Firearm Ownership and Violent Crime in the U.S.: An Ecologic Study

Gunshot injuries in Central Europe - Epidemiology and outcome in Germany, Switzerland and Austria - an analysis based on the TraumaRegister DGU®

BACKGROUND

Firearms are of special interest in trauma research due to high lethality and criminal value. Strong correlation between guns per capita and fire-arm related deaths has been shown. Most of existing literature regarding gun-shot fatalities are from the U.S. and data for Central Europe is lacking. Thus, the aim of this study was to assess the legal frameworks regarding gun-ownership in Germany (DE), Austria (A) and Switzerland (CH), and to retrospectively analyze data from the TraumaRegister DGU® regarding the epidemiology, injury severity, intention and outcome of gunshot-related deaths in these countries.

METHODS

All patients from TR-DGU who sustained a gunshot injury in the time period from 1st January 2009 to 31st December 2019 were considered for analysis. Only cases admitted to level 1 or 2 trauma center in Germany, Switzerland, or Austria were included. Predicted mortality was calculated using the RISC-II. Further, the legal framework for firearm posession were explored.

RESULTS

The legal frameworks do not differ significantly between the countries. However, only ex-military men from Switzerland are allowed to keep their automatic (military) weapon at home. We assessed 1312 gunshot fatalities (DE 1,099, A 111, CH 102) of which most were due to suspected suicide (A 72.1 %, CH 64.7 %, and DE 56.6 %, p = 0.003). Act of suspected violent crime or accidental gunshots were rare in all three countries. Amongst all gunshot fatalities, Austria showed the highest mean age (57.6 years), followed by DE (53.4 years) and CH (49.4 years; p < 0.01). Gunshot fatalities amongst all assessed countries due to suspected suicide showed a peak at the age of 60 years and above, whereas suspected violent crime delicts with gunshots were mainly seen in younger age groups. The highest mortality was found in suspected suicide cases, showing a mortality of 82.1 % (predicted 65.2 %) in Switzerland, 75.3 % (predicted 65.8 %) in Austria and 63.7 % (predicted 56.2 %) in Germany.

CONCLUSION

Gunshot wounds are still rare in central Europe, but gunshot-related suicide rates are high. Gun ownership laws may have an impact on gunshot wounds due to suspected suicide. Injury patterns differ compared to countries where a high incidence of gun ownership is seen.

Engaging a Team of Rivals to Address the Problem of Gun Violence

Gun violence in the United States is a serious problem. Addressing the problem will require not only strong leadership but also a unique approach. One such approach was utilized by U.S. President Abraham Lincoln, who assembled a "Team of Rivals" with positions different than his own that provided helpful perspective in finding solutions to the problems of the time. This article applies the team of rivals approach to the problem of gun violence.

Geographic and Demographic Differences in the Proportion of Individuals Living in Households With a Firearm, 1990-2018

Importance

Measures of the proportion of individuals living in households with a firearm (HFR), over time, across states, and by demographic groups are needed to evaluate disparities in firearm violence and the effects of firearm policies.

Objective

To estimate HFR across states, years, and demographic groups in the US.

Design, Setting, and Participants

In this survey study, substate HFR totals from 1990 to 2018 were estimated using bayesian multilevel regression with poststratification to analyze survey data on HFR from the Behavioral Risk Factor Surveillance System and the General Social Survey. HFR was estimated for 16 substate demographic groups defined by gender, race, marital status, and urbanicity in each state and year.

Exposures

Survey responses indicating household firearm ownership were analyzed and compared with a common proxy for firearm ownership, the fraction of suicides completed with a firearm (FSS).

Main Outcome and Measure

HFR, FSS, and their correlations and differences.

Results

Among US adults in 2018, HFR was significantly higher among married, nonurban, non-Hispanic White and American Indian male individuals (65.0%; 95% credible interval [CI], 61.5%-68.7%) compared with their unmarried, urban, female counterparts from other racial and ethnic groups (7.3%; 95% CIs, 6.0%-9.2%). Marginal HFR rates for larger demographic groups also revealed important differences, with racial minority groups and urban dwellers having less than half the HFR of either White and American Indian (39.5%; 95% CI, 37.4%-42.9% vs 17.2%; 95% CI, 15.5%-19.9%) or nonurban populations (46.0%; 95% CI, 43.8%-49.5% vs 23.1%; 95% CI, 21.3%-26.2%). Population growth among groups less likely to own firearms, rather than changes in ownership within demographic groups, explains 30% of the 7 percentage point decline in HFR nationally from 1990 to 2018. Comparing HFR estimates with FSS revealed the expected high overall correlation across states (r = 0.84), but scaled FSS differed from HFR by as many as 20 percentage points for some states and demographic groups.

Conclusions and Relevance

This survey study of HFR providing detailed, publicly available HFR estimates highlights key disparities among individuals in households with firearms across states and demographic groups; it also identifies potential biases in the use of FSS as a proxy for firearm ownership rates. These findings are essential for researchers, policymakers, and public health experts looking to address geographic and demographic disparities in firearm violence.

Locked and loaded: correlates of in-home firearm storage beliefs and behaviours

OBJECTIVES

To understand how crime and victimisation fears and risks operate alongside social status threats and motivations to shape unsafe in-home firearm storage practices and beliefs.

METHODS

Using data from firearm owners identified in a nationwide sample surveyed in 2023, this study examined how in-home loaded firearm accessibility, firearm storage practice and firearm safety beliefs are associated with: fear of crime and victimisation; perceived and personal victimisation; racial resentment; cultural and status threats; and masculinity threats. Regression models also accounted for the role of gender, race, marital status, political affiliation, geographic region and protective motivation for firearm ownership.

RESULTS

Over 40% of firearm owners reported having a loaded firearm 'always accessible' at home, and almost half think homes with firearms are safer than those without. About one-third of owners reported storing firearms locked but still loaded. Crime and victimisation fears and threats were unrelated to firearm storage behaviours and beliefs; however, firearm owners who experience higher levels of sociocultural anxiety are more likely to always have a loaded firearm accessible at home, store firearms locked and loaded, and believe that firearms make homes safer.

