Characterization of homicide and associated factors with use of drugs in a state capital city in Northeast Brazil

RESUMO Introdução: O homicídio é um problema de Saúde Pública no Brasil não raro relacionado com drogas ilícitas. Objetivo: Caracterizar os homicídios e os aspectos associados ao uso de drogas ilícitas. Métodos: Estudo transversal, com abordagem quantitativa, realizado em João Pessoa, no estado da Paraíba, no Brasil, em 2014. Consideraram-se 424 vítimas de homicídios cujos dados foram coletados através de um instrumento próprio, analisados com auxílio de software estatístico, com Teste de QuiQuadrado e Regressão Robusta de Poisson, considerando um nível confiança de 95% e significância estatística quando p<0,05. Resultados: Predominância de vítimas de homicídios homens (93,2%), não brancos (97,2%), com até 30 anos, considerando as faixas etárias de menor de 20 anos (22,6%), de 20 a 24 (26,7%) e 25 a 29 (18,8%), com menos de sete anos de estudo (67,5%), com histórico de envolvimento com drogas ilícitas (72,5%) e de encarceramento (59,7%). Observaram-se associações entre envolvimento com drogas ilícitas e as variáveis: sexo (p=0,037), idade (p=0,002) e histórico de encarceramento (p<0,001). A prevalência ajustada de envolvimento com drogas ilícitas foi 67% maior entre aqueles com histórico de encarceramento (RP: 1,67; IC95%: 1,44-1,94) e 28% menor entre indivíduos com 30 anos ou mais (RP: 0,72; IC: 0,58-0,88). Conclusão: O homicídio está inserido em um quadro de complexas questões sociais, dentre as quais se insere o envolvimento com drogas ilícitas, e é mais prevalente entre indivíduos com histórico de encarceramento e menos prevalente entre os de mais de 30 anos.


INTRODUCTION
Homicide, interpersonal injury infringed per any means and with lethal outcome, has high social impact, and not by chance has been considered the main indicator of violence; which has a significant effect on populations in a number of countries, particularly the peripheral and developing 1 .
In Latin America, from 1999 to 2009, it is concluded that the countries with the highest homicide rates, considering a base of 100 thousand inhabitants, were El Salvador (62.9), Guatemala (51.2), Colombia (42.5), Venezuela (33.2) and Puerto Rico (25.8).
In the same period, it was found that in the case of Brazil, although with a lower rate than those (25.2), which remained relatively stable, is still about four times higher than the world average 2,3 .
Indeed, considering the Brazilian context, in 2014, year of the present study, 59.681 homicides were recorded, and, the state of Paraiba, in the northeastern region, which has systematically presented, increase in the aforementioned injuries, 1.522 were reported, representing 39.3 deaths per 100 thousand inhabitants.
Highlighting its capital, João Pessoa, scenario of the present study, with just over one third of the deaths, a result that made it occupy in ranking among all the other capitals 4,5 .
Disregarding the aspects presented, it is certain that homicide is the expression of violence that has demanded attention, especially because it does not reach the population in a homogeneous way, but rather unevenly, has been noticed in all studies on these themes, and although the growth of feminicide statistics has been consistently reported 6 , its highest incidence among young, black, low-educated men 7,8 , from the outskirts of large urban centers 9 , and among those with some kind of involvement with illicit drugs 10 . Reveals, a number of factors related to the offense in question are revealed, particularly those of a socioeconomic nature and the issue of drug use and trafficking, especially 11,12 . Thus, if, on the one hand, the increase in homicide studies can contribute to reinforce the intrinsic relationship between these and widely known socioeconomic aspects, by the way, when it includes the theme of illicit drugs, as it did not present any study, it is even more relevant in that it can contribute to discussions and operationalization of actions on issues such as legalization and decriminalization, which are certainly on the agenda.
This study, in particular, which merits the use of police investigations, not information systems data, therefore it allows exploring aspects that cannot be gauged through those, besides the theoretical contribution, it also has practical applicability. That is why with a greater understanding of these grievances one can contribute beyond the context of public security, and it is important to subsidize or delineate intersectoral policies that involve different political actors, especially in the context of the economic crisis and current fiscal austerity, which will certainly further impact the reality in the coming decades. Given the exposed, this study aims to characterize homicides and aspects associated with illicit drug use in João Pessoa, one of the capitals of northeastern Brazil. Regarding the characteristics of the injuries, homicides, it was found that the majority occurred during working days (67%), at night (56.4%) and on public roads (75%), by means of fire (86.8%), multiple injuries (84.2%), and death still reported at the crime scene (82.5%) ( Table 2).

