Article

Homicide and Suicide Risks Associated with Firearms in the Home: A National Case-Control Study

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Abstract

I test the hypothesis that having a gun in the home is a risk factor for adults to be killed (homicide) or to commit suicide. Two case-control analyses were based on national samples of subjects 18 years of age or older. Homicide and suicide case subjects were drawn from the 1993 National Mortality Followback Survey. Living control subjects were drawn from the 1994 National Health Interview Survey. Ten control subjects matched by sex, race, and age group were sought for each case subject. The homicide sample consisted of 1,720 case subjects and 8,084 control subjects. Compared with adults in homes with no guns, the adjusted odds ratio (OR) for homicide was 1.41 (95% confidence interval [CI] 1.20 to 1.65) for adults with a gun at home and was particularly high among women (adjusted OR 2.72; 95% CI 1.89 to 3.90) compared with men (adjusted OR 1.23; 95% CI 1.01 to 1.49) and among nonwhite subjects (adjusted OR 1.74; 95% CI 1.37 to 2.21) compared with white subjects (adjusted OR 1.27; 95% CI 1.03 to 1.56). Further analyses revealed that a gun in the home was a risk factor for homicide by firearm means (adjusted OR 1.72; 95% CI 1.40 to 2.12) but not by nonfirearm means (OR 0.83; 95% CI 0.62 to 1.11). The suicide sample consisted of 1,959 case subjects and 13,535 control subjects. The adjusted OR for suicide was 3.44 (95% CI 3.06 to 3.86) for persons with a gun at home. However, further analysis revealed that having a firearm in the home was a risk factor for suicide by firearm (adjusted OR 16.89; 95% CI 13.26 to 21.52) but was inversely associated with suicide by other means (adjusted OR 0.68; 95% CI 0.55 to 0.84). Having a gun at home is a risk factor for adults to be shot fatally (gun homicide) or commit suicide with a firearm. Physicians should continue to discuss with patients the implications of keeping guns at home. Additional studies are warranted to address study limitations and to better understand the implications of firearm ownership.

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... Of the 47,511 suicides in the United States in 2019, 23,941 (50%) were by firearm [3]. Easy, immediate access to firearms in the home places household members at 3-5 fold increased risk for suicide [107][108][109], up to 9-fold increased risk with unsafe storage practices [107], and at 17-fold increased risk for suicide by firearm [108]. Further, this "heightened risk of suicide [with household firearm ownership] is not explained by a higher risk of psychopathology among gun-owning families" [110] (and see [111]). ...
... Of the 47,511 suicides in the United States in 2019, 23,941 (50%) were by firearm [3]. Easy, immediate access to firearms in the home places household members at 3-5 fold increased risk for suicide [107][108][109], up to 9-fold increased risk with unsafe storage practices [107], and at 17-fold increased risk for suicide by firearm [108]. Further, this "heightened risk of suicide [with household firearm ownership] is not explained by a higher risk of psychopathology among gun-owning families" [110] (and see [111]). ...
... Further, this "heightened risk of suicide [with household firearm ownership] is not explained by a higher risk of psychopathology among gun-owning families" [110] (and see [111]). Moreover, "persons with a gun in the home were [are] more likely than others to use a gun to [die by] suicide and less likely than others to [die by] suicide by means of drug overdose, hanging, or other method other than a gun" [108]. Population (household) rates of gun ownership are strongly associated with overall suicide rates, gun suicide rates, and percentage of suicides by 22:1360 gun in the US (Table 4 and Fig. 3) [112][113][114], even when prescription rates of antidepressants are considered [115]. ...
Article
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Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity. The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51–85 + years old for both sexes. Of all US suicides from 1999–2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71–85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2–4 times higher suicide rates than women, despite having only 1/4—1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations. To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
... 11 Handguns are used in approximately three quarters of suicides by firearm. [12][13][14] Ecologic [15][16][17] and case-control [18][19][20][21][22][23][24][25] studies have consistently shown a positive association between firearm availability and suicide. Collectively, the evidence indicates that the risk of suicide is three times as high when there is firearm access as when there is not -an excess risk attributable to higher rates of suicide by firearm, not of suicide by other methods. ...
