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Morral AR, Agniel D, Smart R, Schell TL. Household Firearm Ownership and Firearm Mortality. JAMA Netw Open 2024; 7:e2429335. [PMID: 39167407 DOI: 10.1001/jamanetworkopen.2024.29335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Importance Causal associations between household firearm ownership rates (HFRs) and firearm mortality rates are not well understood. Objective To assess the population-level temporal sequencing of firearm death rates and HFRs. Design, Setting, and Participants This cohort study used autoregressive cross-lagged models to analyze HFRs, firearm suicide rates, and firearm homicide rates in the US from 1990 to 2018. The suicide analyses included 16 demographic subgroups of adults, defined by study year, state, sex, race and ethnicity, marital status, and urbanicity. The homicide analyses consisted of adult subgroups living in urban or rural areas. Data analysis was conducted from March to December 2023. Exposures Firearm mortality rates and HFRs. Main Outcomes and Measures Firearm homicide and suicide rates with HFRs as the exposure, and HFR with mortality as the exposure. Results A total of 10 416 observations of 16 demographic subgroups by state and 2-year periods were included in the suicide analyses, while 1302 observations from 2 demographic subgroups by state and 2-year period were included in the homicide analysis. At baseline, the mean (SD) rate per 100 000 population across strata was 7.46 (7.21) for firearm suicides and 3.32 (2.13) for firearm homicides. The mean (SD) baseline HFR was 36.9% (20.2%) for firearm suicides and 36.9% (14.8%) for firearm homicides. Higher HFR preceded increases in suicide rates: demographic strata with equal firearm suicide rates but which differ by 18.6 percentage points on HFR (1 SD) would be expected to have firearm suicide rates that diverged by 0.19 (95% CI, 0.15-0.23) deaths per 100 000 population per period. With these differences accumulated over 8 years, firearm suicide rates in subgroups with the highest decile HFR would be expected to have 1.93 (95% CI, 1.64-2.36) more suicides per 100 000 population than strata with lowest decile HFR, a difference of 25.7% of the overall firearm suicide rate in 2018 and 2019. Firearm suicide rates had a smaller magnitude of association with subsequent changes in HFR: strata with equal HFRs but which differ by 1 SD in firearm suicide rates had minimal subsequent change in HFRs (-0.02 [95% CI, -0.04 to 0.01] percentage points). A 1-SD difference in HFRs was associated with little difference in next-period overall firearm homicides rates (0.03 [95% CI, -0.02 to 0.08] per 100 000 population), but a 1-SD difference in homicide rates was associated with a decrease in HFR (-0.09 [95% CI, -0.16 to -0.04] percentage points). Conclusions and Relevance This cohort study found an association between high HFRs and subsequent increases in rates of firearm suicide. In contrast, higher firearm homicide rates preceded decreases in HFRs. By demonstrating the temporal sequencing of firearm ownership and mortality, this study may help to rule out some theories of why gun ownership and firearm mortality are associated at the population level.
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Affiliation(s)
- Andrew R Morral
- Gun Policy in America Initiative, RAND Corporation, Arlington, Virginia
| | - Denis Agniel
- Gun Policy in America Initiative, RAND Corporation, Arlington, Virginia
| | - Rosanna Smart
- Gun Policy in America Initiative, RAND Corporation, Arlington, Virginia
| | - Terry L Schell
- Gun Policy in America Initiative, RAND Corporation, Arlington, Virginia
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Sokol RL, Oliphant SN, Bhatia S, Thulin EJ, Esposti MD, Hans Z. Associations Between Perceived Threats and Firearm Behaviors Among U.S. Adults. Am J Prev Med 2024:S0749-3797(24)00224-1. [PMID: 38960293 DOI: 10.1016/j.amepre.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION The number of U.S. adults who own and carry a firearm for self-defense is rising. Research has established that owning or carrying a firearm increases the risk of injury and death for firearm owners and the people in their lives. This study sought to better understand this paradox by estimating associations of perceived specific and diffuse threats with firearm behaviors among U.S. adults. METHODS The authors used data from the 2023 National Firearm Attitudes and Behaviors Study, a nationally representative cross-sectional survey of U.S. adults. Binary and ordinal logistic regression estimated associations of perceived specific (fear of attack in the community, fear of someone breaking into the home) and diffuse threats (belief in a dangerous world) with firearm ownership and carriage frequency, overall and stratified by gender. Adjusted models controlled for violence exposures and demographic characteristics. The authors conducted analyses in 2024. RESULTS Among all U.S. adults, the perceived specific threat of someone breaking into the home was associated with firearm ownership (AOR: 1.09 [0.98, 1.23]). Among firearm-owning adults, the diffuse threat of belief in a dangerous world was associated with firearm carriage frequency (1.11 [0.98, 1.25]). Both the associations persisted among men (AORs = 1.27 [1.05-1.52] and 1.15 [1.01-1.31], respectively), but analyses found no associations between perceived threats and firearm behaviors among women. CONCLUSIONS Perceived threats are associated with firearm behaviors among U.S. men, even after accounting for the actual violence they report experiencing or witnessing.
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Affiliation(s)
- Rebeccah L Sokol
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan; School of Social Work, University of Michigan, Ann Arbor, Michigan.
| | - Stephen N Oliphant
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan
| | - Shaun Bhatia
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan
| | - Elyse J Thulin
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan
| | | | - Zainab Hans
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan
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Hill TD, Zeng L, Burdette AM, Dowd-Arrow B, Bartkowski JP, Ellison CG. Size Matters? Penis Dissatisfaction and Gun Ownership in America. Am J Mens Health 2024; 18:15579883241255830. [PMID: 38819006 PMCID: PMC11143840 DOI: 10.1177/15579883241255830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
In this study, we formally examine the association between penis size dissatisfaction and gun ownership in America. The primary hypothesis, derived from the psychosexual theory of gun ownership, asserts that men who are more dissatisfied with the size of their penises will be more likely to personally own guns. To test this hypothesis, we used data collected from the 2023 Masculinity, Sexual Health, and Politics (MSHAP) survey, a national probability sample of 1,840 men, and regression analyses to model personal gun ownership as a function of penis size dissatisfaction, experiences with penis enlargement, social desirability, masculinity, body mass, mental health, and a range of sociodemographic characteristics. We find that men who are more dissatisfied with the size of their penises are less likely to personally own guns across outcomes, including any gun ownership, military-style rifle ownership, and total number of guns owned. The inverse association between penis size dissatisfaction and gun ownership is linear; however, the association is weakest among men ages 60 and older. With these findings in mind, we failed to observe any differences in personal gun ownership between men who have and have not attempted penis enlargement. To our knowledge, this is the first study to formally examine the association between penis size and personal gun ownership in America. Our findings fail to support the psychosexual theory of gun ownership. Alternative theories are posited for the apparent inverse association between penis size dissatisfaction and personal gun ownership, including higher levels of testosterone and constructionist explanations.
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Affiliation(s)
- Terrence D. Hill
- Department of Sociology and Demography, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Liwen Zeng
- College of Nursing and Health Sciences, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA
| | - Amy M. Burdette
- Department of Sociology and Public Health Program, Florida State University, Tallahassee, FL, USA
| | - Benjamin Dowd-Arrow
- Department of Sociology and Public Health Program, Florida State University, Tallahassee, FL, USA
| | - John P. Bartkowski
- Department of Sociology and Demography, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Christopher G. Ellison
- Department of Sociology and Demography, The University of Texas at San Antonio, San Antonio, TX, USA
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Webb PB, Jimenez J, Elder A, Cotte AO, Ravichandran A, Holbrook E, Baer RD, Wilson JW. Exploring lived experiences of gunshot wound survivors: A key to ethnographically informed public health interventions for curbing firearm violence. Injury 2024; 55:111240. [PMID: 38159335 DOI: 10.1016/j.injury.2023.111240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
INTRO The high rates of gun violence in the United States are a recognized public health concern with increased attention since the 1990's. The predominant studies used in gun violence research have been epidemiological approaches and quantitative analyses. This study, instead, examines lived experiences of gunshot wound survivors to better understand their situations. This study also compared the different census categories and their types of gunshot wound injuries. Ethnographic informed analyses may inform public health interventions to decrease firearm injuries. METHODS Data was collected through a series of semi-structured interviews at the emergency department of an urban, Level-1, academic trauma center. 96 patients with gunshot wounds (GSWs) from 2018-2022 were included in the study. Thematic analysis was conducted after coding interview responses. RESULTS There was a significant difference found between the 2 census categories (White and Minority populations). Those who self-identified as white had more self-inflicted GSWs (6) than other groups. Those who self-identified in the minority population had more GSWs as a result of an altercation (36) or as an innocent bystander (20). Interview data also demonstrated a trend in changing opinions about firearms in a group of participants with remote previous gunshot wounds (pGSW). When compared to the acute gunshot wound group (aGSW) the previous gunshot wound group (pGSW) responses showed support for increased gun safety and policies that limit firearm access. CONCLUSION Different injury patterns between census groups demonstrates that multiple public health approaches will be needed to decrease firearm violence. Ethnographically informed approaches, including the support of people with previous GSW injuries, may help craft those interventions to reduce injury. Matched peer support programs represent one potential intervention to decrease secondary injury and firearm violence.