Cross
Continuing with the characteristics of homicides, injuries to the head (60.8%) and thorax (55.4%) regions were highlighted ( Table 3).
As a significant part of the victims had a history of involvement with illicit drugs, univariate analysis was performed considering it as the dependent variable, and sociodemographic aspects as independent, revealing statistical significance with the sex (p=0.037), the age (p=0.002), and the incarceration history (p<0.001) ( Table 4).
Prevalence of illicit drug involvement was higher 16% in males    Although recognizing the broad reality in which homicide fits in, in the broader context of the characteristics of its occurrence,  Homicides and illicit drug use including a number of issues that, individually, could be widely studied and discussed, such as those already posed here -sex, age, education and color -which need to be analyzed not by themselves, but because they point to broad social issues such as inequality, especially the latter two. While widely known and debated, such an impression continues to demand important reflections, especially due to the degree of naturalization reached 4 .
About the above, from the analysis of homicides in almost a decade, between 2000 and 2009, it appears that aspects related to schooling, as well as color, may be competing factors for greater victimization by these diseases 18 , which was also discussed from other analyzes 25 . However, according to the authors' conclusion, even if we consider the most and least educated, those injuries were more prevalent among non-white individuals when compared to whites, and therefore suggests that the second aspect explains an important part of it is occurrence 25 .
Still considering the more general context of characteristics of the occurrence of homicides, in addition to those previously mentioned, it is important to note that the victims mostly died at the crime scene, which can be explained, in part, if it is considered that the majority suffered multiple injuries, which positions are located, such as the chest and the head, as you have already found 26 ; the firearm being the main instrument involved, an aspect observed in previous analyzes [26][27][28] .
At the outset, in the context in question, it can be assumed that Excluding firearm-related homicides consistently increased 5 , although in a context of more restrictive legislation, with the Disarmament Statute, expanding social policies, income distribution, housing, access to education and health, especially in the first decade of the 2000s, and, also, increasing the proportion of elderly people, less exposed to external injuries, such as accidents and violence, and reducing young people and adults from 15 to 29 years old, who are more vulnerable instead 29  In addition to the firearm, involvement with illicit drugs such as marijuana, crack and cocaine is a clear issue among homicide victims, as it appears that a significant amount used one or some of these substances 10,31 . Such observations are not limited only in the investigated scenario of the Northeast, but also outside it, as in the Southeast 21,29 , and even more internationally, since the aspects that circumscribe the use of these substances, especially trafficking, are correlated with greater risk for the type of injury in question 27,32 .
Hence, the context that circumscribes illicit drug use and trafficking is currently recognized as one of the main risk factors for death by homicide 33,34 , and, considering the associated characteristics, as also shown in this study -age, sex, and incarceration history-these are aspects that need to be considered, especially in the current scenario, in which there is an international movement of individuals who, through diverse organizations, strongly intend to debate the legalization and decriminalization of the use of these substances in order to qualify the positions.
As observed, when considering the adjustment of variables in a regression model, age and history of seclusion remained statistically associated with involvement with illicit drugs, noting that the prevalence of this condition was higher among those already incarcerated and lower as the older age group, especially for those over 30 years old. It is assumed that the association between the use of these substances and the violent behavior of users can be explained, on the one hand, by the need to focus on crimes through which they obtain resources necessary for their acquisition, and on the other, and perhaps mainly by their closer relationship with drug trafficking, whose agents have been recruiting ever younger individuals 30,32,35,36 , both realities that often result in death or imprisonment.
In a scenario of exacerbated prohibitionism and therefore lack of regulation for drugs other than tobacco and alcohol, and deep social inequality, makes these substances important driving forces for crime, which has one of its most profitable segments in trafficking, and which ultimately recruits and victimizes, in particular, homicide, exactly those who are the greatest victims of the Among the youngest, children and adolescents, inequalities impact the lives of six out of 10 individuals, 61% live with fundamental rights deprivations such as education, sanitation, information, housing, clean water and protection against child labor 40 . Moreover, it would be worth highlighting, in addition to the retro-mentioned points, also the expansion of actions to prevent homicide, based on a culture of peace that reaches all social groups, with a greater discussion about possession and possession of firearms and the illicit drug use, allied to effective public policies against impunity, especially in trafficking, as pointed out in an important study on the issue of 30 . These initiatives can be potentially beneficial in reducing the number of homicides and the deleterious effects on society, but will only be effective if considered as part of a complex intersectoral strategy.
Regarding the limitations of this study, it is considered that research on homicides is always complex, especially in crosssectional studies, since multiple factors, including outcome and exposures, are evaluated concomitantly, which does not allow establishing causal relationships. Besides, involvement with illicit drugs, also addressed, is a multidetermined outcome, so control of all factors that influence it in an analysis is unlikely.
This study, therefore, it does not deal with factors that cause homicide or the use of illicit drugs, but intends to diagnose, in the studied scenario, the more general context in which they occur.
Finally, the difference between some of the data presented here and those provided by the Sistema de Mortality Information System may diverge slightly because after sending the same data to the Ministry of Health, it is not rare that imply some changes due to corrections made, including redistribution of deaths by place of residence.