... 50 Risk estimates from case-control studies range widely, in part because many have analyzed only a few hundred suicides. [18][19][20]22,25 Psychological autopsy, the standard method for determining gun access in case-control studies, 18,[20][21][22]24 is vulnerable to recall bias, with proxies of recent victims of gunshot injuries plausibly more likely to report access than proxies of controls. 51 Some case-control studies have used dead controls 22,24 or drawn controls from a population other than that of the cases 21,22,24,25 ; both approaches are potential sources of bias. ...
... [18][19][20]22,25 Psychological autopsy, the standard method for determining gun access in case-control studies, 18,[20][21][22]24 is vulnerable to recall bias, with proxies of recent victims of gunshot injuries plausibly more likely to report access than proxies of controls. 51 Some case-control studies have used dead controls 22,24 or drawn controls from a population other than that of the cases 21,22,24,25 ; both approaches are potential sources of bias. Finally, case-control studies are ill-suited to measuring temporal changes in risk. ...
Article
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Background Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership. Methods We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns). Results A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition. Conclusions Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.)
... Nonetheless, important differences may exist in how firearm ownership affects different types of violence. In general, it appears that firearm access increases risks of homicide and suicide (Anglemyer et al., 2014;Dahlberg et al., 2004;Wiebe, 2003;Wilson & Petersilia, 2002). People who commit crimes like robbery or burglary while armed with a firearm are far more likely to kill someone than if they did not have a gun, simply because of the firearm's presence (Wilson & Petersilia, 2002). ...
... This suggests the firearm plays a partial causal role in their act of homicide. Similarly, having a firearm in the home appears to increase the likelihood of suicide (Dahlberg et al., 2004;Wiebe, 2003). The reason for this effect is not entirely clear, but it is at least possible that for suicidal people, knowing that a firearm is within reach has a causal effect on their decision to end their lives. ...
... This study's results also help clarify the role of firearms in public mass shootings. Although having a firearm within reach increases the risks of more common forms of homicide and suicide (Anglemyer et al., 2014;Dahlberg et al. 2004;Wiebe, 2003;Wilson & Petersilia, 2002), firearm ownership itself may play a lesser role in causing public mass shootings. Half of the perpetrators we studied did not acquire their first firearm until the final year before their attack, and only 21% had been gun owners for more than three years. ...
Article
Although it is important to know what public mass shooters have in common, it is also helpful to understand when different variables were present on their pathways to violence. This study explored the timing of key life events for the deadliest public mass shooters in the United States since Columbine (N = 14). Using data from official reports and supplementary sources, we found perpetrators’ mental health contacts often began more than a decade before their mass shootings, and often ended more than a year before their attacks. Mental illness was typically a constant in their lives, not something that automatically caused them to attack. While treatment may help prevent some mass shootings, mental health professionals have limited influence over patients they have not recently seen. In turn, perpetrators’ work and school problems also typically began long before their mass shootings, but these issues continued closer to their attacks. Employers and educators may therefore have an opportunity to intervene later in the process. Firearms acquisition often occurred in the final stages, after perpetrators were already interested in mass murder. Red flag laws and ERPOs which prohibit sales to explicitly dangerous individuals may therefore help reduce the prevalence of these attacks.
... Despite the 1996 Dickey Amendment's restriction of federal funding for research on gun violence by the Centers for Disease Control and Prevention (Rostron, 2018), more than 30 years of public health research supports thinking of guns as statistically more of a personal hazard than a benefit. Case-control studies have repeatedly found that gun ownership is associated with an increased risk of gun-related homicide or suicide occurring in the home (Kellermann and Reay, 1986;Kellermann et al., 1993;Cummings and Koepsell, 1998;Wiebe, 2003;Dahlberg et al., 2004;Hemenway, 2011;Anglemeyer et al., 2014). For homicides, the association is largely driven by gun-related violence committed by family members and other acquaintances, not strangers (Kellermann et al., 1993(Kellermann et al., , 1998Wiebe, 2003). ...