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Affiliation(s)
- Paul Bryce Webb
- Morsani College of Medicine, University of South Florida, United States
| | - Jack Jimenez
- Morsani College of Medicine, University of South Florida, United States
| | - Andre Elder
- Morsani College of Medicine, University of South Florida, United States
| | | | | | - Emily Holbrook
- Department of Anthropology, University of South Florida, United States; Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa General Hospital, United States
| | - Roberta D Baer
- Department of Anthropology, University of South Florida, United States
| | - Jason W Wilson
- Department of Anthropology, University of South Florida, United States; Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa General Hospital, United States.
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5
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Gerdes MB. Assessing the relationship between gun ownership and fear of mass shootings. Soc Sci Med 2023; 336:116288. [PMID: 37783156 DOI: 10.1016/j.socscimed.2023.116288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
RATIONALE Gun sales spike after mass shooting incidents. As firearm presence is associated with numerous health and safety risks, it is imperative to understand what catalyzes gun ownership. Despite evidence that Americans' fear of mass shootings is increasing at a pace that exceeds their likelihood of victimization, the relationship between fear of mass shootings and gun ownership has received minimal attention. OBJECTIVE The current study examines group differences in fear of mass shootings and openness to gun ownership. Specifically, it is hypothesized that (1) fear of mass shootings will increase openness to future firearm ownership among non-owners, (2) gun owners will be more afraid of mass shootings than non-owners, and (3) protective owners will be more afraid than non-protective owners. METHODS This paper uses Wave 26 of Pew Research Center's nationally representative American Trends Panel (n = 1968). RESULTS Binary logistic regression analyses indicate that among non-gun-owners, fear of mass shootings decreases openness to ownership. Ordinal logistic regression analyses indicate that while fear of mass shootings does not differ between gun owners and non-owners, protective gun owners are more afraid than non-protective owners. CONCLUSIONS Combined with prior research, these findings suggest that protective gun owners, non-protective gun owners, and non-owners have distinct views of the relationship between guns and mass shootings and are motivated to acquire firearms by different processes. Additional longitudinal work is needed to confirm these findings and clarify the role of causal attributions.
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Affiliation(s)
- Madison B Gerdes
- Northeastern University School of Criminology and Criminal Justice, 204 Churchill Hall, 360 Huntington Ave, Boston, MA, 02115, USA.
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Christopoulos K. Associations between Gun Ownership and Firearm Homicide Rates in US States. J Urban Health 2023; 100:651-656. [PMID: 37386342 PMCID: PMC10447772 DOI: 10.1007/s11524-023-00734-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 07/01/2023]
Abstract
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.
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Kaufman EJ, Richmond TS, Hoskins K. Youth Firearm Injury: A Review for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:357-371. [PMID: 36898779 PMCID: PMC9662754 DOI: 10.1016/j.ccc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firearms are now the leading cause of death among youth in the United States, with rates of homicide and suicide rising even more steeply during the SARS-CoV-2 pandemic. These injuries and deaths have wide-ranging consequences for the physical and emotional health of youth and families. While pediatric critical care clinicians must treat the injured survivors, they can also play a role in prevention by understanding the risks and consequences of firearm injuries; taking a trauma-informed approach to the care of injured youth; counseling patients and families on firearm access; and advocating for youth safety policy and programming.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, MOB Suite 120, 51 North 39th Street, Philadelphia, PA 19104, USA
| | - Therese S Richmond
- University of Pennsylvania School of Nursing, Fagin Hall 330, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
| | - Katelin Hoskins
- University of Pennsylvania School of Nursing, Fagin Hall 312, 418 Curie Boulevard, Philadelphia, PA 19104, USA
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8
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Conrick KM, Smith MB, Rooney L, Morgan E, Rowhani-Rahbar A, Moore M. Openness to church-based firearm safety interventions among Protestant Christian firearm owners. Public Health 2023; 216:45-50. [PMID: 36796220 DOI: 10.1016/j.puhe.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Protestant Christians are more likely to own firearms and not store them locked/unloaded compared to those from other religions. This study examines how Protestant Christians view the relationship between their religious and firearm beliefs and how that informs openness to church-based firearm safety interventions. STUDY DESIGN Grounded theory analysis of 17 semi-structured interviews with Protestant Christians. METHODS Interviews, conducted August-October 2020, focused on firearms owned, carrying/discharge/storage behaviors, Christian belief compatibility with firearm ownership, and openness to church-based firearm safety interventions. Audio-recorded interviews were transcribed verbatim and analyzed using grounded theory techniques. RESULTS Participant perspectives varied on firearm ownership motivations and compatibility of Christian values with firearm ownership. Variation in these themes and in openness to church-based firearm safety interventions resulted in clustering of participants into three groups. Group 1 owned firearms for collecting/sporting purposes and intricately connected their Christian identity with firearm ownership, but they were not open to intervention due to perceived high firearm proficiency. Group 2 did not connect their Christian identity to their firearm ownership; some believed these identities were incompatible, so were also not open to intervention. Group 3 owned firearms for protection and believed church, as a community hub, was an excellent location for firearm safety interventions. CONCLUSIONS The clustering of participants into groups varying in openness to church-based firearm safety interventions suggests it is feasible to identify Protestant Christian firearm owners open to intervention. This study presents a first step in coupling firearm owner characteristics with community-based, tailored interventions with promise for efficacy.
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Affiliation(s)
- K M Conrick
- School of Social Work, University of Washington, Seattle, WA, USA; Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.
| | - M B Smith
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA; Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - L Rooney
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - E Morgan
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - A Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - M Moore
- School of Social Work, University of Washington, Seattle, WA, USA; Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
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Marrero CE, Petrie JK, Bonvillain K, Leonardi C, Stinger BA. The Economic Impact of Acute Firearm Injuries at a Trauma Center in New Orleans. Am J Prev Med 2023; 64:221-226. [PMID: 36336563 DOI: 10.1016/j.amepre.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The objective of this study was to examine the payer mix and the economic impact of acute firearm injuries at a Level I Trauma Center in New Orleans. METHODS Acute firearm injury economic data were obtained from the trauma registry database of the University Medical Center in New Orleans, Louisiana for 2016 through 2019. Patients were identified by the ICD-10-CM external causes of morbidity codes found in their electronic medical records. All patients with codes for initial encounters for gunshot wounds were included. Abstracted data included total charges and payments. Using the hospital cost-to-charge ratio, the estimated costs and losses were tabulated. Data analysis for this study occurred from 2020 to 2021. RESULTS A total of 2,094 patients with acute firearm injuries were identified over the 4-year period. These patients incurred charges of $122,440.642, whereas $17,293,655 was collected as payment. The estimated cost associated with the encounters was $37,602,667, resulting in a net loss of $20,309,012 from 2016 to 2019 for the hospital. CONCLUSIONS Firearm injuries continue to plague the U.S. as a serious public health problem, causing preventable death, illness, and disability. They also continue to result in a major economic burden.
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Affiliation(s)
- Christopher E Marrero
- Department of Orthopaedic Surgery, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jaudé K Petrie
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
| | - Kirby Bonvillain
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Claudia Leonardi
- Department of Behavioral & Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Brett A Stinger
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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A qualitative framing analysis of how firearm manufacturers and related bodies communicate to the public on gun-related harms and solutions. Prev Med 2023; 166:107346. [PMID: 36427567 DOI: 10.1016/j.ypmed.2022.107346] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
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.
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Seewald LA, Myers M, Zimmerman MA, Walton MA, Cunningham RM, Rupp LA, Haasz M, Carter PM. Firearm safety counseling among caregivers of high-school age teens: Results from a National Survey. Prev Med 2022; 165:107285. [PMID: 36183798 PMCID: PMC9900740 DOI: 10.1016/j.ypmed.2022.107285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/08/2023]
Abstract
Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020-7/22/2020) was conducted among caregivers (n = 2924) of teens (age:14-18). Weights were applied to generate nationally representative estimates. Bivariate analyses and multivariate regressions were examined. Among respondents, 56.0% were women, 75.1% were non-Hispanic White, and mean (SD) age was 47.4. Firearm safety was the least discussed topic among caregivers reporting their teen received HCP preventative counseling (14.9%). For caregivers receiving counseling, the most common issues discussed were household firearms screening (75.7%); storing firearms locked (66.8%); and storing firearms unloaded (53.0%). Only 24.6% of caregivers indicated firearm safety was an important issue for teen HCPs to discuss and only 21.9% trusted teen HCPs to counsel about firearm safety. Female caregivers (aOR = 1.86;95%CI = 1.25-2.78), those trusting their teen's HCP to counsel on firearm safety (aOR = 9.63;95%CI = 6.37-14.56), and those who received teen HCP firearm safety counseling (aOR = 5.14;95%CI = 3.02-8.72) were more likely to favor firearm safety counseling. Caregivers of teens with prior firearm safety training (aOR = 0.50;95%CI = 0.31-0.80) were less likely to agree that firearm safety was an important preventative health topic. In conclusion, few caregivers receive preventive counseling on firearm safety from their teen's HCP, with trust a key barrier to effective intervention delivery. Future research, in addition to understanding barriers and establishing effective strategies to increase safety practices, should focus on increasing provider counseling competency.