CONCLUSIONS

Identifying the barriers to safer storage beliefs and behaviours is essential for refining and enhancing effective firearm injury prevention strategies. Sociocultural anxieties may not reflect concrete threats to physical safety, but they can be experienced as feelings of insecurity, instability and distress that-for some Americans-may be managed by knowing they have a (loaded) firearm within reach.

Associations between Gun Ownership and Firearm Homicide Rates in US States

The United States combine high rates of firearm homicides with high gun prevalence. In the past, a significant positive association was found between the two. This study revisits the gun prevalence-gun homicide debate using more elaborate estimates of gun ownership for the 50 States. Longitudinal data (1999-2016) were analysed with Bayesian multilevel Gamma-Poisson models. The results demonstrated a very small positive association that diminished after adjusting for crime rates. Findings suggest that the association either attenuated in more recent years, or previous studies had overestimated this association.

Your neighborhood matters: an ecological social determinant study of the relationship between residential racial segregation and the risk of firearm fatalities

BACKGROUND

Firearm fatalities are a major public health concern, claiming the lives of 40,000 Americans each year. While firearm fatalities have pervasive effects, it is unclear how social determinants of health (SDOH) such as residential racial segregation, income inequality, and community resilience impact firearm fatalities. This study investigates the relationships between these SDOH and the likelihood of firearm fatalities.

METHODS

County-level SDOH data from the Agency for Health Care Research and Quality for 2019 were analyzed, covering 72 Wisconsin counties. The dependent variable was the number of firearm fatalities in each county, used as a continuous variable. The independent variable was residential racial segregation (Dissimilarity Index), defined as the degree to which non-White and White residents were distributed across counties, ranging from 0 (complete integration) to 100 (complete segregation), and higher values indicate greater residential segregation (categorized as low, moderate, and high). Covariates were income inequality ranging from zero (perfect equality) to one (perfect inequality) categorized as low, moderate, and high, community resilience risk factors (low, moderate, and high risks), and rural-urban classifications. Descriptive/summary statistics, unadjusted and adjusted negative binomial regression adjusting for population weight, were performed using STATA/MPv.17.0; P-values ≤ 0.05 were considered statistically significant. ArcMap was used for Geographic Information System analysis.

RESULTS

In 2019, there were 802 firearm fatalities. The adjusted model demonstrates that the risk of firearm fatalities was higher in areas with high residential racial segregation compared to low-segregated areas (IRR.:1.26, 95% CI:1.04-1.52) and higher in areas with high-income inequality compared to areas with low-income inequality (IRR.:1.18, 95% CI:1.00-1.40). Compared to areas with low-risk community resilience, the risk of firearm fatalities was higher in areas with moderate (IRR.:0.61, 95% CI:0.48-0.78), and in areas with high risk (IRR.:0.53, 95% CI:0.41-0.68). GIS analysis demonstrated that areas with high racial segregation also have high rates of firearm fatalities.

CONCLUSION

Areas with high residential racial segregation have a high rate of firearm fatalities. With high income inequality and low community resilience, the likelihood of firearm fatalities increases.

Legal Firearm Sales at State Level and Rates of Violent Crime, Property Crime, and Homicides

INTRODUCTION

The effects of firearm sales and legislation on crime and violence are intensely debated, with multiple studies yielding differing results. We hypothesized that increased lawful firearm sales would not be associated with the rates of crime and homicide when studied using a robust statistical method.

METHODS

National and state rates of crime and homicide during 1999-2015 were obtained from the United States Department of Justice and the Centers for Disease Control and Prevention. National Instant Criminal Background Check System background checks were used as a surrogate for lawful firearm sales. A general multiple linear regression model using log event rates was used to assess the effect of firearm sales on crime and homicide rates. Additional modeling was then performed on a state basis using an autoregressive correlation structure with generalized estimating equation estimates for standard errors to adjust for the interdependence of variables year to year within a particular state.

RESULTS

Nationally, all crime rates except the Centers for Disease Control and Prevention-designated firearm homicides decreased as firearm sales increased over the study period. Using a naive national model, increases in firearm sales were associated with significant decreases in multiple crime categories. However, a more robust analysis using generalized estimating equation estimates on state-level data demonstrated increases in firearms sales were not associated with changes in any crime variables examined.

CONCLUSIONS

Robust analysis does not identify an association between increased lawful firearm sales and rates of crime or homicide. Based on this, it is unclear if efforts to limit lawful firearm sales would have any effect on rates of crime, homicide, or injuries from violence committed with firearms.

A qualitative framing analysis of how firearm manufacturers and related bodies communicate to the public on gun-related harms and solutions

There is a growing understanding that the producers and sellers of harmful products directly and indirectly affect population health and policy, including through seeking to influence public understanding about the nature of harms and their solutions. However, the firearm industry and related organisations have not to date been the subject of this type of enquiry. This study sought to address this evidential gap through examining the ways in which the firearm industry and industry-associated organisations frame firearms, firearm-related harms and possible solutions to gun violence. This was a thematic qualitative documentary analysis of materials from 7 of the largest firearm manufacturers and associated organisations. Two authors independently extracted textual material from web articles, press releases, annual reports and shareholder communications between 1st April 2019 to 1st April 2020 (302 documents). A hybrid approach combining both deductive and inductive coding was adopted, guided by the literature on the commercial determinants of health and using NVivo version 12. The firearm industry and firearm industry-funded organisations use framings about the safety and role of guns, evidence on associated harms and solutions that align with the industry's business interests, consistent with evidence on other harmful product manufacturers. This study identified framing strategies employed by the firearm industry and related organisations. These included attempts to undermine evidence, linking regulation to a dystopian future, minimising some of the most common harms, placing the responsibility for harms on individuals, and attempting to foster a heightened sense of risk to personal safety.