... Case-control studies have repeatedly found that gun ownership is associated with an increased risk of gun-related homicide or suicide occurring in the home (Kellermann and Reay, 1986;Kellermann et al., 1993;Cummings and Koepsell, 1998;Wiebe, 2003;Dahlberg et al., 2004;Hemenway, 2011;Anglemeyer et al., 2014). For homicides, the association is largely driven by gun-related violence committed by family members and other acquaintances, not strangers (Kellermann et al., 1993(Kellermann et al., , 1998Wiebe, 2003). ...
... Kleck and Gertz (1998) noted that membership in street gangs and drug dealing might be important confounds of risk in case control studies, just as unsafe storage practices such as keeping a firearm loaded and unlocked may be another (Kellerman et al., 1993). Other studies have found that the homicide risk associated with guns in the home is greater for women compared to men and for non-whites compared to whites (Wiebe, 2003). Consequently, white men-by far the largest demographic that owns guns-might be especially likely to think of themselves as immune to the risks of gun ownership and, through confirmation bias, cherry-pick the data to support preexisting intuitions and fuel motivated disbelief about guns. ...
Article
Full-text available
The gun debate in America is often framed as a stand-off between two immutable positions with little potential to move ahead with meaningful legislative reform. Attempts to resolve this impasse have been thwarted by thinking about gun ownership attitudes as based on rational choice economics instead of considering the broader socio-cultural meanings of guns. In this essay, an additional psychological perspective is offered that highlights how concerns about victimization and mass shootings within a shared culture of fear can drive cognitive bias and motivated reasoning on both sides of the gun debate. Despite common fears, differences in attitudes and feelings about guns themselves manifest in variable degrees of support for or opposition to gun control legislation that are often exaggerated within caricatured depictions of polarization. A psychological perspective suggests that consensus on gun legislation reform can be achieved through understanding differences and diversity on both sides of the debate, working within a common middle ground, and more research to resolve ambiguities about how best to minimize fear while maximizing personal and public safety.
... Therefore, access to firearms is crucial to evaluating suicide risk. The presence of a firearm in the home increases an individual's risk of suicide nearly 5-fold [24,25]. Firearm ownership is more than twice as common in rural areas, where 46% of the population reports owning at least one firearm, compared to 19% in urban centers [26]. ...
... Individuals who own a firearm or live with someone who does have a 3-to 5-fold increased risk of death by suicide [24,25,42]. A case-control analysis that matched suicide decedents to controls by sex, race, age, and neighborhood of residence identified that decedents were more likely to have lived alone, taken prescribed psychotropic medications, been arrested, abused drugs or alcohol, and not graduated from high school. ...
Article
Full-text available
Purpose of Review Suicide rates have risen over the past two decades in the United States of America (USA). Rates are higher in rural settings, but more total suicides occur in urban areas. Understanding risk and protective factors prevalent in urban areas is essential in reducing the individual and public health impact of suicide. Recent Findings Lower rates of suicide in urban settings derive less from underlying differences in mental distress than from variation in access to care and to highly lethal means of suicide. Culturally appropriate interventions incorporating intersectional perspectives are needed to prevent and reduce suicide among people of color, particularly Native American and Black youth, and among lesbian, gay, bisexual, and transgender (LGBT) populations. Summary The Zero Suicide Initiative aims to coordinate multi-level suicide prevention interventions across sites of healthcare, and may be particularly well-suited to urban areas, where sources of care are more densely available and healthcare contacts may be more frequent.
... Does having firearms at house cause an increase in suicide risk? Wiebe (2003) examined this question using a case-referent analysis based on national samples of subjects 18 years or older. The suicide case subjects were obtained from the 1993 National Mortality Followback Survey (NMFS) (Centers for Disease Control and Prevention, 1993). ...