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Affiliation(s)
- Laura A Seewald
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, United States of America.
| | - Matthew Myers
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Marc A Zimmerman
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maureen A Walton
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Addiction Center, Dept of Psychiatry, Univ of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America
| | - Rebecca M Cunningham
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Laney A Rupp
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maya Haasz
- Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America
| | - Patrick M Carter
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
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Bernardin ME, Clukies L, Gu H, Fairfax C, Keller MS. COVID-19 Pandemic effects on the epidemiology and mortality of pediatric firearm injuries; A single center study. J Pediatr Surg 2022:S0022-3468(22)00678-9. [PMID: 36402591 PMCID: PMC9596183 DOI: 10.1016/j.jpedsurg.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased firearm injuries amongst adults, though the pandemic's effect on children is less clearly understood. METHODS This cross-sectional study was performed at a Level 1 Pediatric Trauma Center and included youths 0-19 years. The trauma registry was retrospectively queried for firearm injuries occurring pre-COVID-19 pandemic (March 2015-February 2020). Baseline data was compared to prospectively collected data occurring during the COVID-19 pandemic (March 2020-March 2022). Fischer's exact, Pearson's Chi-square and/or correlation analysis was used to compare pre and post-COVID-19 firearm injury rates and intent, victim demographics and disposition. Temporal relationships between firearm injury rates and local COVID-19 death rates were also described. RESULTS 413 pre-COVID-19 firearm injuries were compared to 259 pandemic firearm injuries. Victims were mostly Black males with a mean age of 13.4 years. Compared to the 5 years pre-pandemic, monthly firearm injury rates increased 51.5% (6.8 vs 10.3 shootings/month), including a significant increase (p = 0.04) in firearm assaults/homicides and a relative decrease in unintentional shootings. Deaths increased 29%, and there were significantly fewer ED discharges and more admissions to OR and/or PICU (p = 0.005). There was a significant increase in Black victims (p = 0.01) and those having Medicaid or self-pay (p<0.001). Firearm injury spikes were noted during or within the 3 months following surges in local COVID-19 death rates. CONCLUSIONS The COVID-19 pandemic was associated with an increase in the frequency and mortality of pediatric firearm injuries, particularly assaults amongst Black children following surges in COVID death rates. Increased violence-intervention services are needed, particularly amongst marginalized communities. LEVEL OF EVIDENCE This is a prognostic study, evaluating the effects of the COVID-19 pandemic on pediatric firearm injuries, including victim demographics, injury intent and mortality. This study is retrospective and observational, making it Oxford Level III evidence.
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Affiliation(s)
- Mary Elizabeth Bernardin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO, USA; Division of Pediatric Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Lindsay Clukies
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongjie Gu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Connor Fairfax
- Trauma Services, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Martin S Keller
- Division of Pediatric Surgery, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Zakopoulos I, Varshney K, Macy JT, McIntire RK. A Descriptive Analysis of Mass Shootings in the United States From 2010 to 2020: The Relationship Between Firearm Dealership Density and Proximity to Mass Shooting Sites and a Comparison With McDonald's and Starbucks Retailers. Cureus 2022; 14:e29302. [DOI: 10.7759/cureus.29302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/05/2022] Open
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Dyer L, Vilda D, Harville E, Theall K, Wallace M. Income Inequality and Pregnancy-Associated Homicide in the US: A Longitudinal, State-Level Analysis. Violence Against Women 2022:10778012221120446. [PMID: 36017550 DOI: 10.1177/10778012221120446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pregnancy-associated homicide remains an understudied yet critical issue. Using restricted use mortality files provided by the National Center for Health Statistics and the National Violent Death Reporting System, annual state-level pregnancy-associated homicide ratios were estimated as the count of deaths divided by the number of live births. The exposure, the state Gini index, was categorized into tertiles to compare states by levels of income inequality. In the final adjusted longitudinal linear model, those who experienced the greatest amount of income inequality had a significant 1.28 per 100,000 homicide rate when compared to the lowest income inequality tertile.
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Affiliation(s)
- Lauren Dyer
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Dovile Vilda
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emily Harville
- Department of Epidemiology, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Katherine Theall
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Maeve Wallace
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Studdert DM, Zhang Y, Holsinger EE, Prince L, Holsinger AF, Rodden JA, Wintemute GJ, Miller M. Homicide Deaths Among Adult Cohabitants of Handgun Owners in California, 2004 to 2016 : A Cohort Study. Ann Intern Med 2022; 175:804-811. [PMID: 35377715 DOI: 10.7326/m21-3762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although personal protection is a major motivation for purchasing firearms, existing studies suggest that people living in homes with firearms have higher risks for dying by homicide. Distribution of those risks among household members is poorly understood. OBJECTIVE To estimate the association between living with a lawful handgun owner and risk for homicide victimization. DESIGN This retrospective cohort study followed 17.6 million adult residents of California for up to 12 years 2 months (18 October 2004 through 31 December 2016). Cohort members did not own handguns, but some started residing with lawful handgun owners during follow-up. SETTING California. PARTICIPANTS 17 569 096 voter registrants aged 21 years or older. MEASUREMENTS Homicide (overall, by firearm, and by other methods) and homicide occurring in the victim's home. RESULTS Of 595 448 cohort members who commenced residing with handgun owners, two thirds were women. A total of 737 012 cohort members died; 2293 died by homicide. Overall rates of homicide were more than twice as high among cohabitants of handgun owners than among cohabitants of nonowners (adjusted hazard ratio, 2.33 [95% CI, 1.78 to 3.05]). These elevated rates were driven largely by higher rates of homicide by firearm (adjusted hazard ratio, 2.83 [CI, 2.05 to 3.91]). Among homicides occurring at home, cohabitants of owners had sevenfold higher rates of being fatally shot by a spouse or intimate partner (adjusted hazard ratio, 7.16 [CI, 4.04 to 12.69]); 84% of these victims were female. LIMITATIONS Some cohort members classified as unexposed may have lived in homes with handguns. Residents of homes with and without handguns may have differed on unobserved traits associated with homicide risk. CONCLUSION Living with a handgun owner is associated with substantially elevated risk for dying by homicide. Women are disproportionately affected. PRIMARY FUNDING SOURCE The National Collaborative on Gun Violence Research, the Fund for a Safer Future, the Joyce Foundation, Stanford Law School, and the Stanford University School of Medicine.
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Affiliation(s)
- David M Studdert
- Department of Health Policy, Stanford University School of Medicine, and Stanford Law School, Stanford, California (D.M.S.)
| | - Yifan Zhang
- Department of Health Policy, Stanford University School of Medicine, Stanford, California (Y.Z., E.E.H., L.P., A.F.H.)
| | - Erin E Holsinger
- Department of Health Policy, Stanford University School of Medicine, Stanford, California (Y.Z., E.E.H., L.P., A.F.H.)
| | - Lea Prince
- Department of Health Policy, Stanford University School of Medicine, Stanford, California (Y.Z., E.E.H., L.P., A.F.H.)
| | - Alexander F Holsinger
- Department of Health Policy, Stanford University School of Medicine, Stanford, California (Y.Z., E.E.H., L.P., A.F.H.)
| | - Jonathan A Rodden
- Department of Political Science, Stanford University, Stanford, California (J.A.R.)
| | - Garen J Wintemute
- School of Medicine, University of California at Davis, Sacramento, California (G.J.W.)
| | - Matthew Miller
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (M.M.)
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16
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Comparing and Contrasting Rates of Firearm Homicides and Suicides. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1007/s40806-021-00311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Gun ownership, community stress, and sleep disturbance in America. Sleep Health 2021; 8:161-166. [PMID: 34924344 DOI: 10.1016/j.sleh.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although there is widespread speculation about guns helping people to sleep better, this idea has only recently faced empirical scrutiny. We test whether people who own guns tend to exhibit healthier sleep outcomes than people who do not own guns and whether the association between community stress and sleep is less pronounced for people who own guns. DESIGN We use ordinary least squares, multinomial logistic, and binary logistic regression to model cross-sectional survey data. SETTING Our data span the United States. PARTICIPANTS The 2021 Crime, Health, and Politics Survey (CHAPS) is based on a national probability sample of 1714 adults. MEASUREMENTS Our analyses include multiple measures of gun ownership (personal ownership, keeping a gun in one's bedroom, and COVID-19 pandemic gun purchases), community stress (neighborhood disorder, neighborhood danger during the pandemic, and perceptions of police protection), and sleep (insomnia symptoms, sleep duration, and pandemic sleep). RESULTS We found that people who own guns and people who do not own guns tend to exhibit similar sleep outcomes and that people who experience community stressors tend to exhibit similar sleep outcomes regardless of gun ownership. CONCLUSION Our analyses confirm that gun ownership is unrelated to sleep and that guns are insufficient to mitigate the detrimental effects of community stress on sleep. We extend prior work by (a) using more detailed measurements of gun ownership, community stress, and sleep, (b) assessing whether people keep a gun in their bedroom, and (c) exploring the intersection of pandemic gun purchases and pandemic sleep quality.