"Lock to Live" for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system

Objective

Few patients with suicide risk are counseled on lethal means safety by health providers. This study tested the feasibility of different delivery methods for Lock to Live (L2L), a web-based decision aid of safe storage options for firearms and medications.

Methods

Patients reporting suicide ideation on the PHQ9 depression screener during outpatient health visits were included. Invitation messages to visit L2L were sent via combinations of email, text, Electronic Health Record (EHR) message, mailed letter, or provider referral, followed by a survey about storage behavior and acceptability. Provider interviews evaluated logistical considerations and acceptability.

Results

The population-based method reached 2,729 patients and the best method (EHR message plus 2 email reminders) had 11% uptake (L2L visitation rate). Provider referral had small reach (14 patients) and 100% uptake (all visited). Provider interviews identified several strategies to promote uptake including: EHR reminders, provider training, quality metrics with accountability, a clearly communicated lethal means screening/counseling policy, and strong organizational leadership support.

Conclusion

Despite the low uptake for population-based (11%), far more patients with suicide risk were engaged in the L2L tool through population-based outreach than provider-referral over the same time frame.

An Epidemic Within the Pandemic: The Rising Tide of Trauma DuringCOVID-19

Background

In the age of COVID-19 and enforced social distancing, changes in patterns of trauma were observed but poorly understood. Our aim was to characterize traumatic injury mechanisms and acuities in 2020 and compare them with previous years at our level I trauma center.

Material and methods

Patients with trauma triaged in 2016 through 2020 from January to May were reviewed. Patient demographics, level of activation (1 versus 2), injury severity score, and mechanism of injury were collected. Data from 2016 through 2019 were combined, averaged by month, and compared with data from 2020 using chi-squared analysis.

Results

During the months of interest, 992 patients with trauma were triaged in 2020 and 4311 in 2016-2019. The numbers of penetrating and level I trauma activations in January-March of 2020 were similar to average numbers for the same months during 2016 through 2019. In April 2020, there was a significant increase in the incidence of penetrating trauma compared with the prior 4-year average (27% versus 16%, P < 0.002). Level I trauma activations in April 2020 also increased, rising from 17% in 2016 through 2019 to 32% in 2020 (P < 0.003). These findings persisted through May 2020 with similarly significant increases in penetrating and high-level trauma.

Conclusions

In the months after the initial spread of COVID-19, there was a perceptible shift in patterns of trauma. The significant increase in penetrating and high-acuity trauma may implicate a change in population dynamics, demanding a need for thoughtful resource allocation at trauma centers nationwide in the context of a global pandemic.

Firearm purchasing during the beginning of the COVID-19 pandemic in households with teens: a national study

To describe and identify the correlates of firearm purchasing at the beginning of the COVID-19 pandemic among US families with teenagers. In June-July 2020, we conducted a national survey of 2924 parents and their teenagers in the US. We report results from this survey to describe firearm purchasing behaviors following the start of the COVID-19 pandemic and investigate correlates of purchasing. Between the beginning of the pandemic and July 2020, 10% of households with teenagers purchased a firearm, and 3% became first-time firearm-owning households. Among firearm-owning households, firearm storage was associated with purchasing such that households that stored at least one firearm loaded and unlocked were more likely to purchase a firearm (OR: 2.02[1.07-3.79]) compared to households that stored all firearms unloaded and/or locked. Firearms purchased at the beginning of the pandemic were more likely to go to homes where at least one firearm was stored loaded and unlocked, which may contribute to increased risk for teen firearm injury and death.

Firearms Injuries Involving Young Children in the United States During the COVID-19 Pandemic

OBJECTIVES

Increased rates of firearm ownership, school closures, and a suspected decrease in supervision during the coronavirus disease 2019 (COVID-19) pandemic place young children at increased risk of firearm injuries. We measured trends in firearm injuries in children and inflicted by children discharging a firearm during the pandemic and correlated these changes with a rise in firearm acquisition.

METHODS

In this cross-sectional study with an interrupted time series analysis, we used multiyear data from the Gun Violence Archive. We compared trends in (1) firearm injuries in children younger than 12 years old and (2) firearm injuries inflicted by children younger than 12 years old during the pre-COVID-19 period (March to August in the years 2016-2019) and during the first 6 months of the COVID-19 pandemic (March 2020 to August 2020). Linear regression models were developed to evaluate the relationship between firearm injuries and new firearm acquisitions.

RESULTS

There was an increased risk of (1) firearm injuries in young children (relative risk = 1.90; 95% confidence interval 1.58 to 2.29) and (2) firearm injuries inflicted by young children (relative risk = 1.43; 95% confidence interval 1.14 to 1.80) during the first 6 months of the COVID-19 pandemic as compared to the pre-COVID-19 study period. These increased incidents correlate with an increase in new firearm ownership (P < .03).

CONCLUSIONS

There has been a surge in firearm injuries in young children and inflicted by young children during the first 6 months of the COVID-19 pandemic. There is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.

Annual Research Review: Youth firearm violence disparities in the United States and implications for prevention

OBJECTIVE

Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them.

METHOD

Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities.

RESULTS

The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15-24) was at outlier levels - many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors.

CONCLUSIONS

More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.

The Annual Examination for Lesbian, Gay, and Bisexual Patients

The annual examination is a comprehensive evaluation of patients in which all aspects of health and well-being are considered, including proper screening, appropriate preventive care, and recommendations and resources for healthy living. Clinicians commonly avoid certain topics with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients because they may be unprepared to address their health needs. Therefore, clinicians should learn how to conduct an LGBTQ-friendly annual examination in order to provide high-quality care. This article focuses on both the general and unique health needs of lesbian, gay, bisexual, and queer patients; care for transgender and gender-diverse patients is considered elsewhere.

Firearms and violence in Europe-A systematic review

BACKGROUND

Higher availability of firearms has been connected to higher rates of interpersonal violence in previous studies. Yet, those studies have focused mainly on the United States, or used aggregated international data to study firearm violence. Whether those aggregated findings are applicable to understanding the phenomenon in continental Europe specifically remains unclear. The aim of this systematic review is to bring together all studies that exclusively use European data.

