Toward a clearer understanding of what works to reduce gun violence: the role of falsification strategies

Strong epidemiologic evidence from ecologic and individual-level studies in the United States supports the claim that access to firearms substantially increases the risk of dying by suicide, homicide, and firearm accidents. Less certain is how well particular interventions work to prevent these deaths and other firearm-related harms. Given the limits of existing data to study firearm violence, and the infeasibility of conducting randomized trials of firearm access, it is important to do the best we can with the data we already have. We argue that falsification strategies are a critical - yet underutilized - component of any such analytic approach. The falsification strategies we focus on are versions of "negative controls" analyses in which we expect an analysis should yield a null causal effect, and thus where not obtaining a null effect estimate raises questions about the assumptions underlying causal interpretation of a study's findings. We illustrate the saliency of this issue today with examples drawn from studies published within the last five years in leading peer-reviewed journals. Collecting rich, high-quality data always takes time, urgent as the need may be. On the other hand, doing better with the data we already have can start right now.

Gaining masculine power through guns? The impact of masculinity threat on attitudes toward guns

Gun violence is a serious problem in the United States and elsewhere and more so among men than women. We conducted an experiment to examine if men whose masculinity was threatened are more attracted to guns than non-threatened men, presumably to compensate for the threat. After completing a gender knowledge test, men (N = 168) randomly received either false masculinity threatening (experimental condition) or masculinity affirming (control condition) feedback. Subsequently, we measured men's attitudes toward guns and their choice of a gun-range voucher. Men whose masculinity was threatened (vs. affirmed) showed more positive attitudes toward guns and were more likely to choose the voucher. Both effects were statistically significant when the whole sample was analyzed and when very strict exclusion criteria were applied. However, when data exclusions were based on a suspicion check, effects were statistically significant only when a covariate was included (i.e., social dominance orientation, patriotism, or experience with guns). We discuss reasons for this mixed evidence, including the possibility that suspicion regarding the masculinity feedback could itself be a compensatory reaction to threat.

Impact of Changes to Concealed-Carry Weapons Laws on Fatal and Nonfatal Violent Crime, 1980-2019

The United States faces rapidly rising rates of violent crime committed with firearms. In this study, we sought to estimate the impact of changes to laws that regulate the concealed carrying of weapons (concealed-carry weapons (CCW) laws) on violent crimes committed with a firearm. We used augmented synthetic control models and random-effects meta-analyses to estimate state-specific effects and the average effect of adopting shall-issue CCW permitting laws on rates of 6 violent crimes: homicide with a gun, homicide by other means, aggravated assault with a gun, aggravated assault with a knife, robbery with a gun, and robbery with a knife. The average effects were stratified according to the presence or absence of several shall-issue permit provisions. Adoption of a shall-issue CCW law was associated with a 9.5% increase in rates of assault with a firearm during the first 10 years after law adoption and was associated with an 8.8% increase in rates of homicide by other means. When shall-issue laws allowed violent misdemeanants to acquire CCW permits, the laws were associated with higher rates of gun assaults. It is likely that adoption of shall-issue CCW laws has increased rates of nonfatal violent crime committed with firearms. Harmful effects of shall-issue laws are most clear when provisions intended to reduce risks associated with civilian gun-carrying are absent.

Muscle-Building Exercise and Weapon Carrying and Physical Fighting Among U.S. Adolescent Boys

This study aimed to determine the association between engagement in muscle-building exercise and weapon carrying and physical fighting among adolescent boys. Cross-sectional data from the 2019 Youth Risk Behavior Survey (U.S.) were analyzed (N = 4120). Muscle-building exercise was assessed based on the number of days reported in the past 7 days, recategorized into four levels of engagement (no engagement [0 days], low engagement [1-2 days], moderate engagement [3-5 days], and high engagement [6-7 days]). Three forms of weapon carrying (general, on school grounds, gun carrying) and two forms of physical fighting (general, on school grounds) were assessed. Five logistic regression analyses with adjusted odds ratios (AOR) and 95% confidence intervals (CI) were used to determine the association between engagement in muscle-building exercise and weapon carrying and physical fighting, while adjusting for relevant demographic and control variables. Over 75% of participants reported engaging in muscle-building exercise. One in five (19.8%) participants reported any general weapon carrying in the past 30 days, 3.3% reported any weapon carrying at school in the past 30 days, 6.5% reported any gun carrying in the past 12 months, 28.0% reported any general physical fighting in the past 12 months, and 10.7% reported any physical fighting at school in the past 12 months. Logistic regressions showed that, compared to no engagement, participants who reported high engagement of muscle-building exercise had higher odds of general weapon carrying (AOR 2.18, 95% CI 1.54-3.07), gun carrying (AOR 2.12, 95% CI 1.23-3.64), and general physical fighting (AOR 2.07, 95% CI 1.53-2.79). These are novel findings that add to a growing literature related to engagement in muscularity-oriented behaviors among males. Prevention and intervention efforts are needed to ensure that adolescent boys engage in muscle-building exercise in ways that are not harmful and to reduce weapon carrying and physical fighting.