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18
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Hill TD, Wen M, Ellison CG, Wu G, Dowd-Arrow B, Su D. Modeling recent gun purchases: A social epidemiology of the pandemic arms race. Prev Med Rep 2021; 24:101634. [PMID: 34976686 PMCID: PMC8684007 DOI: 10.1016/j.pmedr.2021.101634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
We consider the social patterning of recent pandemic gun purchases. Overall, 6% of the sample reported purchasing a new gun during the pandemic. Pandemic gun purchasers tend to be male, younger, US-born, and living in the south. Pandemic gun purchasers tend to be less educated and recently unemployed. Pandemic gun purchasers tend to be Republicans and experiencing religious change.
In this paper, we document the social patterning of recent gun purchases to advance a contemporary social epidemiology of the pandemic arms race. We employ cross-sectional survey data from the 2020 Health, Ethnicity and Pandemic Study, which included a national sample of 2,709 community-dwelling adults living in the United States. We use binary logistic regression to model recent pandemic gun purchases as a function of age, sex, race/ethnicity, nativity status, region of residence, marital status, number of children, education, household income, pandemic job change, religious service attendance, pandemic religion change, and political party. Overall, 6% of the sample reported purchasing a new gun during the pandemic. Multivariate regression results suggest that pandemic gun purchasers tend to be male, younger, US-born, less educated, recently unemployed, experiencing changes in their religious beliefs, Republicans, and residents of southern states. To our knowledge, we are among the first to formally document a new population of pandemic gun owners that is characterized by youth, US-nativity, and religious volatility. Our analyses underscore the need for public health initiatives designed to enhance gun-related safety during pandemics, including, for example, addressing underlying motivations for recent gun purchases and improving access to training programs.
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Affiliation(s)
- Terrence D Hill
- Department of Sociology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Ming Wen
- Department of Sociology, The University of Utah, 390 1530 E #301, Salt Lake City, UT 84112, USA
| | - Christopher G Ellison
- Department of Sociology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Guangzhen Wu
- Department of Sociology, The University of Utah, 390 1530 E #301, Salt Lake City, UT 84112, USA
| | - Benjamin Dowd-Arrow
- Public Health Program, Florida State University, 526 Bellamy Building, Tallahassee, FL 32306, USA
| | - Dejun Su
- Department of Health Promotion, The University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE 68198, USA
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19
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Hill TD, Dowd-Arrow B, Ellison CG, Garcia-Alexander G, Bartkowski JP, Burdette AM. Sexual Dysfunction and Gun Ownership in America: When Hard Data Meet a Limp Theory. Am J Mens Health 2021; 15:15579883211044342. [PMID: 34521291 PMCID: PMC8447103 DOI: 10.1177/15579883211044342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although there has been no direct empirical evidence linking sexual dysfunction (SD) with gun ownership, speculation has been widespread and persistent for decades. In this paper, we formally examine the association between SD and gun ownership. Our primary hypothesis, derived from the psychosexual theory of gun ownership, asserts that men experiencing SD are more likely to personally own guns than other men. To test this hypothesis, we used recently collected data from the 2021 Crime, Health, and Politics Survey (CHAPS), a national probability sample of 780 men, and binary logistic regression to model gun ownership as a function of SD. Our key finding is that men experiencing SD are no more likely to own guns than men without SD. This interpretation was supported across several indicators of SD (performance anxiety, erection trouble, and ED medication) and gun ownership (personal gun ownership, purchasing a gun during the pandemic, and keeping a gun in one's bedroom). To our knowledge, we are the first to have directly tested the association between SD and gun ownership in America. Our findings are important because they contribute to our understanding of factors associated with gun ownership by challenging the belief that phallic symbolism and masculinity somehow drive men with SD to purchase guns. Our results also remind us of the perils of gun culture rhetoric, which, in this case, function to discredit gun owners and to further stigmatize men with ED. We conclude by calling for more evidence-based discussions of SD and guns in society.
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Affiliation(s)
- Terrence D Hill
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Benjamin Dowd-Arrow
- Department of Sociology, Public Health Program, and Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
| | | | | | - John P Bartkowski
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Amy M Burdette
- Department of Sociology, Public Health Program, and Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
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20
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Brandt CA, Workman TE, Farmer MM, Akgün KM, Abel EA, Skanderson M, Bean-Mayberry B, Zeng-Treitler Q, Mason M, Bastian LA, Goulet JL, Post LA. Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study. West J Emerg Med 2021; 22:525-532. [PMID: 34125022 PMCID: PMC8203018 DOI: 10.5811/westjem.2021.4.51203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Presence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics. METHODS The study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access. RESULTS The proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women). CONCLUSION Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.
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Affiliation(s)
- Cynthia A. Brandt
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - T. Elizabeth Workman
- The George Washington University, Biomedical Informatics Center, Washington, District of Columbia
- VA Medical Center, Washington, District of Columbia
| | - Melissa M. Farmer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kathleen M. Akgün
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Erica A. Abel
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut
| | | | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
- UCLA David Geffen School of Medicine, Department of Medicine, Los Angeles, California
| | - Qing Zeng-Treitler
- The George Washington University, Biomedical Informatics Center, Washington, District of Columbia
- VA Medical Center, Washington, District of Columbia
| | - Maryann Mason
- Northwestern University, Department of Emergency Medicine, Chicago, Illinois
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Joseph L. Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lori A. Post
- Northwestern University, Department of Emergency Medicine, Chicago, Illinois
- Northwestern University, Department of Geriatric Medicine, Chicago, Illinois
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21
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Ferguson CJ, Smith S. Examining homicides and suicides cross-nationally: Economic factors, guns and video games. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:812-823. [PMID: 33786817 DOI: 10.1002/ijop.12760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/13/2021] [Indexed: 11/06/2022]
Abstract
Understanding why different nations have different homicide and suicide rates has been of interest to scholars, policy makers and the general public for years. Multiple theories have been offered, related to the economy, presence of guns and even exposure to violence in video games. In the current study, several factors were considered in combination across a sample of 92 countries. These included income inequality (Gini index), Human Capital Index (education and employment), per capita gun ownership and per capita expenditure on video games. Results suggest that economic factors primarily were related to homicide and suicide cross-nationally. Video game consumption was not a major indicative factor (other than a small negative relationship with homicides). More surprisingly, per capita gun ownership was not an indicator factor cross-nationally. The results suggest that a focus on economic factors and income inequality are most likely to bear fruit regarding reduction of violence and suicide.
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Affiliation(s)
| | - Sven Smith
- Department of Psychology, Stetson University, DeLand, FL, USA
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22
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Manley NR, Huang DD, Lewis RH, Bee T, Fischer PE, Croce MA, Magnotti LJ. Caught in the crossfire: 37 Years of firearm violence afflicting America's youth. J Trauma Acute Care Surg 2021; 90:623-630. [PMID: 33405467 DOI: 10.1097/ta.0000000000003060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Publicly available firearm data are difficult to access. Trauma registry data are excellent at documenting patterns of firearm-related injury. Law enforcement data excel at capturing national violence trends to include both circumstances and firearm involvement. The goal of this study was to use publicly available law enforcement data from all 50 states to better define patterns of firearm-related homicides in the young. METHODS All homicides in individuals 25 years or younger in the United States over a 37-year period ending in 2016 were analyzed: infant, 1 year or younger; child, 1 to 9 years old; adolescent, 10 to 19 years old; and young adult, 20 to 25 years old. Primary data files were obtained from the Federal Bureau of Investigation and comprised the database. Data analyzed included homicide type, situation, circumstance, month, firearm type, and demographics. Rates of all homicides and firearm-related homicides per 1 million population and the proportion of firearm-related homicides (out of all homicides) were stratified by year and compared over time using simple linear regression. RESULTS A total of 171,113 incidents of firearm-related homicide were analyzed (69% of 246,437 total homicides): 5,313 infants, 2,332 children, 59,777 adolescents, and 103,691 young adults. Most (88%) were male and Black (59%) with a median age of 20 years. Firearm-related homicides peaked during the summer months of June, July, and August (median, 1,156 per year; p = 0.0032). Rates of all homicides (89 to 53 per 1 million population) and firearm-related homicides (56 to 41 per 1 million population) decreased significantly from 1980 to 2016 (β = -1.12, p < 0.0001 and β = -0.57, p = 0.0039, respectively). However, linear regression analysis identified a significant increase in the proportion of firearm-related homicides (out of all homicides) from 63% in 1980 to 76% in 2016 (β = 0.33, p < 0.0001). CONCLUSION For those 25 years or younger, the proportion of firearm-related homicides has steadily and significantly increased over the past 37 years, with 3 of 4 homicides firearm related in the modern era. Despite focused efforts, reductions in the rate of firearm-related homicides still lag behind those for all other methods of homicide by nearly 50%. That is, while the young are less likely to die from homicide, for those unfortunate victims, it is more likely to be due to a firearm. This increasing role of firearms in youth homicides underscores the desperate need to better direct prevention efforts and firearm policy if we hope to further reduce firearm-related deaths in the young. LEVEL OF EVIDENCE Epidemiological study, level III.