METHODS

Nine databases were searched, resulting in more than 1900 individual studies. These studies were assessed on relevance and eligibility for this study, based on their title, abstract and full text. Information on study characteristics, operationalizations of main concepts and study results were extracted from the six eligible studies.

RESULTS

Four studies assessed the impact of firearm restrictive regulations on the rate of firearm homicides. Two other studies correlated rates of firearm availability and -violence. Results vary: some studies show a clear decline once availability of firearms is restricted, while others indicate a limited effect on only a very specific subgroup, such as female victims, or national guards with weapons at home. Moreover, studies used various operationalizations for firearm availability, thereby decreasing the comparability of findings.

CONCLUSION

Empirical research exclusively using European data is still lacking. To increase comparability of future studies, methodological inconsistencies and regional gaps need to be overcome. Assessing how firearm availability can be measured with reliable and valid proxies across countries will be a crucial first step to improve future research on the link between firearms and firearm violence.

Neighborhood disadvantage and firearm injury: does shooting location matter?

Background

Firearm violence is a public health problem that disparately impacts areas of economic and social deprivation. Despite a growing literature on neighborhood characteristics and injury, few studies have examined the association between neighborhood disadvantage and fatal and nonfatal firearm assault using data on injury location. We conducted an ecological Bayesian spatial analysis examining neighborhood disadvantage as a social determinant of firearm injury in Seattle, Washington.

Methods

Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index. The index includes proportion of female-headed households with children, proportion of households with public assistance income, proportion of people with income below poverty in the past 12 months, and proportion of the civilian labor force aged 16 and older that are unemployed at the census tract level. Firearm injury counts included individuals with a documented assault-related gunshot wound identified from medical records and supplemented with the Gun Violence Archive between March 20, 2016 and December 31, 2018. Available addresses were geocoded to identify their point locations and then aggregated to the census tract level. Besag-York-Mollie (BYM2) Bayesian Poisson models were fit to the data to estimate the association between the index of neighborhood disadvantage and firearm injury count with a population offset within each census tract.

Results

Neighborhood disadvantage was significantly associated with the count of firearm injury in both non-spatial and spatial models. For two census tracts that differed by 1 decile of neighborhood disadvantage, the number of firearm injuries was higher by 21.0% (95% credible interval: 10.5, 32.8%) in the group with higher neighborhood disadvantage. After accounting for spatial structure, there was still considerable residual spatial dependence with 53.3% (95% credible interval: 17.0, 87.3%) of the model variance being spatial. Additionally, we observed census tracts with higher disadvantage and lower count of firearm injury in communities with proximity to employment opportunities and targeted redevelopment, suggesting other contextual protective factors.

Conclusions

Even after adjusting for socioeconomic factors, firearm injury research should investigate spatial clustering as independence cannot be able to be assumed. Future research should continue to examine potential contextual and environmental neighborhood determinants that could impact firearm injuries in urban communities.

Demographics and Incident Location of Gunshot Wounds at a Single Level I Trauma Center

Introduction

Kansas has seen a steady increase in the rate of firearm deaths and injuries. Little is known surrounding the demographic and geospatial factors of these firearm-related traumas. The purpose of this study was to describe the overall incidence of firearm-related traumas, identify high injury locations, and examine any racial/ethnic disparities that may exist.

Methods

A retrospective review was conducted of all patients 14 years or older who were admitted with a gunshot wound (GSW) to a Level I trauma center between 2016 and 2017.

Results

Forty-nine percent of patients were Caucasian, 26.5% African American, and 19.6% Hispanic/Latino. Hispanic/Latino patients were the youngest (25.8 ± 8.8 years) and Caucasians were the oldest (34.3 ± 14.1 years, p = 0.002). Compared to Caucasian patients, African American (42.0%) and Hispanic/Latino (54.1%) patients were more likely to be admitted to the intensive care unit (ICU; p = 0.034) and experienced longer ICU lengths of stay (2.5 ± 6.3 and 2.4 ± 4.7 days, p = 0.031, respectively). African American patients (96.0%) experienced more assaults, while Caucasians were more likely to receive gunshot wounds accidentally (26.9%, p = 0.001). More African American (86.0%) and Hispanic/Latino (89.2%) patients were injured with a handgun and Caucasians sustained the highest percentage of shotgun/rifle related injuries (16.1%, p = 0.012). Most GSWs occurred in zip codes 67202, 67203, 67213, 67211, and 67214. Geographical maps indicated that GSWs occur in neighborhoods with low-income and high minority residents and in the downtown and nightclub areas of the city.

Conclusions

Most GSW victims were older Caucasian males. Racial differences were noted and injury locations concentrated in certain locations.

Youth and weapons: Patterns, individual and neighborhood correlates of violent crime arrests in Miami-Dade County, Florida

This study uses arrest data from the Miami-Dade County Police Department (n = 13 districts) for 2014-2017 to identify census tracts in which weapon violence arrests among young people aged 10-24 is high, and models area-level predictors of the total number of violent weapons crimes by census tract (greenness and socioeconomic status indices, population density and weapon dealers), after adjusting for arrestee-level factors (age, race and gender). Combined, handguns and firearms accounted for 23.2% (n = 1330) of all arrests (including murder and non-negligent manslaughter, rape, robbery, and aggravated assault). Arrests for weapon -related violent crime are concentrated in census tracts located in the north and south neighborhoods of Miami-Dade County. Findings indicate that arrestee factors and a neighborhood greenness index are more important than population density, weapon dealers and poverty in predicting arrests for weapon-related violent crime at the census tract level.

Firearm Use in Violent Crime: Examining the Role of Premeditation and Motivation in Weapon Choice

Although there is a plethora of research documenting the relationship between firearms and violence, we know little about the influence of offenders' motivation and premeditation as they relate to the choice of weapon for the commission of a violent crime. In this study, we examined a sample of 375 violent crime inmates incarcerated in the New Jersey Department of Corrections. We addressed two research questions: what variables influence the use of a firearm in a violent crime, and do premeditation and motivation increase the odds that an offender will use a firearm in a violent crime? We found that premeditation and motivation are robust covariates of firearm use, which aligns with Rational Choice Theory; this suggests that firearms are used as tools to gain compliance and facilitate the commission of a crime. As a result, prevention strategies that focus on restricting access to firearms to at-risk populations and those that focus on interrupting the cycle of violence may help reduce firearm-related violence, particularly in premeditated events.