Psychiatric disorders among employment requiring firearms

Individuals who carry guns as a requirement of employment frequently experience hazards that can be stress inducing, violent, traumatizing, or cause personal injury. This study used data from the Collaborative Psychiatric Epidemiological Surveys (CPES; n = 20,013), to examine mental health diagnoses of individuals that ever worked at a job requiring a firearm. Consistent with existing literature, the findings indicated that those who worked in professions requiring a firearm showed similar risk of mental health diagnoses as law enforcement officers which includes symptoms of trauma, mood disorders, and alcohol use. Further, race/ethnic differences emerged in patterns of mental health diagnoses, suggesting sociocultural differences influence diagnoses. These findings indicate the necessity for further investigation of the understudied area of mental health of those within employment positions that require firearms.

Parental Perceptions of Their Children's Access to Household Firearms

OBJECTIVES

To provide a nationally representative estimate of the proportion of gun owners who report a child has independent access to one of their guns, and to describe characteristics of these gun owners relative to other gun-owning parents.

STUDY DESIGN

We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of US adults in households with firearms (n = 4030, response 65%). The sample comprised gun-owning respondents living in homes with children (n = 689) who were asked questions about their firearms, including how they were stored, and about who other than themselves had access to their guns: "If you were not there, who in your household could get one of your guns (and load it if it is not loaded already) if they needed to?"

RESULTS

Twelve percent of US gun owners in homes with children report that a child has independent access to one of their guns (about one-fifth of those having children under age 12 years only). Gun owners who reported child access were more likely than those who reported no child access to store guns, unlocked and loaded, but still one-fifth of those reporting access, stored all guns locked and unloaded.

CONCLUSIONS

We find that more than 10% of gun owners with children report that a child can independently access one of their guns, including parents who store all guns locked and unloaded; suggesting that guidance to parents should focus on access in addition to firearm storage.

Should we be paying more attention to firearm threats in ex-partner stalking cases?

This study examined relationship abuse, firearm threats, and threat credibility factors as well as help-seeking for (ex)partner-stalking victims with partners who did (n = 153) and did not own guns (n = 263). Victims with (ex)partners who owned guns experienced increased coercive control and physical violence, a longer duration of stalking, and more threats during the relationship and during the course of stalking. Victims reported that (ex)partner gun owners had more extremist beliefs and other risk factors, and more of them believed their (ex)partner was extremely capable of harming them. Most, regardless of partner gun ownership, turned to informal sources of help, while about one-quarter of victims whose partners did not own guns tried to obtain a protective order or talked to police, compared to about 40% of stalking victims with abusers who owned guns. Fear of harm from guns, coercive control during the relationship, and believing their partner was capable of harming harm them were all associated with an increased number of help-seeking sources whereas being threatened with a firearm and abuser gun ownership were not.

The Influence of Structural Characteristics and Street Codes on Violent Female Offenders: A Decade After Anderson's Initial Observations

A large number of studies have examined predictors of female crime quantities yet considerably less attention has been directed toward exploring patterns in the nature or quality of female violence within and across communities. Although research consistently demonstrates that females engage in less criminal behavior than males, research on the variability across contexts is somewhat sparse. The authors conduct analyses to determine if Anderson's initial observations of female violence in neighborhoods inundated with the code of the streets persist a decade after his initial ethnographic account. Specifically, we examine incident-level data from the National Incident Based Reporting System with contextual-level data on the cities in which the incidents occurred. We use hierarchical linear and nonlinear modeling techniques to explore variations in predictors of offender gun use and extent of victim injury in violent female encounters. Supporting Anderson's initial accounts for street females and prior research we find the probability of gun usage and level of victim injury is not significantly influenced by differences in community context, and specifically not exacerbated by the types of conditions that make the code of the street locally salient.

Gun ownership, community stress, and sleep disturbance in America

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.