... Looking at our 809 matched sets, 620 (76.6%) contain suicides that were known to take place in the home. However, this seemingly reasonable approach may unintentionally introduce selection bias, because "location (home) and exposure (gun in the home) are related, restricting the sample by location might have created bias..." (Wiebe, 2003). More specifically, having firearms at home may induce a suicide case that would have occurred outside the home to commit suicide at home, so this subject would be included in our narrow case analysis if having firearms at home but be excluded if without firearms at home. ...
Preprint
In a matched case-control study, cases are compared to noncases, who are similar in observed covariates, in terms of their retrospective exposure to a treatment to assess the impact of the treatment on the outcome. In the absence of a gold standard case definition, there is often a broad case definition and a narrow case definition. The broad case definition offers a larger sample size of cases but the narrow case definition may offer a larger effect size. Restricting to the narrow case definition may introduce selection bias because the treatment may affect the type of a case a subject is. In this article, we propose a new sensitivity analysis framework for combining broad and narrow case definitions in matched case-control studies, that considers the unmeasured confounding bias and selection bias simultaneously. We develop a valid randomization-based testing procedure using only the narrow case matched sets when the effect of the unmeasured confounder on receiving treatment and the effect of the treatment on case definition among the always-cases are controlled by sensitivity parameters. We then use the Bonferroni method to combine the testing procedures using the broad and narrow case definitions. We also study comprehensively the proposed testing procedures' sensitivity to unmeasured biases using the design sensitivity and extensive power analyses. Our method is applied to study whether having firearms at home increases suicide risk.
... In theory, ready access to a gun in the home could enhance safety by thwarting or deterring attacks. However, available evidence from ecologic (7-9) and case-control (10)(11)(12)(13)(14)(15)(16)(17)(18) studies suggests that gun access has the opposite effect. A 2014 meta-analysis (18) concluded that people in homes with firearms have double the odds of dying by homicide compared with people in homes without firearms. ...
... Our results add to a growing body of evidence (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) showing elevated rates of homicide victimization in homes with guns. However, homes do not own guns, people do, and most homes with guns are inhabited by a mix of owners and nonowners. ...
Article
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.
... Altheimer (2010) and Land, McCall, and Cohen (1990) also suggested that the impact of some predictors of violent crime could vary at different units of analysis. Several studies such as Hemenway and Miller (2000), Hoskin (2001), Killias, Van Kesteren, and Rindlisbacher (2001), Wiebe (2003), Monuteaux et al. (2015), and Siegel et al. (2014) were based on national, cross-national, or state-level analyses. County-and city-level studies on these issues include Wiebe et al. (2009), Cook and Ludwig (2006), Kovandzic, Schaffer, and Kleck (2013), Zeoli and Webster (2010), Parker et al. (2011), and Altheimer (2010), respectively. ...
Article
The linkage between firearms and violent crime has been documented in several criminological research efforts, with different conclusions. This study explores the relationship between gun availability and gun-related violent crimes, using the city of Detroit, Michigan, as a case study. Based on the primary role of federal firearm licensees (FFLs) as a spigot for the flow of firearms into communities, spatial accessibility to FFL locations is used as a measure of gun availability. Global regression models are used to investigate the association between gun-related crime rates and spatial accessibility to FFL locations. Geographically weighted regression (GWR) is also employed to assess such spatially varying accessibility across the study area. In the global models, gun availability and selected population variables explained up to 46 percent of the variation in crime rates. The GWR model explained 59 percent of the variation in crime rates. The analysis shows a global significant positive effect of gun availability on gun-related crime rates, with strong spatial variability across the study area. The results suggest a significant linkage between gun-crime rates and spatial accessibility to FFL in the study area. Based on the findings, the location and activities of FFL dealers might be a contributing factor to the rates of gun-related crimes.