The Role of Reason for Firearm Ownership in Beliefs about Firearms and Suicide, Openness to Means Safety, and Current Firearm Storage

OBJECTIVE

Firearm means safety strategies, such as safe storage, are effective in reducing suicide rates but are not widely implemented in the United States. This study examined the association between reason for firearm ownership, beliefs about firearm ownership and storage and suicide risk, willingness to engage in means safety, and current firearm storage practices.

METHOD

A sample of 300 American firearm owners (53.0% male; 82.3% White; M_age  = 36.11, age range = 20-69) completed an online survey via Amazon's Mechanical Turk (mTurk) program.

RESULTS

Firearm owners who own a firearm for protection, compared to owning a firearm for other reasons, (1) endorsed decreased belief in the relationship between firearm ownership and storage and suicide risk, (2) were less willing to engage in the means safety measures of storing firearms safely and allowing a trusted individual to temporarily remove firearms from the home, and (3) were more likely to store their firearms loaded.

CONCLUSIONS

Reason for firearm ownership influences views regarding firearms and suicide, willingness to engage in firearm means safety, and firearm storage practices. It is essential to understand how differences in reason for firearm ownership impact these outcomes so appropriate, efficacious messaging can be developed and implemented.

The relationship between alcohol consumption and the desire to own a firearm: an empirical study on citizens of São Paulo city, Brazil

OBJECTIVE

The main objective of this study was to investigate the association between alcohol consumption (use and bingeing) and the desire to own a firearm for protection.

STUDY DESIGN

We used data from three random cross-sectional victimisation surveys conducted in São Paulo city, Brazil, in 2003, 2008 and 2013 with people aged ≥16 years.

METHODS

We performed tests for equality of proportions. Our analysis was performed separately for each victimisation survey to check the robustness of the results. We also used probit models, estimated by the maximum likelihood method, to analyse the relationship between desire to own a firearm and alcohol consumption, controlling for many other variables.

RESULTS

In 2013, although only 1.5% of the population surveyed reported living in a household with a firearm, 15.7% report that they would possess a firearm if they could, and 13.0% believed they would be safer/more protected from violence if they had a firearm. The desire to own a firearm is higher among people who consume alcoholic beverages than among those who do not and is higher as alcohol binge frequency increases.

CONCLUSION

In São Paulo city, alcohol consumption and binge drinking are positively associated with the desire to own a firearm.

National Instant Criminal Background Check and Youth Gun Carrying

BACKGROUND

Despite being unable to purchase firearms directly, many adolescents have access to guns, leading to increased risk of injury and death. We sought to determine if the National Instant Criminal Background Check System (NICS) changed adolescents' gun-carrying behavior.

METHODS

We performed a repeated cross-sectional study using National Youth Risk Behavior Survey data from years 1993 to 2017. We used a survey-weighted multivariable logistic regression model to determine if the NICS had an effect on adolescent gun carrying, controlling for state respondent characteristics, state laws, state characteristics, the interaction between the NICS and state gun laws, and time.

RESULTS

On average, 5.8% of the cohort reported carrying a gun. Approximately 17% of respondents who carried guns were from states with a universal background check (U/BC) provision at the point of sale, whereas 83% were from states that did not have such laws (P < .001). The model indicated that the NICS together with U/BCs significantly reduced gun carrying by 25% (adjusted relative risk = 0.75 [95% confidence interval: 0.566-0.995]; P = .046), whereas the NICS independently did not (P = .516).

CONCLUSIONS

Adolescents in states that require U/BCs on all prospective gun buyers are less likely to carry guns compared with those in states that only require background checks on sales through federally licensed firearms dealers. The NICS was only effective in reducing adolescent gun carrying in the presence of state laws requiring U/BCs on all prospective gun buyers. However, state U/BC laws had no effect on adolescent gun carrying until after the NICS was implemented.

State-Level Changes in Firearm Laws and Workplace Homicide Rates: United States, 2011 to 2017

Objectives. To test whether year-over-year strengthening of state-level firearm laws is associated with decreases in workplace homicide rates.Methods. In this time-series ecological study of working people in all 50 US states, we used federal data on workplace homicides by state and year from 2011 to 2017, linked to an index of state-year firearm laws, to characterize the regulatory environment (overall and within legislative categories). We used generalized linear regression to model associations between changes in firearm laws and changes in workplace homicide rates the following year.Results. From 2011 to 2017, more than 3000 people died as a result of workplace homicides; over that period, 23 states strengthened firearm regulations and 23 weakened them. We modeled the impact of states strengthening laws within the interquartile range (IQR; equivalent to adding 20.5 firearm laws). This change was associated with a 3.7% reduction in the workplace homicide rate (95% confidence interval [CI] = -3.86, -3.51). Positive IQR changes in specific categories of firearm laws-concealed carry permitting (-5.79%; 95% CI = -6.09, -3.51), domestic violence-related restrictions (-5.31%; 95% CI = -5.57, -5.05), and background checks (-5.07%; 95% CI = -5.32, -4.82)-were also associated with significant reductions.Conclusions. Strengthening state-level firearm laws may reduce the population-level mortality and morbidity burden posed by workplace homicides.

Community distress predicts youth gun violence

BACKGROUND

The purpose of this study was to investigate our institution's experience with pediatric firearm events. We sought to determine the relationship between a community's level of socioeconomic distress and the incidence of youth gun violence.