Sexual Dysfunction and Gun Ownership in America: When Hard Data Meet a Limp Theory

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.

Suicide prevention and mood disorders: Self-exclusion agreements for firearms as a suicide prevention strategy

Suicide involves a complex set of behaviors and emotions that lead up to actions that may be based on planning and forethought or the result of impulse. While there are a host of antecedent circumstances the presence of a mood disorder, primarily depression, is the most common factor in suicide. While management of depression is recognized as important prevention strategy in depression, the means by which suicide occurs must be a critical element of prevention. Policies that lower access to the means for suicide will decrease the fatality. Guns are associated with half of suicides and the case fatality rate of gun associated suicide is over 90% compared to 7% for all other means. This emphasizes the importance of offering strategies that limit access to guns to those at higher risk for suicide. A declaration of formal self-exclusion for access to firearms (guns and ammunition) offers the individual at greater risk for suicide to place themselves on an official list that would prevent them from purchasing lethal weapons. A person with depression, when well, might wish to enroll voluntarily to prevent themselves, when ill, from procuring a weapon to harm themselves or others. This recognizes the autonomy of the person and protects both the individual, the family, and society.

County Variation in Intimate Partner Homicide: A Comparison of Hispanic and Non-Hispanic Victims

Over the past 5 years, intimate partner homicides have increased among Hispanic women, although ethnicity has rarely been brought into macro-level research on intimate partner homicide. These trends have occurred alongside many macro-level changes in the United States. Although both Hispanic and non-Hispanic women are most likely to die at the hands of a partner via a firearm, no study to date has examined the importance of licensed firearm dealer availability in addition to leading macro-level correlates of intimate partner homicide. Using data from the Centers for Disease Control and Prevention's National Violent Death Reporting System, the current study explores the role of licensed firearm dealer availability, economic disadvantage, and other features of counties to explore ethnic-specific variation in intimate partner homicides from 2010 to 2016. Results from multilevel negative binomial models revealed consistency in the estimated effects of the rate of licensed firearm dealers and divorce on partner homicides across all models, although the significant association of gun stores and intimate partner homicide was witnessed in urban counties for total and non-Hispanic (both Black and White) models only. Important variation also exists across racial and ethnic groups, including well-established correlates of overall intimate partner homicide (i.e., economic disadvantage, rurality, non-intimate homicide rate, and state policies).

Promoting the Public's Health with Personal Commitment and Gun Safety Policies

The high level of gun violence in the United States is unique. Self-harm is the leading reason for death from a gun in the white population, and homicide is the leading reason for death from a gun in the Black population. Because three-quarters of gun owners say they could never see themselves not owning a gun, and half of gun owners say owning a gun is important to their overall identity, the path to reducing deaths and other harm from guns is narrow and must be tread with knowledge and skill. The experience of other countries and that of states like Connecticut and Indiana is evidence that gun safety laws - in particular, universal background checks and extreme risk protection orders - can reduce deaths and injury due to gun violence. Safe storage for firearms, preferably out of the home, also reduces the risk of death and injury from guns. The goal of this article, after briefly describing the intensity and causes of gun violence in the United States, is to give the reader some basic tools to become an effective advocate for gun safety and gun violence reduction.

Sexual and Gender Minority Status and Firearms in the Household: Findings From the 2017 Behavioral Risk Factor Surveillance System Surveys, California and Texas

OBJECTIVES

Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked.

METHODS

We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design.

RESULTS

Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation.

CONCLUSIONS

Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.

Firearm ownership among young adults: Associations with impulsivity and impulse control disorders

BACKGROUND

Firearm ownership is extremely common in parts of the United States. Yet little research has examined whether it is associated with impulsive symptoms and traits.

METHODS

Adults age 18 to 29 who gamble at least occasionally were recruited in 2 cities in the United States using media advertisements for an exploratory study examining general mental health, impulse control disorders, impulsive personality, and aspects of cognition (decision-making, response inhibition, and flexible responding). The participants were grouped as firearm owners and non-firearm owners; these 2 groups were compared on the above measures.

RESULTS

For this study, 149 young adults took part, of whom 33 (22.1%) endorsed owning ≥1 firearm. Firearm ownership was significantly associated with male gender and elevated risk of gambling disorder, but not with other measures of impulsivity.

CONCLUSIONS

The link between firearm ownership and disordered gambling merits further research and may have policy implications, such as in terms of screening for guns in gambling arenas, including casinos. Further research is needed to explore potential associations between gun ownership and impulsivity in cohorts with other demographic characteristics, including longitudinally.