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Affiliation(s)
- Nathan R Manley
- From the Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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23
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Gomez DB, Xu Z, Saleh JH. From Regression Analysis to Deep Learning: Development of Improved Proxy Measures of State-Level Household Gun Ownership. PATTERNS 2020; 1:100154. [PMID: 33336203 PMCID: PMC7733878 DOI: 10.1016/j.patter.2020.100154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/05/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
In the absence of direct measurements of state-level household gun ownership (GO), the quality and accuracy of proxy measures for this variable are essential for firearm-related research and policy development. In this work, we develop two highly accurate proxy measures of GO using traditional regression analysis and deep learning, the former accounting for non-linearities in the covariates (portion of suicides committed with a firearm [FS/S] and hunting license rates) and their statistical interactions. We subject the proxies to extensive model diagnostics and validation. Both our regression-based and deep-learning proxy measures provide highly accurate models of GO with training R2 of 96% and 98%, respectively, along with other desirable qualities-stark improvements over the prevalent FS/S proxy (R2 = 0.68). Model diagnostics reveal this widely used FS/S proxy is highly biased and inadequate; we recommend that it no longer be used to represent state-level household gun ownership in firearm-related studies.
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Affiliation(s)
- David Benjamin Gomez
- School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Zhaoyi Xu
- School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Joseph Homer Saleh
- School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Magee LA, Fortenberry JD, Tu W, Wiehe SE. Neighborhood variation in unsolved homicides: a retrospective cohort study in Indianapolis, Indiana, 2007-2017. Inj Epidemiol 2020; 7:61. [PMID: 33256823 PMCID: PMC7706017 DOI: 10.1186/s40621-020-00287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homicide is a widely acknowledged public health problem in the United States. The majority of homicides are committed with a firearm and have long-term health consequences for family members and entire communities. When left unsolved, violence may be perpetuated due to the retaliatory nature of homicides. Improving homicide clearance rates may help prevent future violence, however, we know little about the community-level social dynamics associated with unsolved homicides. METHODS This study examines the individual-and-community-level social processes associated with low homicide clearance rates in Indianapolis, Indiana between 2007 and 2017. Homicide clearance is the primary outcome, defined as if a perpetrator was arrested for that homicide case between 2007 and 2017. Individual-level variables include the victim's race/ethnicity, sex, and age. Community-level (i.e., census tracts) variables include the number of resident complaints against the police, resident complains of community disorder, income inequality, number of police interactions, and proportion of African American residents. RESULTS In Indianapolis over a 11-year period, the homicide clearance rate decreased to a low of 38% in 2017, compared to a national clearance rate of 60%. Homicide case clearance was less likely for minority (OR 0.566; 95% CI, 0.407-0.787; p < 0.01) and male (OR 0.576; 95% CI, 0.411-0.807; p < 0.01) victims. Resident complaints of community disorder were associated with a decreased odds of case clearance (OR 0.687; 95% CI, 0.485-0.973; p < .01)., African American victim's cases were less likely to be cleared in 2014-2017 (OR 0.640; 95% CI, 0.437-0.938; p < 0.05), compared to 2007. CONCLUSIONS Our study identified differences in neighborhood social processes associated with homicide clearance, indicating existing measures on these community factors are complex. Programs aimed at improving signs of community disorder and building community engagement may improve neighborhood clearance rates, lower violence, and improve the health of these communities.
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Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, 801 W. Michigan Street, Indianapolis, Indiana, 46202, USA.
| | - J Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, 410 W. 10th Street, Suite 1000, Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, 410 W. 10th Street, Suite 3000, Indianapolis, Indiana, USA
| | - Sarah E Wiehe
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Suite 2000, Indianapolis, USA
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Yu SSV, Lee D, Pizarro JM. Illegal Firearm Availability and Violence: Neighborhood-Level Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:3986-4012. [PMID: 29294789 DOI: 10.1177/0886260517712272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Violence involving firearms poses a serious threat to public safety in urban areas. The present study examines how illegal firearm availability (IFA) is related to firearm violence at the neighborhood level. We analyzed 3 years (from 2005 to 2007) of recovered firearm and violent index crime data from Newark, New Jersey. Violent index crime is separated into three categories by level of firearm use: shootings, display of firearm violence (DFV), and no-firearm violence (NFV). Negative binominal regression was conducted to examine the relationship between IFA and firearm violence at the neighborhood level while controlling for neighborhood conditions. Firearm violence is prevalent in Newark: over 90% of homicides and 47% of robberies were committed with a firearm. IFA is related to increased shootings and NFV, but not to DFV. IFA is a robust predictor of shootings in Newark, New Jersey. Neighborhood conditions influence IFA and firearm violence. IFA may reflect neighborhood distress level, given that areas with high IFA experience increased firearm violence as well as NFV. The local clustering of violent crime suggests placed-focused policing strategies aimed at removing firearms would aid in curbing serious firearm violence in urban neighborhoods.
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Affiliation(s)
| | - Daiwon Lee
- New York City Police Department, New York, NY, USA
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26
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Azrael D, Miller M. Access to Firearms, Homicide, and Suicide: Role of the Mortality Multiplier. Am J Public Health 2020; 110:1456-1457. [PMID: 32903077 DOI: 10.2105/ajph.2020.305876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Deborah Azrael
- Deborah Azrael is with the Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Bouvé School of Health Sciences, Northeastern University, Boston
| | - Matthew Miller
- Deborah Azrael is with the Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Bouvé School of Health Sciences, Northeastern University, Boston
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Chung SH, Biely C, Dudovitz R. Firearm access and adolescent health: Safety in numbers? SSM Popul Health 2020; 11:100568. [PMID: 32258356 PMCID: PMC7115163 DOI: 10.1016/j.ssmph.2020.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/01/2022] Open
Abstract
Access to firearms and perceived unsafe school environments are associated with negative adolescent health outcomes. Whether widespread acceptance of firearms alters these associations, however, is unknown. To address this literature gap, we examined whether peer acceptance of firearms moderates associations between personal firearm access and health outcomes. In 2018-2019, we analyzed Wave I of the National Longitudinal Study of Adolescent to Adult Health (collected 1994-1995) to assess personal firearm access and school-level percentage of firearm access, using weighted multilevel analyses with interactions to determine associations among personal access, school-level percentage of access, and adolescent depression, suicidality, general health, and perceived school safety. Models controlled for age, sex, race, region, urbanicity, family structure, parental income and education level, school type, school size, and school quality. Results showed that personal firearm access was associated with depression (OR 1.20 p = 0.03), suicidal ideation (OR 1.73, p < 0.001), and perceiving school as unsafe (OR 1.59, p < 0.001). A higher school-level percentage of access, however, was associated with lower rather than higher odds of perceiving school as unsafe (OR 0.83, p = 0.003). With interaction terms included, the association between personal access and suicidal ideation was weaker when school-level access was more common. Similarly, the association between school-level access and poor general health was negative among students with personal access but positive among students with no access. These findings suggest firearm access is a complex social phenomenon. In a low-access environment, personal firearm access may signify a high-risk physical and mental state. In schools where access is common, however, personal access may signify social belonging, possibly mitigating some potential negative health effects. Although evidence that firearm access is harmful remains clear, local norms may have a substantial moderating impact.
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Affiliation(s)
- Samantha H Chung
- Marlborough School, USA.,Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.,Children's Discovery & Innovation Institute, UCLA Mattel Children's Hospital, USA
| | - Christopher Biely
- Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.,Children's Discovery & Innovation Institute, UCLA Mattel Children's Hospital, USA
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.,Children's Discovery & Innovation Institute, UCLA Mattel Children's Hospital, USA
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28
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Dollar NT, Gutin I, Lawrence EM, Braudt DB, Fishman SH, Rogers RG, Hummer RA. The persistent southern disadvantage in US early life mortality, 1965-2014. DEMOGRAPHIC RESEARCH 2020; 42:343-382. [PMID: 32317859 PMCID: PMC7173329 DOI: 10.4054/demres.2020.42.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent studies of US adult mortality demonstrate a growing disadvantage among southern states. Few studies have examined long-term trends and geographic patterns in US early life (ages 1 to 24) mortality, ages at which key risk factors and causes of death are quite different than among adults. OBJECTIVE This article examines trends and variations in early life mortality rates across US states and census divisions. We assess whether those variations have changed over a 50-year time period and which causes of death contribute to contemporary geographic disparities. METHODS We calculate all-cause and cause-specific death rates using death certificate data from the Multiple Cause of Death files, combining public-use files from 1965-2004 and restricted data with state geographic identifiers from 2005-2014. State population (denominator) data come from US decennial censuses or intercensal estimates. RESULTS Results demonstrate a persistent mortality disadvantage for young people (ages 1 to 24) living in southern states over the last 50 years, particularly those located in the East South Central and West South Central divisions. Motor vehicle accidents and homicide by firearm account for most of the contemporary southern disadvantage in US early life mortality. CONTRIBUTION Our results illustrate that US children and youth living in the southern United States have long suffered from higher levels of mortality than children and youth living in other parts of the country. Our findings also suggest the contemporary southern disadvantage in US early life mortality could potentially be reduced with state-level policies designed to prevent deaths involving motor vehicles and firearms.