METHODS

We performed a retrospective review of children <18 years involved in firearm events. Using visual cluster analysis, we portrayed all firearm events and violent firearm events (assaults + homicides). Distressed community indices (DCIs) were obtained from an interface that uses US Census Bureau data. Incident rate ratios (IRRs) were calculated for firearm circumstances (i.e. assault, homicide, suicide) using a DCI. Significant IRRs were analyzed to discern which DCI metrics contributed most to gun violence.

RESULTS

There were 114 children involved in firearm events; 66 were county residents. The DCI of injury location significantly predicted total firearm events (IRR 1.02, 95% CI 1.01-1.03), assaults (IRR 1.02, 95% CI 1.01-1.05), and violent firearm events (IRR 1.03, 95% CI 1.01-1.05). The proportion of adults without a high school diploma, poverty rate, median income ratio, and housing vacancy rate were highly predictive of gun violence (VIP >1).

CONCLUSION

Community distress significantly predicts pediatric firearm violence. Local interventions should target neighborhoods with high levels of distress to prevent further youth gun violence.

LEVEL OF EVIDENCE

Retrospective study, IV.

Licensed firearm dealer availability and intimate partner homicide: A multilevel analysis in sixteen states

This paper investigates the association between legal access to firearms in the community through licensed dealers and homicides perpetrated by intimate partners (IPH). We conducted a series of multilevel negative binomial models to assess the relationship between the rate of county-level federally licensed firearm dealers and intimate partner homicides, by gender and age, controlling for leading macro-level correlates of IPH. The rate of county-level federally licensed firearm dealers is significantly associated with intimate partner homicides in urban counties, regardless of gender and age. Although data cannot discern that the rate of licensed firearm dealers is linked to greater legal firearm access, our findings focus attention on the role of community factors, including gun stores, as significant risk factors for violence. Policies to reduce legal options to purchase firearms, especially for those with prior domestic violence offenses, may help to decrease intimate partner homicide, but better data tracking is needed to help us understand how guns move from purchase into the hands of IPH perpetrators.

Firearm Ownership and Domestic Versus Nondomestic Homicide in the U.S

INTRODUCTION

Gun ownership is associated with firearm mortality, although this association differs across victim-offender relationships. This study examines the relationship between gun ownership and domestic versus nondomestic homicide rates by victim sex.

METHODS

Several sources of state-level panel data from 1990 through 2016 were merged from each of the 50 states to model domestic (i.e., family and intimate partners) and nondomestic firearm homicide as a function of state-level household firearm ownership. Firearm ownership was examined using a validated proxy measure and homicide rates came from the Supplemental Homicide Reports of the Federal Bureau of Investigation's Uniform Crime Reports. Negative binomial regression with fixed effects was used to model the outcomes and employed generalized estimating equations to account for clustering within states. Statistical analyses were completed in 2018.

RESULTS

State-level firearm ownership was uniquely associated with domestic (incidence rate ratio=1.013, 95% CI=1.008, 1.018) but not nondomestic (incidence rate ratio=1.002, 95% CI=0.996, 1.008) firearm homicide rates, and this pattern held for both male and female victims. States in the top quartile of firearm ownership had a 64.6% (p<0.001) higher incidence rate of domestic firearm homicide than states in the lowest quartile; however, states in the top quartile did not differ significantly from states in the lowest quartile of firearm ownership in observed incidence rates of nondomestic firearm homicide.

CONCLUSIONS

State-level firearm ownership rates are related to rates of domestic but not nondomestic firearm homicide.

Psychometric Properties and Development of a Scale Designed to Evaluate the Potential of Predatory Violent Behavior

The objective of this study was to develop and determine the psychometric properties of an instrument designed to detect traits and behavior that are associated with predatory violent behavior, which is defined as a determined, planned, controlled, and proactive aggression. The sample was comprised of 564 students, mostly in their last year of high school, or in their first year of college. The initial instrument had 78 items, ultimately resulting in 13 with good internal consistency (α = 0.825). Factor analysis showed four factors: anger-in, appeal for weapons, suicidal ideation, and the tendency to take justice into one’s own hands. Said factors showed significant correlations of convergent validity. Data shown here allows inferring that the instrument is a novel and concise tool that evaluates and detects the potential of predatory violent behavior.

State gun laws, gun ownership, and mass shootings in the US: cross sectional time series

OBJECTIVE

To determine whether restrictiveness-permissiveness of state gun laws or gun ownership are associated with mass shootings in the US.

DESIGN

Cross sectional time series.

SETTING AND POPULATION

US gun owners from 1998-2015.

EXPOSURE

An annual rating between 0 (completely restrictive) and 100 (completely permissive) for the gun laws of all 50 states taken from a reference guide for gun owners traveling between states from 1998 to 2015. Gun ownership was estimated annually as the percentage of suicides committed with firearms in each state.

MAIN OUTCOME MEASURE

Mass shootings were defined as independent events in which four or more people were killed by a firearm. Data from the Federal Bureau of Investigation's Uniform Crime Reporting System from 1998-2015 were used to calculate annual rates of mass shootings in each state. Mass shooting events and rates were further separated into those where the victims were immediate family members or partners (domestic) and those where the victims had other relationships with the perpetrator (non-domestic).

RESULTS

Fully adjusted regression analyses showed that a 10 unit increase in state gun law permissiveness was associated with a significant 11.5% (95% confidence interval 4.2% to 19.3%, P=0.002) higher rate of mass shootings. A 10% increase in state gun ownership was associated with a significant 35.1% (12.7% to 62.7%, P=0.001) higher rate of mass shootings. Partially adjusted regression analyses produced similar results, as did analyses restricted to domestic and non-domestic mass shootings.

CONCLUSIONS

States with more permissive gun laws and greater gun ownership had higher rates of mass shootings, and a growing divide appears to be emerging between restrictive and permissive states.