Protective Gun Ownership as a Coping Mechanism

Firearms are one of the central flashpoints in American life, and yet the motivations underlying their ownership have been generally understudied by psychologists. In this article, I review work from across the social sciences to model the psychological utility that people get from gun ownership. I propose the coping model of protective gun ownership and argue that those who own their weapon for protection are using their gun symbolically as an aid to manage psychological threats-to their safety, control, and sense of belongingness-that come from their belief that the world is a dangerous place and that society will not keep them safe. I discuss the ramifications of this coping strategy and present a research agenda for exploring this framework.

International Student Perceptions of American Gun Culture and School Shootings: A Public Health Examination

A shooting in an American education institution quickly creates a global ripple effect, due to the large number of international students enrolled in American secondary schools and higher education institutions. International students studying in the United States may offer unique insight into local and global perceptions of American gun culture, highlight the transnational physical, emotional, and psychological impact of gun violence, and offer fresh understandings about the American gun violence public health problem. A qualitative research study was conducted at The University of California, Los Angeles (UCLA) that included focus groups and in-depth interviews of students from China and India. These nations represent the largest American international student populations. The study included a random sampling methodology. Findings show that gun violence in American schools is a major concern for prospective international students and their families. While concerns about targeted-shootings diminish, students develop behaviors that indicate a pervasive fear of indiscriminate attacks (e.g., mass shootings and petty crime), such as avoidance of large public gatherings and traveling in groups for safety. They also question university campuses' unfettered visitor access and remain perplexed by the ease of gun access in America, which they directly attribute to causing America's gun violence problem. Social and mass media play large roles in perception-building processes by supplying accurate and real-time as well as fake or misleading information. However, divergent viewpoints emerge among family members concerned for their overseas relatives' safety while international students develop more refined perspectives.

Political Beliefs, Region of Residence, and Openness to Firearm Means Safety Measures to Prevent Suicide

Firearms account for approximately half of all suicides in the United States and are highly lethal, widely available, and popular; thus, are an ideal candidate for targeted means safety interventions. However, despite their value as a suicide prevention tool, firearm means safety strategies are not widely utilized, possibly due to factors which impede openness to their use. This study examines the relationship between region, political beliefs, and openness to firearm means safety in a sample of 300 American firearm owners. Overall, firearm owners were more willing to engage in means safety for others than for themselves and to store firearms safely than temporarily remove them from the home. Social policy views and region were significantly associated with openness to firearm means safety measures, however, economic policy views were not. This study provides further context for the development and implementation of efficacious means safety measures capable of overcoming potential barriers to their use.

Screening for Access to Firearms by Pediatric Trainees in High-Risk Patients

OBJECTIVE

Access to firearms is an independent risk factor for completed suicide and homicide, and the American Academy of Pediatrics recommends that pediatricians screen and counsel about firearm access and safe storage. This study investigates how often pediatric residents screen for access to firearms or counsel about risk-reduction in patients with suicidal or homicidal ideation.

METHODS

Retrospective chart review of visits by patients younger than the age of 19 years presenting to the pediatric emergency department (ED) of a tertiary academic medical center from January to December 2016. Visits were eligible if there was an ultimate ED discharge diagnosis of "suicidal ideation," "suicide attempt," or "homicidal ideation" as identified by International Statistical Classification of Diseases and Related Health Problems, 10th revision codes and the patient was seen by a pediatric resident before evaluation by psychiatry. Descriptive statistics were used to analyze results.

RESULTS

Ninety-eight patients were evaluated by a pediatric resident for medical assessment before evaluation by a psychiatry team during the study period and were therefore eligible for inclusion. Screening for firearm access was documented by a pediatric resident in 5 of 98 (5.1%) patient encounters. Twenty-five patients (25.5%) had no documented screening for firearm access by any provider during the ED visit, including in 5 cases when patients were discharged home.

CONCLUSIONS

Pediatric residents rarely document screening for firearm access in patients with known suicidal or homicidal ideation who present to the ED. Additional understanding of the barriers to screening and potential strategies for improving screening and counseling are critical to providing appropriate care for high-risk pediatric patients.

Gun-related eye injuries: A primer

Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.