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Affiliation(s)
| | - Iliya Gutin
- University of North Carolina at Chapel Hill, USA
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29
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Winfield RD, Crandall M, Williams BH, Sakran JV, Shorr K, Zakrison TL. Firearm violence in the USA: a frank discussion on an American public health crisis-The Kansas City Firearm Violence Symposium. Trauma Surg Acute Care Open 2019; 4:e000359. [PMID: 31897436 PMCID: PMC6924760 DOI: 10.1136/tsaco-2019-000359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 01/05/2023] Open
Abstract
Kansas City is a microcosm for USA. Although Kansas City shows a relatively diverse population, it is one that is segregated along the lines of race and income. This is an inequity that is common to all cities across the country. With this inequity comes unequal opportunity to survive and to thrive. Firearm violence is a core component of this societal inequity. In this article, we present the proceedings of the 2019 Kansas City Firearm Violence Symposium, where distinguished experts in trauma convened to share their experience, evidence and voices of gun violence-directly and indirectly. There were discussions on topics such as the human toll of gun violence, the role of structural violence in its perpetuation, the intersectional nature of race with both violence and medical care, and guidance on measures that could be taken to advocate for the reduction and elimination of gun violence. This was a symposium that started a country-wide conversation between academia, healthcare, survivors and the community on the most pressing public health crisis facing USA today.
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Affiliation(s)
| | - Marie Crandall
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Brian H Williams
- Department of Surgery, University of Chicago Division of Biological Sciences, Chicago, Illinois, USA
| | | | - Kathy Shorr
- University of Kansas Medical Center, Department of Surgery, University of Kansas, Kansas City, KS, USA
| | - Tanya L Zakrison
- Department of Surgery, University of Chicago Division of Biological Sciences, Chicago, Illinois, USA
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Zhang Y, Holsinger EE, Prince L, Rodden JA, Swanson SA, Miller MM, Wintemute GJ, Studdert DM. Assembly of the LongSHOT cohort: public record linkage on a grand scale. Inj Prev 2019; 26:153-158. [PMID: 31662345 PMCID: PMC7146924 DOI: 10.1136/injuryprev-2019-043385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Virtually all existing evidence linking access to firearms to elevated risks of mortality and morbidity comes from ecological and case-control studies. To improve understanding of the health risks and benefits of firearm ownership, we launched a cohort study: the Longitudinal Study of Handgun Ownership and Transfer (LongSHOT). METHODS Using probabilistic matching techniques we linked three sources of individual-level, state-wide data in California: official voter registration records, an archive of lawful handgun transactions and all-cause mortality data. There were nearly 28.8 million unique voter registrants, 5.5 million handgun transfers and 3.1 million deaths during the study period (18 October 2004 to 31 December 2016). The linkage relied on several identifying variables (first, middle and last names; date of birth; sex; residential address) that were available in all three data sets, deploying them in a series of bespoke algorithms. RESULTS Assembly of the LongSHOT cohort commenced in January 2016 and was completed in March 2019. Approximately three-quarters of matches identified were exact matches on all link variables. The cohort consists of 28.8 million adult residents of California followed for up to 12.2 years. A total of 1.2 million cohort members purchased at least one handgun during the study period, and 1.6 million died. CONCLUSIONS Three steps taken early may be particularly useful in enhancing the efficiency of large-scale data linkage: thorough data cleaning; assessment of the suitability of off-the-shelf data linkage packages relative to bespoke coding; and careful consideration of the minimum sample size and matching precision needed to support rigorous investigation of the study questions.
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Affiliation(s)
- Yifan Zhang
- Medicine, Stanford University, Stanford, California, USA
| | | | - Lea Prince
- Medicine, Stanford University, Stanford, California, USA
| | | | - Sonja A Swanson
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Matthew M Miller
- Health Sciences, Bouvé College of Health Sciences, Boston, Massachusetts, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, UC Davis, Sacramento, California, USA
| | - David M Studdert
- Medicine, Stanford University, Stanford, California, USA .,Stanford Law School, Stanford University, Stanford, California, USA
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31
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Gearhart MC, Berg KA, Jones C, Johnson SD. Fear of Crime, Racial Bias, and Gun Ownership. HEALTH & SOCIAL WORK 2019; 44:241-248. [PMID: 31665433 DOI: 10.1093/hsw/hlz025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Firearm-related violence is a significant threat to public health and safety in America. However, research highlights a critical disparity in firearm-related deaths by race. Researchers often cite racial bias as a contributing factor for the racial disparity in firearm-related deaths. To provide a foundation for potential social work interventions, the present article discusses the results of an assessment of whether explicit racial biases toward four racial and ethnic groups (white, black, Asian, Hispanic/Latino), fear of crime, and the quantity and quality of interactions with neighbors of a different race are predictors of gun ownership. Findings suggest that explicit racial bias toward black, Asian, and Hispanic/Latino individuals is a significant predictor of gun ownership. Fear of crime and more frequent interactions with neighbors of a different race are also significant predictors of gun ownership. Taken as a whole, findings suggest that gun owners are more likely to be more vigilant toward people of color because of stereotypical assumptions that racial and ethnic minorities are more likely to be involved with crime. Social work practice and policy implications include developing interventions aimed at reducing implicit bias and identifying policies that are associated with lower levels of implicit bias among gun owners.
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Schmidt CJ, Rupp L, Pizarro JM, Lee DB, Branas CC, Zimmerman MA. Risk and protective factors related to youth firearm violence: a scoping review and directions for future research. J Behav Med 2019; 42:706-723. [PMID: 31367936 PMCID: PMC8682918 DOI: 10.1007/s10865-019-00076-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022]
Abstract
To conduct our scoping review of risk and protective factors for firearm violence among youth, we searched PubMed, Scopus, EMBASE, and Criminal Justice Abstracts for English-language research articles published between January 1985 and May 2018. We included studies of modifiable risk or protective factors associated with intentional (including suicide) or unintentional firearm victimization or perpetration with samples that included youth ≤ 17. Among the 28 included studies, 15 explored risk/protective factors for victimization, five focused on perpetration, five did not differentiate between victimization and perpetration, and five focused on suicide. Most studies examined individual-level risk factors. The few that explored factors beyond the individual were limited by methodological weaknesses and inconsistent findings. Protective factors for youth firearm outcomes were understudied. We need more research on youth firearm violence using longitudinal data and robust statistical methods. Future research is needed to understand the underlying mechanisms by which risk/protective factors influence firearm violence.
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Affiliation(s)
- Carissa J. Schmidt
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laney Rupp
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Jesenia M. Pizarro
- Arizona State University, School of Criminology and Criminal Justice, 411 N. Central Ave. Ste. 600, Phoenix, AZ 85004
| | - Daniel B. Lee
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Charles C. Branas
- Columbia Mailman School of Public Health, Department of Epidemiology, 722 W. 168th St., New York, NY 10032
| | - Marc A. Zimmerman
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
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33
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Junuzovic M, Rietz A, Jakobsson U, Midlöv P, Eriksson A. Firearm deaths in Sweden. Eur J Public Health 2019; 29:351-358. [PMID: 30060182 DOI: 10.1093/eurpub/cky137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sweden's firearm legislation obligates physicians to report patients that are deemed unsuitable to possess a firearm. This study aimed to explore the involvement of firearm use in firearm fatalities and to evaluate physician reporting concerning cases of firearm deaths. METHODS Fatal firearm suicides and homicides in Sweden were studied for the years 2012-2013, accidental deaths and undetermined manner of deaths for the period 1987-2013. Police reports and autopsy protocols were collected from the National Board of Forensic Medicine, health care data in 1 year before the fatality from the National Board of Health, and information about physician reports and firearm licences from the Swedish Police. RESULTS A total of 291 firearm deaths (213 suicides, 52 accidental deaths, 23 solved homicides and 3 cases with undetermined manner of death) were identified. Firearm suicides were positively correlated with the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in homicides. No suicide victim or shooter in an accidental death was previously reported by a physician to the police according to the firearm law. The majority of the shooters in accidental deaths and suicides had no registered health care visits. Less than half (42%) of all suicide victims had a previous health care contact due to mental health problems. CONCLUSIONS Not one single suicide victim nor any shooter in accidental deaths in the present study had been reported according to the firearm law, bringing the evidence of a suboptimal framework.