Hands Up! Atypical Defensive Reactions in Heavy Players of Violent Video Games When Exposed to Gun-Attack Pictures

Threatening cues and surrounding contexts trigger specific defensive response patterns. Posturography, a technique for measuring postural strategies, has been used to evaluate motor defensive reactions in humans. When exposed to gun pointed pictures, humans were shown to exhibit an immobility reaction. Short and long-term exposure to violent video games was shown to be a causal risk factor for increased violent and aggressive behavior. Assaultive violence with a gun is a major trigger for motor defensive reactions, and post-traumatic stress disorder (PTSD) is the most characteristic psychiatric sequelae. Recent studies point to links between PTSD symptoms and emotional shortfalls in non-clinical trauma-exposed samples. The present study investigated defensive reactions to gun threat and PTSD symptoms in heavy players of violent video games compared to non-players. Male university students were screened according to use of violent video games and divided in three groups: non-players, moderate players, and heavy players. Stimuli were pictures depicting a man pointing a gun directed at the participant. In matched control pictures, non-lethal objects replaced the gun. Posturography was recorded and PTSD symptoms were assessed. When exposed to the threat pictures, non-players exhibited the expected reduction in amplitude of body sway (immobility), heavy players presented atypical augmented amplitude of body sway, and moderate players showed intermediate reactivity. Heavy players presented a significant distinct reaction compared to non-players. They also scored significantly higher in PTSD symptoms than non-players. Disadvantageous defensive reactions and higher vulnerability to PTSD symptoms, revealed in the present study, add to other shortcomings for heavy players.

Banning open carry of unloaded handguns decreases firearm-related fatalities and hospital utilization

Background

Since 1967, in California it has been illegal to openly carry a loaded firearm in public except when engaged in hunting or law enforcement. However, beginning January 1, 2012, public open carry of unloaded handguns also became illegal. Fatal and non-fatal (NF) firearm injuries were examined before and after adoption of the 2012 ban to quantify the effect of the new law on public health.

Methods

State-level data were obtained directly from California and nine other US state inpatient and emergency department (ED) discharge databases, and the Centers for Disease Control Web-Based Injury Statistics Query and Reporting System. Case numbers of firearm fatalities, NF hospitalizations, NF ED visits, and state-level population estimates were extracted. Each incident was classified as unintentional, self-inflicted, or assault. Crude incidence rates were calculated. The strength of gun laws was quantified using the Brady grade. There were no changes to open carry in these nine states during the study. Using a difference-in-difference technique, the rate trends 3 years preban and postban were compared.

Results

The 2012 open carry ban resulted in a significantly lower incident rate of both firearm-related fatalities and NF hospitalizations (p<0.001). The effect of the law remained significant when controlling for baseline state gun laws (p<0.001). Firearm incident rate drops in California were significant for male homicide (p=0.023), hospitalization for NF assault (p=0.021 male; p=0.025 female), and ED NF assault visits (p=0.04). No significant decreases were observed by sex for suicides or unintentional injury. Changing the law saved an estimated 337 lives (3.6% fewer deaths) and 1285 NF visits in California during the postban period.

Discussion

Open carry ban decreases fatalities and healthcare utilization even in a state with baseline strict gun laws. The most significant impact is from decreasing firearm-related fatal and NF assaults.

Level of evidence

III, epidemiology.

Firearm Violence: A Global Priority for Nursing Science

PURPOSE

This purpose of this article is to frame firearm violence as a health and public health problem, to illustrate the magnitude of the problem, to examine factors that increase the risk to be injured by a firearm, or conversely, that confer protection, and to identify relevant priority areas for nursing science.

ORGANIZING CONSTRUCT

Firearm violence results in physical and psychological injuries and is a global health priority. Firearm violence is categorized as intentional (interpersonal and self-inflicted) and unintentional (interpersonal and self-inflicted) and accounts for an estimated 196,000 to 220,000 nonconflict deaths annually.

METHODS

We reviewed the theoretical and scientific literature to analyze the magnitude and geographic distribution of firearm violence, the factors associated with firearm injury, the consequences of firearm violence, and areas where nursing science can make an impact on prevention, outcomes, and recovery.

FINDINGS

Firearm violence is a significant public health problem that affects the health of individuals, families, and communities. The burdens and contributors to firearm violence vary worldwide, making it important to understand the local context of this global phenomenon. Relevant areas of inquiry span primary prevention focusing on individual and environmental risk factors; and focus on managing the physical and psychological consequences postinjury; and mitigating long-term consequences of firearm violence.

CONCLUSIONS

Reducing the global burden of firearm violence and improving the health and safety of individuals, families, and communities provide compelling reasons to integrate this area into nursing science.

CLINICAL RELEVANCE

The goals of nursing are to keep people healthy and safe and to help return those injured to their optimal levels of health and well-being. Understanding the factors that come together to injure people with a firearm in various physical, social, economic, and cultural environments positions nurses to both extend the dialogue beyond pro-gun versus anti-gun and to design and carry out rigorous studies to reduce firearm violence.

Gun Exposure Among Black American Youth Residing in Low-Income Urban Environments

Objective: The current study examined the extent of gun exposure, referring to the mere presence of guns in youth’s lives, in a sample of Black American adolescents residing in low-income urban neighborhoods. The relationship of gun exposure to internalizing and externalizing outcomes was also explored. Method: Data were collected from a sample of 185 Black American eighth-grade students ( M = 13.58 years old, 59% female). Results: Just under half of the youth reported some type of gun exposure with youth most often exposed to guns outside of the home. Overall gun exposure was related to externalizing but not internalizing symptoms, while knowing someone who owns a gun was related to both externalizing and internalizing symptoms. However, the majority of youth reported exposure to guns in a safe manner (stored locked and unloaded). Conclusions: In addition to gun violence and gun carrying, general gun exposure is a factor that should be accounted for when attempting to address consequences associated with guns.