Victim Characteristics, Situational Factors, and the Lethality of Urban Gun Violence

The objective of this study is to hone in on the contextual, social, and individual characteristics that influence lethal outcomes across shootings. Although most criminological research focuses on differential outcomes for gun violence relative to nongun violence, we argue that great insight can be drawn through examining shootings in isolation. We focus on five ways that shooting outcomes vary: the number of shots fired, the number of times the victim was hit, where the victim was hit, the number of victims that were hit, and whether the shooting resulted in a fatality. Building on the adversary effects hypothesis and public health research on the impact of gunshot wound volume and location, we examine the factors that account for variation across shooting outcomes. Our analysis of data from the Rochester Shooting Database suggests that both adversary effects and random factors influence shooting outcomes. In addition, the results also reveal that adversary effects are more important during some stages of a shooting than others. The implications of these findings are discussed.

Evaluating small-scale simulation for training firearm safety skills

There is limited research using small-scale simulation in applied behavior analysis. We used small-scale simulation to train firearm safety skills to 3- to 5-year-old children and assessed whether the skills generalized to the natural environment through in situ assessment. Three participants completed the training, and all participants learned the safety skills from simulation training. Two of the participants acquired the safety skills after the first simulation training, and the third participant required one booster training before demonstrating the safety skills in the natural environment.

Managing Conflicts in Urban Communities: Youth Attitudes Regarding Gun Violence

Gun violence remains a pressing public health concern, especially in high-risk urban environments. Community-level violence intervention efforts are being mounted in cities across the United States to prevent and reduce the most severe forms of violence. There is growing evidence to suggest the effectiveness of the Safe Streets Program/ Cure Violence as a community-based intervention to reduce homicides and shootings. The mechanism underlying the reductions in community violence is theorized to be linked with changes in attitudes toward violence as well as shifts in social norms related to violence and retaliation, but there are few tools to assess these domains. This preliminary investigation sought to establish the metric properties of the Survey on Attitudes About Guns and Shootings (SAGAS) with the goal of providing an empirical measure of attitudes and community-level norms. Males aged 18 to 24 were surveyed using the SAGAS in two high-violence communities in Baltimore, Maryland, using street intercept methodology. We found acceptable reliability and validity metrics for the SAGAS. Reliability and validity of the SAGAS were assessed using internal consistency and a latent class analysis with violent behavior outcomes. The internal consistency of the total scale was in the extensive range (α = .70-.79) and the internal consistency of the factors was in the exemplary range (α ≥ .80). In addition, latent classes of attitudes were predictive of being arrested or being shot. Future studies will examine if rates of violence decrease in neighborhoods targeted by the Safe Streets Program and the mediating role of attitudes toward gun violence using the SAGAS.

Nonfatal Gun Use in Intimate Partner Violence: A Systematic Review of the Literature

Guns figure prominently in the homicide of women by an intimate partner. Less is known, however, about their nonfatal use against an intimate partner. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched eight electronic databases and identified 10 original research articles that reported the prevalence of the nonfatal use of firearms against an intimate partner. Results indicate that (1) there is relatively little research on the subject of intimate partners' nonfatal gun use against women. (2) The number of U.S. women alive today who have had an intimate partner use a gun against them is substantial: About 4.5 million have had an intimate partner threaten them with a gun and nearly 1 million have been shot or shot at by an intimate partner. Whether nonfatal gun use is limited to the extreme form of abuse (battering) or whether it occurs in the context of situational violence remains to be seen. Regardless, when it comes to the likely psychological impact, it may be a distinction without a difference; because guns can be lethal quickly and with relatively little effort, displaying or threatening with a gun can create a context known as coercive control, which facilitates chronic and escalating abuse. Implications for policy, practice, and research are discussed, all of which include expanding an implicit focus on homicide to include an intimate partner's nonfatal use of a gun.

Do Weapons Facilitate Adolescent Delinquency? An Examination of Weapon Carrying and Delinquency Among Adolescents

This article examines whether weapon carrying influences the frequency and variety of violent, property, and drug delinquency adolescents commit through fixed-effects analyses of data from the Rochester Youth Development Study (RYDS). We conclude that weapon carrying contributes to violent, substance, and property delinquency, and delinquent behaviors learned during weapon carrying continue to affect substance and property delinquency long after carrying has ceased.

Guns in Intimate Partner Violence: Comparing Incidents by Type of Weapon

Objective: The goal of this study was to assess the frequency, nature, and outcome of weapon use in intimate partner violence (IPV) and to assess compliance with related gun policies.