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Affiliation(s)
- M Junuzovic
- Section of Forensic Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - A Rietz
- Section of Forensic Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - U Jakobsson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - P Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - A Eriksson
- Section of Forensic Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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34
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Eastern Association for the Surgery of Trauma firearm injury prevention statement. Trauma Surg Acute Care Open 2019; 4:e000294. [PMID: 30899800 PMCID: PMC6407542 DOI: 10.1136/tsaco-2018-000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 11/04/2022] Open
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35
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Eastern Association for the Surgery of Trauma Firearm Injury Prevention Statement. J Trauma Acute Care Surg 2019; 86:168-170. [DOI: 10.1097/ta.0000000000002148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Alves-Costa F, Hamilton-Giachritsis C, Christie H, Halligan SL. Self-perception of adaptation among homicidally bereaved individuals following a psychoeducational intervention: a UK longitudinal qualitative study. BMJ Open 2018; 8:e020443. [PMID: 30082343 PMCID: PMC6078228 DOI: 10.1136/bmjopen-2017-020443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Research on homicidal bereavement has focused on postloss impact and coping. Less is known about how individuals perceive their adjustment posthomicide. Adverse experiences are likely to leave individuals with an increased risk of developing severe psychological difficulties, such as depression, Post-traumatic stress (PTSD), anxiety and complicated grief. This study aimed to explore how individuals perceive their change and progression posthomicide and post-psychoeducational intervention. DESIGN Semistructured qualitative interviews were conducted both as part of a prospective study and retrospectively to allow for a longer follow-up period. SETTING Homicidally bereaved individuals who participated in a residential psychoeducational intervention offered by a national charity (Escaping Victimhood (EV)). PARTICIPANTS Twenty-nine individuals (mainly females) took part: 14 as part of a 6-9-month follow-up (short-term trajectory group (STG) individuals-mean age 45.25) and 15 individuals (long-term trajectory group (LTG) individuals-mean age 48.50), retrospectively, 2 to 5 years postintervention. RESULTS Interviews were analysed using an inductive Thematic Analysis method. Three main themes and nine subthemes emerged, and applied to both groups, as follows: (1) actual changes perceived by the participants (increased understanding, improved coping strategies and positive self-change), (2) barriers to recovery (severe psychological difficulties over time, need for further support, reminders and close relationships with both victim and perpetrator), and finally perceived future progression (living day by day, hope and hopelessness). The only significant differences between the two groups related to the reported self-growth among LTG individuals and the perceived increased informal support among STG individuals by keeping in touch in other EV participants. CONCLUSION This unique study provides insight into how homicidally bereaved individuals perceive their bereavement paths and helped to identify elements that appear to contribute for their adjustment. Importantly, it has highlighted that positive changes can also be an outcome.
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Affiliation(s)
| | | | - Hope Christie
- Department of Psychology, University of Bath, Bath, UK
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37
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Pear VA, Castillo-Carniglia A, Kagawa RM, Cerdá M, Wintemute GJ. Firearm mortality in California, 2000–2015: the epidemiologic importance of within-state variation. Ann Epidemiol 2018; 28:309-315.e2. [DOI: 10.1016/j.annepidem.2018.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
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Kim J. Beyond the trigger: The mental health consequences of in-home firearm access among children of gun owners. Soc Sci Med 2018; 203:51-59. [PMID: 29237560 PMCID: PMC5924443 DOI: 10.1016/j.socscimed.2017.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/07/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022]
Abstract
RATIONALE The high prevalence of household firearms in the U.S. has ignited a growing body of research seeking to understand its health consequences. While a large number of studies examine the impact of firearm availability on health risks of gun owners in the household, relatively little attention is given to whether and how in-home firearm access may shape psychological outcomes among children of gun owners. OBJECTIVE This study examined whether and how in-home firearm access is associated with adolescents' depressive symptoms. Given a strong social/cultural association between masculinity and gun possession as well as stark gender differences in perceptions of safety and attitudes toward firearms, this study also investigated whether this association differs for male and female adolescents. METHODS Participants were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (n = 14,013). This study used random- and fixed-effects regression analyses as well as propensity-score matching models in order to reduce the chances of bias due to individual-level heterogeneity. RESULTS The present study showed that gaining access to guns at home was significantly related to increased depressive symptoms among children of gun owners, even after accounting for both observed and unobserved individual characteristics. Both fixed-effects and propensity-score matching models yielded consistent results. In addition, the observed association between in-home firearm access and depression was more pronounced for female adolescents. Finally, this study found suggestive evidence that the perceptions of safety, especially about school (but not neighborhood), are an important mechanism linking in-home firearm access to adolescent depression. CONCLUSION As a substantial proportion of U.S. adolescents reported in-home firearm access, the findings of this study suggest that scholars and policymakers must seriously consider mental as well as physical health consequences related to household access to firearms among children of gun owners.
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Affiliation(s)
- Jinho Kim
- Department of Sociology, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA.
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39
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Lachaud J, Donnelly PD, Henry D, Kornas K, Calzavara A, Bornbaum C, Rosella L. A population-based study of homicide deaths in Ontario, Canada using linked death records. Int J Equity Health 2017; 16:133. [PMID: 28738872 PMCID: PMC5525348 DOI: 10.1186/s12939-017-0632-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022] Open
Abstract
Background Homicide – a lethal expression of violence – has garnered little attention from public health researchers and health policy makers, despite the fact that homicides are a cause of preventable and premature death. Identifying populations at risk and the upstream determinants of homicide are important for addressing inequalities that hinder population health. This population-based study investigates the public health significance of homicides in Ontario, Canada, over the period of 1999–2012. We quantified the relative burden of homicides by comparing the socioeconomic gradient in homicides with the leading causes of death, cardiovascular disease (CVD) and neoplasm, and estimated the potential years of life lost (PYLL) due to homicide. Methods We linked vital statistics from the Office of the Registrar General Deaths register (ORG-D) with Census and administrative data for all Ontario residents. We extracted all homicide, neoplasm, and cardiovascular deaths from 1999 to 2012, using International Classification of Diseases codes. For socioeconomic status (SES), we used two dimensions of the Ontario Marginalization Index (ON-Marg): material deprivation and residential instability. Trends were summarized across deprivation indices using age-specific rates, rate ratios, and PYLL. Results Young males, 15–29 years old, were the main victims of homicide with a rate of 3.85 [IC 95%: 3.56; 4.13] per 100,000 population and experienced an upward trend over the study period. The socioeconomic neighbourhood gradient was substantial and higher than the gradient for both cardiovascular and neoplasms. Finally, the PYLL due to homicide were 63,512 and 24,066 years for males and females, respectively. Conclusions Homicides are an important cause of death among young males, and populations living in disadvantaged neighbourhoods. Our findings raise concerns about the burden of homicides in the Canadian population and the importance of addressing social determinants to address these premature deaths. Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0632-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James Lachaud
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Peter D Donnelly
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Public Health Ontario, Santé publique Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - David Henry
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Institute for Clinical Evaluative Sciences (ICES), G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Andrew Calzavara
- Institute for Clinical Evaluative Sciences (ICES), G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Catherine Bornbaum
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, Elborn College, Room 2200, London, ON, N6A 1H1, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada. .,Public Health Ontario, Santé publique Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada. .,Institute for Clinical Evaluative Sciences (ICES), G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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40
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Geier DA, Kern JK, Geier MR. A longitudinal ecological study of household firearm ownership and firearm-related deaths in the United States from 1999 through 2014: A specific focus on gender, race, and geographic variables. Prev Med Rep 2017; 6:329-335. [PMID: 28451519 PMCID: PMC5403795 DOI: 10.1016/j.pmedr.2017.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 11/07/2022] Open
Abstract
Firearms have a longstanding tradition in the United States (US) and are viewed by many with iconic stature with regards to safety and personal freedom. Unfortunately, from a public health point of view, firearm-related deaths (FRDs) in the US have reached a crisis point with an estimated > 31,000 deaths and 74,000 nonfatal injuries resulting from firearms each year. This longitudinal ecological study analyzed variations in FRDs following firearm assaults (FAs) and law enforcement incidents involving a firearm (LEIF) in comparison to variations in household firearm ownership (HFO) among different geographic and demographic groups in the US from 1999 to 2014. The Underlying Cause of Death database was examined on the CDC Wonder online interface. Records coded with ICD-10 codes: FA (X93 – assault by handgun discharge, X94 – assault by rifle, shotgun, and larger firearm discharge, or X95 – assault by other and unspecified firearm discharge) and LEIF (Y35.0) were examined, and the prevalence of HFO was determined using the well-established proxy of the percentage of suicides committed with a firearm. Gender, ethnicity, Census Division, and urbanization significantly impacted the death rates from FA and LEIF. Significant direct correlations between variations in HFO and death rates from FAs and LEIF were observed. Understanding the significant impacts of gender, race, Census Division, and urbanization status may help shape future public health policy to promote increased firearm safety.
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Affiliation(s)
- David A Geier
- The Institute of Chronic Illnesses, Inc., 14 Redgate Ct, Silver Spring, MD 20905, USA.,CoMeD, Inc., 14 Redgate Ct, Silver Spring, MD 20905, USA
| | - Janet K Kern
- The Institute of Chronic Illnesses, Inc., 14 Redgate Ct, Silver Spring, MD 20905, USA.,CoMeD, Inc., 14 Redgate Ct, Silver Spring, MD 20905, USA.,CONEM US Autism Research Group, 408 N Allen Dr., Allen, TX 75013, USA
| | - Mark R Geier
- The Institute of Chronic Illnesses, Inc., 14 Redgate Ct, Silver Spring, MD 20905, USA.,CoMeD, Inc., 14 Redgate Ct, Silver Spring, MD 20905, USA
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Bachier-Rodriguez M, Freeman J, Feliz A. Firearm injuries in a pediatric population: African-American adolescents continue to carry the heavy burden. Am J Surg 2017; 213:785-789. [DOI: 10.1016/j.amjsurg.2016.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/08/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
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Abstract
Firearm injury is a leading cause of death and injury for children and adolescents, able to cause disability and interfere with normal development. Child developmental stages, variance of behavior, and mental health may all put children at risk for firearm injury or lead to increased morbidity after experiencing firearm violence. Family, community, and contextual factors can accentuate the risk of violence. Adults and social structures have the responsibility to protect children and adolescents from firearm violence.