A decompositional analysis of firearm-related mortality in the United States, 2001-2012

Prior literature reporting increased rates of firearm-related homicide and suicide with increasing firearm availability is limited by only examining the availability of firearms, which is only one component of firearm-related mortality. The objective of the current study is to separate the rates into their respective components and determine which components contribute to mortality rate changes. To address the objective, nationally representative data from 2001 to 2012 was collected from a variety of publicly-available sources. Utilizing decompositional methodology, a negative binomial regression was used to estimate rate ratios for the association between the components and year category, and relative contributions of each component were calculated. From 2001 to 2012, the homicide and unintentional mortality rate decreased while the suicide rate increased. The suicide rate was only the firearm prevalence rate. The unintentional mortality rate was a factor of firearm prevalence, injury incidence, and case fatality rate. The homicide rate was a factor of firearm prevalence, violent crime rate, injury incidence, and case fatality rate. The current results suggest that the contributors of changes in firearm-related mortality are multi-faceted. Future studies should perform a decompositional analysis utilizing more granular data to examine whether the currently reported results are true associations or a factor of ecologic fallacy.

Spending on social and public health services and its association with homicide in the USA: an ecological study

OBJECTIVE

To examine whether state-level spending on social and public health services is associated with lower rates of homicide in the USA.

DESIGN

Ecological study.

SETTING

USA.

PARTICIPANTS

All states in the USA and the District of Columbia for which data were available (n=42).

PRIMARY OUTCOME MEASURE

Homicide rates for each state were abstracted from the US Department of Justice Federal Bureau of Investigation's Uniform Crime Reporting.

RESULTS

After adjusting for potential confounding variables, we found that every $10 000 increase in spending per person living in poverty was associated with 0.87 fewer homicides per 100 000 population or approximately a 16% decrease in the average homicide rate (estimate=-0.87, SE=0.15, p<0.001). Furthermore, there was no significant effect in the quartile of states with the highest percentages of individuals living in poverty but significant effects in the quartiles of states with lower percentages of individuals living in poverty.

CONCLUSIONS

Based on our findings, spending on social and public health services is associated with significantly lower homicide rates at the state level. Although we cannot infer causality from this research, such spending may provide promising avenues for homicide reduction in the USA, particularly among states with lower levels of poverty.

Preparing for Disaster: a Cross-Sectional Study of Social Connection and Gun Violence

Living in communities with persistent gun violence is associated with negative social, behavioral, and health outcomes, analogous to those of a natural disaster. Taking a disaster-preparedness approach may identify targets for community-based action to respond to on-going gun violence. We assessed the relevance of adapting a disaster-preparedness approach to gun violence and, specifically, the relationship between perceived collective efficacy, its subscales of social cohesion and informal social control, and exposure to gun violence. In 2014, we conducted a cross-sectional study using a community-based participatory research approach in two neighborhoods in New Haven, CT, with high violent crime rates. Participants were ≥18 years of age and English speaking. We measured exposure to gun violence by adapting the Project on Human Development in Chicago Neighborhoods Exposure to Violence Scale. We examined the association between perceived collective efficacy, measured by the Sampson Collective Efficacy Scale, and exposure to gun violence using multivariate modeling. We obtained 153 surveys (51% response rate, 14% refusal rate, and 35% non-response rate). Ninety-five percent reported hearing gunfire, 58% had friend or family member killed by gun violence, and 33% were physically present during a shooting. In the fully adjusted model, one standard deviation higher perceived collective efficacy was associated with lower reported exposure to gun violence (β = -0.91, p < 0.001). We demonstrated that it is possible to activate community members and local officials to engage in gun violence research. A novel, community-based approach adapted from disaster-preparedness literature may be an effective framework for mitigating exposure to gun violence in communities with persistent gun violence.

Falling through the cracks: the decline of mental health care and firearm violence

BACKGROUND

This paper argues that the decline in the availability of long-term, intensive mental health services, particularly through state mental health hospital systems, has had negative impacts on firearm-related deaths and possibly on the incidence of mass shooting events.

AIMS

Establish the effect of reduced availability of long-term, intensive mental health treatment on firearm-related violence in the United States.

METHOD

Ordinary least squares regressions on cross-sectional data of US states.

RESULTS

Mass shooting perpetrators had significantly higher rates of mental illness than the general population. In addition, using simple regressions, this paper's results demonstrate that increasing the number of state psychiatric hospital beds is associated with lower rates of homicide.

CONCLUSIONS

The shrinking number of intensive, long-term mental health facilities in US states has had many negative consequences, including higher rates of firearm homicide.

Associations between active shooter incidents and gun ownership and storage among families with young children in the United States

The presence of firearms and their unsafe storage in the home can increase risk of firearm-related death and injury, but public opinion suggests that firearm ownership is a protective factor against gun violence. This study examined the effects of a recent nearby active shooter incident on gun ownership and storage practices among families with young children. A series of regression models, with data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort merged with the FBI's Active Shooter Incidents data collected in 2003-2006, were used to examine whether household gun ownership and storage practices differed in the months prior to and following an active shooter incident that occurred anywhere in the United States or within the same state. Approximately one-fifth of young children lived in households with one or more guns; of these children, only two-thirds lived in homes that stored all guns in locked cabinets. Results suggest that the experience of a recent active shooter incident was associated with an increased likelihood of storing all guns locked, with the magnitude dependent on the temporal and geographic proximity of the incident. The severity of the incident, defined as the number of fatalities, predicted an increase in storing guns locked. Findings suggest that public shootings change behaviors related to firearm storage among families with young children.

Frequency of Guns in the Households of High School Seniors

BACKGROUND

In 2013, President Obama lifted the federal ban on gun violence research. The current study provides one of the first reports to estimate household gun ownership as reported by youth.

METHODS

In this cohort study of 3006 high school seniors from 24 schools, we examined the frequency of household guns ownership.

RESULTS

About 65% reported having at least 1 gun in their household. White males were more likely to have a gun and to have more guns than other demographically characterized groups. After adjustment for race and sex, those of higher income, who lived in suburban or rural areas, identified as being exclusively attracted to the opposite sex, and in a romantic relationship, were more likely to have a gun in their household. Having a gun was not associated with increasing symptoms of depression or current poor physical or mental health.

CONCLUSIONS

Whereas we cannot determine gun types or reasons for having a gun, this research indicates that high school seniors are aware of and may have access to guns for use other than their intended purpose. Household gun ownership among students at higher risk for violence may pose safety challenges for communities and schools.