Methods: Data were drawn from forms police are mandated to complete at the scene of IPV in the fifth largest U.S. city during 2013. Proportions were calculated and odds ratios were adjusted for demographic and contextual characteristics and a Bonferroni correction for multiple statistical tests was applied.

Results: Of the 35,413 incidents, 6,573 involved hands, fists, or feet, and 1,866 involved external weapons of which 576 were guns. Most incidents were male-on-female: 63.4% (no weapon), 77.4% (bodily weapon), 50.2% (nongun external weapon), and 79.5% (gun). Guns were used most often to threaten the partner (69.1%). When a gun (vs. bodily or nongun external weapon) was used, IPV victims were less likely to have visible injuries (adjusted odds ratio [AOR] = 0.64 and 0.23, respectively)—offenders were less likely to have pushed or shoved, grabbed, punched, or kicked the victim—but (victims) were more likely to be frightened (AOR = 3.13 and 1.49, respectively).

Conclusions: Weapon use of any type by an intimate partner is associated with a wide range of violent offender behavior and multiple negative outcomes for victims. The use of a gun has implications that include, but go beyond, physical injury of the victim. Documentation of the enforcement of state law regarding gun removal merits improvement, which has important implications for the evaluation of policies designed to keep guns out of the hands of abusers.

Physicians Asking Patients About Guns: Promoting Patient Safety, Respecting Patient Rights

Recent debate on whether physicians should discuss gun ownership with their patients has centered on determining whether gun injuries are an issue of health or safety, and on protecting patient privacy. Yet, physicians' duties span personal health, public health, and safety spheres, and they often must address private patient matters. To prioritize gun safety and reduce gun injuries, the primary policy-driving question should be: will physician counseling on gun ownership effectively reduce gun-related injuries without interfering with the physician's other treatment obligations or compromising the physician-patient relationship? Existing data on physician-initiated conversations with patients about guns support a positive prevention effect. However, it is critical that physician-initiated discussions of safe gun practices are not motivated by, nor convey, disapproval of gun ownership. To be ethical, respectful, and efficient, the conversation should be standard between primary care providers and all of their patients (not limited to patient subsets); questions and education should be limited to topics of gun-ownership risks and storage practices; and the conversation must be framed without bias against gun ownership.

Are We Missing Something Pertinent? A Bias Analysis of Unmeasured Confounding in the Firearm-Suicide Literature

Despite the magnitude and consistency of risk estimates in the peer-reviewed literature linking firearm availability and suicide, inferring causality has been questioned on the theoretical basis that existing studies may have failed to account for the possibility that members of households with firearms differ from members of households without firearms in important ways related to suicide risk. The current bias analysis directly addresses this concern by describing the salient characteristics that such an unmeasured confounder would need to possess in order to yield the associations between firearm availability and suicide observed in the literature when, in fact, the causal effect is null. Four US studies, published between 1992 and 2003, met our eligibility criteria. We find that any such unmeasured confounder would need to possess an untenable combination of characteristics, such as being not only 1) as potent a suicide risk factor as the psychiatric disorders most tightly linked to suicide (e.g., major depressive and substance use disorders) but also 2) an order of magnitude more imbalanced across households with versus without firearms than is any known risk factor. No such confounder has been found or even suggested. The current study strongly suggests that unmeasured confounding alone is unlikely to explain the association between firearms and suicide.

Decreasing the supply of and demand for guns: Oakland's Youth Advocacy Project

This paper is a case study of how Youth ALIVE!, a nonprofit public health organization, blended direct service and policy goals to reduce youth gun violence at a time when guns became the number one killer of children in California. Youth ALIVE! trained young people living in California communities with the highest rates of gun violence to become peer educators and leaders to reduce both the supply of, and demand for, guns. The youth presented health and criminal justice data in the context of their own experiences living in communities endangered by gun violence to help build public policy solutions, contributing to the subsequent drop in gun homicides. Youth ALIVE's vibrant grassroots model provides a real-life tableau of research and direct services working together to yield realistic policy solutions to a lethal public health problem. The youths' successes demonstrate how nonprofit direct service organizations are uniquely positioned to advocate for policy and regulatory changes that can be beneficial to both program participants and society. Direct service organizations' daily exposure to real-life client needs provides valuable insights for developing viable policies-plus highly motivated advocates. When backed by scientific findings on the causes of the problem, this synergy of youth participant engagement in civil society can promote good policy and build healthy communities.