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Affiliation(s)
- Judy Schaechter
- Department of Pediatrics, University of Miami Miller School of Medicine and Holtz Children's Hospital at Jackson Health Systems, 1601 Northwest 12th Avenue, Miami, FL 33136, USA.
| | - Patricia G Alvarez
- Department of Pediatrics, University of Miami Miller School of Medicine and Holtz Children's Hospital at Jackson Health Systems, 1601 Northwest 12th Avenue, Miami, FL 33136, USA
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Mekawi Y, Bresin K. Is the evidence from racial bias shooting task studies a smoking gun? Results from a meta-analysis. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2015. [DOI: 10.1016/j.jesp.2015.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wintemute GJ. Alcohol misuse, firearm violence perpetration, and public policy in the United States. Prev Med 2015; 79:15-21. [PMID: 25937594 DOI: 10.1016/j.ypmed.2015.04.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/24/2015] [Accepted: 04/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Firearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings. METHOD Narrative review augmented by new tabulations of publicly-available data. RESULTS Acute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence. CONCLUSION The evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated.
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Affiliation(s)
- Garen J Wintemute
- University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 95817, USA.
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Monuteaux MC, Lee LK, Hemenway D, Mannix R, Fleegler EW. Firearm Ownership and Violent Crime in the U.S.: An Ecologic Study. Am J Prev Med 2015; 49:207-14. [PMID: 26091930 DOI: 10.1016/j.amepre.2015.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although some view the ownership of firearms as a deterrent to crime, the relationship between population-level firearm ownership rates and violent criminal perpetration is unclear. The purpose of this study is to test the association between state-level firearm ownership and violent crime. METHODS State-level rates of household firearm ownership and annual rates of criminal acts from 2001, 2002, and 2004 were analyzed in 2014. Firearm ownership rates were taken from a national survey and crime data were taken from the Federal Bureau of Investigation Uniform Crime Reports. Rates of criminal behavior were estimated as a function of household gun ownership using negative binomial regression models, controlling for several demographic factors. RESULTS Higher levels of firearm ownership were associated with higher levels of firearm assault and firearm robbery. There was also a significant association between firearm ownership and firearm homicide, as well as overall homicide. CONCLUSIONS The findings do not support the hypothesis that higher population firearm ownership rates reduce firearm-associated criminal perpetration. On the contrary, evidence shows that states with higher levels of firearm ownership have an increased risk for violent crimes perpetrated with a firearm. Public health stakeholders should consider the outcomes associated with private firearm ownership.
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Affiliation(s)
| | - Lois K Lee
- Boston Children's Hospital, Boston, Massachusetts
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Rudolph KE, Stuart EA, Vernick JS, Webster DW. Association Between Connecticut's Permit-to-Purchase Handgun Law and Homicides. Am J Public Health 2015; 105:e49-54. [PMID: 26066959 DOI: 10.2105/ajph.2015.302703] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to estimate the effect of Connecticut's implementation of a handgun permit-to-purchase law in October 1995 on subsequent homicides. METHODS Using the synthetic control method, we compared Connecticut's homicide rates after the law's implementation to rates we would have expected had the law not been implemented. To estimate the counterfactual, we used longitudinal data from a weighted combination of comparison states identified based on the ability of their prelaw homicide trends and covariates to predict prelaw homicide trends in Connecticut. RESULTS We estimated that the law was associated with a 40% reduction in Connecticut's firearm homicide rates during the first 10 years that the law was in place. By contrast, there was no evidence for a reduction in nonfirearm homicides. CONCLUSIONS Consistent with prior research, this study demonstrated that Connecticut's handgun permit-to-purchase law was associated with a subsequent reduction in homicide rates. As would be expected if the law drove the reduction, the policy's effects were only evident for homicides committed with firearms.
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Affiliation(s)
- Kara E Rudolph
- Kara E. Rudolph is with the School of Public Health, University of California, Berkeley; Center for Health and Community, University of California, San Francisco; and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Elizabeth A. Stuart is with the Departments of Mental Health and Biostatistics, Bloomberg School of Public Health. Jon S. Vernick and Daniel W. Webster are with the Center for Gun Policy and Research, Bloomberg School of Public Health
| | - Elizabeth A Stuart
- Kara E. Rudolph is with the School of Public Health, University of California, Berkeley; Center for Health and Community, University of California, San Francisco; and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Elizabeth A. Stuart is with the Departments of Mental Health and Biostatistics, Bloomberg School of Public Health. Jon S. Vernick and Daniel W. Webster are with the Center for Gun Policy and Research, Bloomberg School of Public Health
| | - Jon S Vernick
- Kara E. Rudolph is with the School of Public Health, University of California, Berkeley; Center for Health and Community, University of California, San Francisco; and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Elizabeth A. Stuart is with the Departments of Mental Health and Biostatistics, Bloomberg School of Public Health. Jon S. Vernick and Daniel W. Webster are with the Center for Gun Policy and Research, Bloomberg School of Public Health
| | - Daniel W Webster
- Kara E. Rudolph is with the School of Public Health, University of California, Berkeley; Center for Health and Community, University of California, San Francisco; and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Elizabeth A. Stuart is with the Departments of Mental Health and Biostatistics, Bloomberg School of Public Health. Jon S. Vernick and Daniel W. Webster are with the Center for Gun Policy and Research, Bloomberg School of Public Health
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Carter PM, Walton MA, Roehler DR, Goldstick J, Zimmerman MA, Blow FC, Cunningham RM. Firearm violence among high-risk emergency department youth after an assault injury. Pediatrics 2015; 135:805-15. [PMID: 25847808 PMCID: PMC4411782 DOI: 10.1542/peds.2014-3572] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The risk for firearm violence among high-risk youth after treatment for an assault is unknown. METHODS In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months). RESULTS A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22). CONCLUSIONS High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;
| | - Maureen A Walton
- University of Michigan Injury Center, Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Douglas R Roehler
- University of Michigan Injury Center, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jason Goldstick
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and
| | - Marc A Zimmerman
- University of Michigan Injury Center, Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Frederic C Blow
- University of Michigan Injury Center, University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; National Serious Mental Illness Treatment, Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; and
| | - Rebecca M Cunningham
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
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Siegel M, Negussie Y, Vanture S, Pleskunas J, Ross CS, King C. The relationship between gun ownership and stranger and nonstranger firearm homicide rates in the United States, 1981-2010. Am J Public Health 2014; 104:1912-9. [PMID: 25121817 DOI: 10.2105/ajph.2014.302042] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relationship between gun ownership and stranger versus nonstranger homicide rates. METHODS Using data from the Supplemental Homicide Reports of the Federal Bureau of Investigation's Uniform Crime Reports for all 50 states for 1981 to 2010, we modeled stranger and nonstranger homicide rates as a function of state-level gun ownership, measured by a proxy, controlling for potential confounders. We used a negative binomial regression model with fixed effects for year, accounting for clustering of observations among states by using generalized estimating equations. RESULTS We found no robust, statistically significant correlation between gun ownership and stranger firearm homicide rates. However, we found a positive and significant association between gun ownership and nonstranger firearm homicide rates. The incidence rate ratio for nonstranger firearm homicide rate associated with gun ownership was 1.014 (95% confidence interval=1.009, 1.019). CONCLUSIONS Our findings challenge the argument that gun ownership deters violent crime, in particular, homicides.
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Affiliation(s)
- Michael Siegel
- Michael Siegel, Yamrot Negussie, Sarah Vanture, and Jane Pleskunas are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Craig S. Ross is with Virtual Media Resources, Natick, MA. Charles King III is with Greylock McKinnon Associates, Cambridge, MA, and Pleiades Consulting Group, Lincoln, MA
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Jena AB, Sun EC, Prasad V. Does the declining lethality of gunshot injuries mask a rising epidemic of gun violence in the United States? J Gen Intern Med 2014; 29:1065-9. [PMID: 24452421 PMCID: PMC4061370 DOI: 10.1007/s11606-014-2779-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/27/2013] [Accepted: 01/12/2014] [Indexed: 11/27/2022]
Abstract
Recent mass shootings in the U.S. have reignited the important public health debate concerning measures to decrease the epidemic of gun violence. Editorialists and gun lobbyists have criticized the recent focus on gun violence, arguing that gun-related homicide rates have been stable in the last decade. While true, data from the U.S. Centers for Disease Control and Prevention also demonstrate that although gun-related homicide rates were stable between 2002 and 2011, rates of violent gunshot injuries increased. These seemingly paradoxical trends may reflect the declining lethality of gunshot injuries brought about by surgical advances in the care of the patient with penetrating trauma. Focusing on gun-related homicide rates as a summary statistic of gun violence, rather than total violent gunshot injuries, can therefore misrepresent the rising epidemic of gun violence in the U.S.
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Affiliation(s)
- Anupam B. Jena
- />Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
- />Department of Medicine, Massachusetts General Hospital, Cambridge, MA USA
- />National Bureau of Economic Research, Cambridge, MA USA
| | - Eric C. Sun
- />Department of Anesthesia, Stanford University Hospitals, Stanford, CA 94305 USA
| | - Vinay Prasad
- />Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 10 Center Dr. 10/12 N226, Bethesda, MD 20892 USA
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