definition, is political violence sometimes justifiable for objectives such as the abolition of slavery and the right to vote?    

GW: Specifying that violence involves physical force makes our definition more specific than most, but yes, we deliberately did not specify objectives in the definition. One of the major aims of the survey was to determine which political objectives might justify violence, in the view of our respondents, and how those views might vary with respondents’ sociodemographic characteristics. We presented 17 objectives in that survey. Some were quite specific, such as “to return Donald Trump to the presidency this year” (recall that the survey was conducted in mid-2022), and others more general, such as “to preserve the American way of life I believe in”.

GL: To understand the public attitude toward political violence, you conducted the Life in America Survey using the Ipsos KnowledgePanel. How did you secure the necessary funding for this project? How did you design the survey? And why did you use the online research panel?

GW: We designed the survey to provide nationally representative results, with a sample size sufficient to meet our statistical power requirements and with oversamples of firearm owners, veterans, and others to allow for preplanned subgroup analyses. We used the Ipsos  KnowledgePanel because we were impressed with the care that had been taken to assemble the panel (sampling is address-based and many efforts are made to secure participation by those sampled, including providing Internet access at no charge) and because it had been used in other high-quality surveys on violence, notably the National Firearm Survey conducted by Matt Miller and Deb Azrael. We received a grant for the survey from the Joyce Foundation and had core funding available from other foundations and from the California Firearm Violence Research Center.

 GL: Your paper is loaded with data tables and figures.  What are the top three findings in your opinion? 

GW: Yes, there was a lot to present! We found that nearly a third (32.8%) of respondents considered physical violence to be usually or always justified for at least one of the 17 specified political objectives we presented. About 1 in 7 (13.7%) agreed strongly or very strongly with the statement that “in the next few years, there will be civil war in the United States”. But the final top finding was good news and has the potential to provide the framework for prevention work: two-thirds of respondents rejected political violence altogether, and of the one-third who endorsed it, about 80% were repeatedly unwilling to become involved in violence themselves.

GL: Your study indicates that one-third of the survey respondents considered violence to be justified to advance important political objectives. Would you please help us to put this finding in the historical context? 

GW: One of the motivators for the study was the scarcity of rigorous research on what appeared to us to be an urgent problem. Prior surveys had asked just 1 or only a few questions regarding political violence, and to our knowledge there had been no exploration of personal willingness to become involved. But the existing data, summarized in the introduction to the article, were quite concerning. For example, a 2021 study found that 36% of adults agreed with the proposition that “the traditional American way of life is disappearing so fast that we may have to use force to save it”. In 2022, 18% of adults agreed that “because things have gotten so far off track, true American patriots may have to resort to violence in order to save our country”. We repeated those items in our survey and got similar results; that similarity increased our confidence that responses to items in our survey that had not been used before were likely valid.

GL: Your study raises many disturbing questions about the future of our democracy and society.  Are there any silver linings coming out of this study?  What are the actionable solutions to political violence from the public health perspective?

GW: You are correct; readers have been shocked by the bad news in this study and the others published since that have flowed from the project. We continue to focus attention on the third finding I mentioned above, that most Americans reject political violence and most of those who don’t reject it are not willing to join it.

The research will help focus prevention efforts on groups at highest risk for involvement in political violence. At the same time, it is very important that those of us who reject violence make our opposition known, loud and clear. People pay attention to what their family members, friends, and thought leaders say. Each of us also has the obligation to say something if we see or hear something. Many successful efforts to prevent threatened political violence (and violence of other types, such as mass shootings) have resulted from information provided by a member of the public to people in a capacity to do something about the threat.

GL: There is a palpable elegance of classical epidemiology in your research, be it the motor vehicle immersion study in the 1980s, or the cohort studies of firearm purchasers and crime guns, and the Life in America Survey in the 21st century.  How did the training in public health and epidemiology influence your work so profoundly? 

GW: Thank you! I trained initially as a field biologist, and then as a clinician (I still practice emergency medicine in a Level I trauma center, seeing 65-70 patients per shift as the triage physician). The experience that led me to public health and epidemiology was a 5-month experience working in a refugee camp in Cambodia, right after Pol Pot time—a very intensive experience in the power of violence to reshape entire societies, when we saw everything from battle trauma (daily) to neonatal tetanus and had no electricity, let alone computers.

All of this early experience emphasized inductive reasoning. What do we know on the ground? What are the data? What patterns emerge from those data? Can those patterns be found in similar data elsewhere? Much of the work we’ve done has been motivated by an interesting situation in the field (that motor vehicle immersion study), uniquely rich and unexplored data (all our cohort studies of firearm owners), or a looming crisis (a variation on “interesting situation in the field”), particularly one that is being ignored (the political violence work).

Public health and epidemiology (and, to be honest, many other disciplines) have given our research group an impressive set of tools that make our explorations productive and, we hope, help them contribute to the world’s ability to solve the difficult problems we study.

GL: As one of the most accomplished violence researchers, could you share a few pearls of wisdom with our young investigators and graduate students in the field of injury epidemiology and prevention? 

GW: Happy to; this is a subject I’ve thought about a lot. Particularly for violence, but to some extent for injuries generally, there isn’t the kind of funding available that exists for more mainstream problems. There can be opposition to the work, particularly as our research highlights the social determinants of the problems we study. Fair enough. Accept these challenges, don’t take no for an answer, be willing to be different (and know that you’re not alone), and commit to the long haul. Let other people do the easy and comfortable stuff; you have more important things to do.

GL: Thank you for taking the time to chat with me. I look forward to hosting you at the award ceremony in New York City this fall.

GW: Looking forward as well, and thanks for your great questions.

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