Prevalence and Correlates of Firearm Ownership in the Homes of Fifth Graders: Birmingham, AL, Houston, TX, and Los Angeles, CA

Firearms in the home are associated with increased injury risk, especially when loaded and unlocked. In this study, 5,010 fifth-graders and their caregivers in three U.S. metropolitan areas participated in the 2004-2006 Healthy Passages study on adolescent health. Firearm ownership and storage patterns were examined by four self-reported sociodemographic characteristics (child's race/ethnicity, child's gender, family socioeconomic status, and study site) and reasons for ownership. Eighteen percent (n = 880) of the families reported firearms in the home. Families with African American and Hispanic children had lower odds of owning firearms than families with non-Hispanic White children. The most common reasons for ownership were protection from crime and hunting. Six percent (n = 56) of the families with firearms stored at least one firearm unlocked, assembled, without a trigger lock, and with unlocked ammunition. Compared with families with non-Hispanic White children, families with African American children engaged in safer storage practices. Results can inform childhood firearm injury prevention activities.

Gun violence trends in movies

BACKGROUND

Many scientific studies have shown that the mere presence of guns can increase aggression, an effect dubbed the "weapons effect." The current research examines a potential source of the weapons effect: guns depicted in top-selling films.

METHODS

Trained coders identified the presence of violence in each 5-minute film segment for one-half of the top 30 films since 1950 and the presence of guns in violent segments since 1985, the first full year the PG-13 rating (age 13+) was used. PG-13-rated films are among the top-selling films and are especially attractive to youth.

RESULTS

Results found that violence in films has more than doubled since 1950, and gun violence in PG-13-rated films has more than tripled since 1985. When the PG-13 rating was introduced, these films contained about as much gun violence as G (general audiences) and PG (parental guidance suggested for young children) films. Since 2009, PG-13-rated films have contained as much or more violence as R-rated films (age 17+) films.

CONCLUSIONS

Even if youth do not use guns, these findings suggest that they are exposed to increasing gun violence in top-selling films. By including guns in violent scenes, film producers may be strengthening the weapons effect and providing youth with scripts for using guns. These findings are concerning because many scientific studies have shown that violent films can increase aggression. Violent films are also now easily accessible to youth (e.g., on the Internet and cable). This research suggests that the presence of weapons in films might amplify the effects of violent films on aggression.

Firearms and suicide in the United States: is risk independent of underlying suicidal behavior?

On an average day in the United States, more than 100 Americans die by suicide; half of these suicides involve the use of firearms. In this ecological study, we used linear regression techniques and recently available state-level measures of suicide attempt rates to assess whether, and if so, to what extent, the well-established relationship between household firearm ownership rates and suicide mortality persists after accounting for rates of underlying suicidal behavior. After controlling for state-level suicide attempt rates (2008-2009), higher rates of firearm ownership (assessed in 2004) were strongly associated with higher rates of overall suicide and firearm suicide, but not with nonfirearm suicide (2008-2009). Furthermore, suicide attempt rates were not significantly related to gun ownership levels. These findings suggest that firearm ownership rates, independent of underlying rates of suicidal behavior, largely determine variations in suicide mortality across the 50 states. Our results support the hypothesis that firearms in the home impose suicide risk above and beyond the baseline risk and help explain why, year after year, several thousand more Americans die by suicide in states with higher than average household firearm ownership compared with states with lower than average firearm ownership.

Bang Bang, You're … NOT Dead and You're … NOT Even Hurt?! Messages Provided by Animated Cartoons about Gun Violence

Relying upon a content analysis of animated cartoons, this study examines the messages provided about gun violence, focusing on the following questions: (1) How prevalent is gun violence in animated cartoons? (2) Has this prevalence changed over time? (3) What characteristics are associated with being a perpetrator of gun violence? (4) What types of effects are shown to result from the perpetration of gun violence? (5) What reasons are given for why cartoon characters use guns? (6) What "types" of characters are victimized by firearms? Results indicate that gun violence is prevalent in cartoons and the prevalence has not diminished over time. Cartoons provide inaccurate information about the characteristics associated with perpetrating or being a victim of gun violence. Oftentimes, the use of firearms is shown to result in no negative consequences to the perpetrator or the victim, and this is true even when victims are shown to be shot. When effects are shown, they tend to be minor in nature. Anger, revenge, and inherent meanspiritedness are the most common reasons implied for why characters commit acts of gun violence.

Violence in Jamaica: an analysis of homicides 1998-2002

The aim of the study was to create a profile of Jamaican homicide victims and to describe the circumstances, motives, and the weapons used in homicide incidents. The authors read the police narratives for all Jamaican homicides 1998-2002 and coded them using a predetermined set of variables. Analyses were conducted to describe victim characteristics, motive, and weapon use. The majority of homicide victims were male (over 89%), and 15-44 years old (80%). The rate of homicide for males age 15-44 years was 121 per 100,000 compared with a rate of 12 per 100,000 for females in the same age group. The main motives for homicide were disputes (29%) and reprisals (30%). Gunshot wounds were the cause of death in 66% of all homicides. Guns were used primarily in reprisals, robbery, and drug/gang related homicides; in half of all dispute related homicides the perpetrator used a knife. Homicides in Jamaica are not primarily gang or robbery related. Rather, they are mainly caused by arguments or reprisals. Homicide has become a common feature of dispute resolution in Jamaica.

The supply and demand for guns to juveniles: Oakland's gun tracing project

In response to Oakland, California's high level of gun violence affecting young people, the East Oakland Partnership to Reduce Juvenile Gun Violence, a citywide collaboration, was formed in 1997. In 1999, the Partnership established the Oakland Gun Tracing Project to develop evidence-based policy recommendations aimed at reducing the supply of and demand for gun acquisition among urban youth. The advocacy project involved gathering, analyzing, and using police record and gun sale/registration data to inform policy and practice. Such data were collected for all gun crimes committed in Oakland, California between 1998 and 1999 in which a juvenile was either the suspect or the victim. The 213 cases involved 263 juveniles of which 170 were suspects/perpetrators and 93 were victims. Suspects as well as victims were predominantly male and African American. The 213 cases involved 132 recovered guns. Only 55% of the cases were traced to a federally licensed dealer. Three-quarters of the guns were purchased near Oakland, California. Successful traces, defined as the ability to identify federally licensed dealers and initial purchasers, were completed on only 52 of the 132 guns, demonstrating systemic tracing difficulties. Data gathered for the project was used to advocate for numerous policy changes. Recommended policy strategies include initiating a comprehensive gun tracing program so police can track all secondary sales, new laws requiring federal handgun registration which would track ownership changes, required reporting of stolen firearms, and providing effective intervention services to all juveniles the first time they enter the criminal justice system.

The epidemiology of firearm suicide in the United States

CONTEXT

Little attention has been given to the role of firearms in suicide. In 1998, firearms were the leading method of committing suicide for both men and women, responsible for three times the number of suicides compared to the next leading method. Understanding the epidemiology of firearm suicide will increase awareness of firearm suicide as a major public health problem.

RESULTS

Rates of firearm suicide have changed little over the past two decades and have consistently exceeded rates of firearm homicide. The firearm suicide rate among men is approximately six times that of women. While firearm suicide rates are highest among the elderly, the majority (66%) of firearm suicides are among persons under 55 years of age. Firearm suicide rates among women of all ages have dropped modestly, while rates among elderly men have risen considerably. Whites have roughly twice the rate of firearm suicide as do blacks and other race/ethnicity groups. Individual-level empirical studies have consistently indicated that keeping firearms in the home is associated with an increased risk of suicide.

CONCLUSIONS

For suicide prevention to be effective, the availability and use of firearms in suicides must be addressed.

Firearm availability and suicide, homicide, and unintentional firearm deaths among women

CONTEXT

In the United States, more than 45,000 women died from gun violence over the last decade.

OBJECTIVE

To determine whether measures of firearm availability are related to rates of suicide, homicide, and unintentional firearm deaths among women in the United States.

DESIGN

Pooled cross-sectional time series data on suicide, homicide, and unintentional firearm deaths (1988-1997) were used to estimate the association between the rate of violent death among women and four proxies of firearm availability. Two proxies came from survey reports of household firearm ownership rates; two were derived from mortality statistics.

SETTING

United States, 1988-1997.

RESULTS

The increased rate of suicide and homicide in states with high gun levels was accounted for primarily by significantly elevated firearm suicide and firearm homicide rates. Unintentional firearm death rates were also increased in states with more guns. At the regional level, qualitatively similar results were obtained.

CONCLUSION

Between 1988 and 1997, the suicide, homicide, and unintentional firearm death rates among women were disproportionately higher in states where guns were more prevalent. The elevated rates of violent death in states with more guns was not entirely explained by a state's poverty or urbanization and was driven primarily by lethal firearm violence, not by lethal nonfirearm violence.