... The elevated suicide risk applies to other household members as well as the firearm owner. [9][10][11][12][13][14][15][16][17][18] Survivors of suicide attempts using firearms report that the availability of guns at home is the primary reason for their method choice. 19,20 There is a common misperception that people who are intent on suicide and are thwarted or survive an attempt using one method will try again with another. ...
Article
Background: US veterans die by suicide at a higher rate than that of the civilian population and are more likely to use a firearm as their method. Systemic efforts to address the use of firearms in suicide had been largely evaded. In June 2020, the White House published the Roadmap to Empower Veterans and End the National Tragedy of Suicide (PREVENTS) task force report, which verified the link between, and the need to address, at-risk veterans and their access to firearms. This paper reviews the literature on the intersection of veterans, firearms, and suicide, then explores existing VA prevention initiatives aimed at reducing at-risk veterans' access to lethal means and offers policy recommendations to expand efforts in the context of the PREVENTS Roadmap. Observations: The PREVENTS report recommends widespread distribution of safety education materials that encourage at-risk individuals to temporarily transfer or store their guns safely and the expansion of free or affordable options for storing weapons. Recommended policy actions to accomplish this goal include delaying access to firearms for at-risk veterans, facilitating temporary storage out of the home, improving in-home safe storage options, requiring that health care providers who care for high-risk veterans are trained in lethal means safety counseling, and creating campaigns to shift cultural norms for firearms' storage during crises. Conclusions: Suicide prevention requires a multimodal approach, and attention to firearms access must become a more salient component. The high rate of veteran suicides involving firearms requires far-reaching interventions at societal, institutional, community, family, and individual levels.
... Now, perhaps more than ever before, is an important time to discuss lethal means safety. There is a well-establish link between firearms and suicides in the United States, where fifty percent of suicide deaths are due to firearms, and the greatest portion of firearms deaths, nationally, are suicides (Anglemyer et al., 2014;Kellermann et al., 1992;Miller & Hemenway, 1999;Wiebe, 2003). Working to ensure a safe home environment can have a particularly significant effect on extending the time between the onset of a crisis and one's ability to initiate self-directed violence. ...
... Lethal means safety counseling aims to create additional time between thoughts of suicide and behaviors intended to act on those thoughts, thus providing individuals an opportunity to change their mind, seek help, be interrupted, or receive other interventions. Evidence supporting the effectiveness of lethal means safety counseling has strengthened in the last 15 years ( Zalsman et al., 2016). Lethal means safety counseling has resulted in lower suicide rates by firearm (Shenassa, Rogers, Spalding & Roberts, 2004) without off-setting increases in suicides by other methods (Anestis, Selby, & Butter- worth, 2017). ...
Article
Objective: Veterans die by suicide at a higher rate than the U.S. population, and veterans more frequently use a firearm as the suicide method. Consequently, firearm accessibility and storage represent important prevention considerations. This project aimed to explore the implementation of suicide prevention efforts among veterans who went on to die by suicide, with and without the use of a firearm, and to identify factors that differentiated veteran suicide decedents to help inform suicide prevention efforts. Methods: Data from the Veteran Health Administration Behavior Health Autopsy Program was analyzed for 97 veteran suicide decedents. Results: Results demonstrated that veterans who used a firearm for suicide were less likely to have engaged in suicide prevention efforts overall and were less likely to have received lethal means safety counseling / safety planning. Veterans who died by firearm had lower levels of notable risk factors (e.g., prior suicide attempt, no-shows for appointments), however were more likely to have a documented unsecured firearm in their home. Conclusion: These findings support the benefit of broadening the reach of suicide prevention efforts, especially for high-risk veterans with access to firearms.
... [1][2][3] Firearms in the home increase the risk of firearm-related harm. [4][5][6][7][8][9] Storing all firearms unloaded and locked up using a locking device can reduce the risk of unintentional firearm injury and firearm suicide for children and adolescents. 10 Nationally, fewer than one-third of individuals who own guns and live in households with children report storing all guns locked up and unloaded (the manner recommended by the American Academy of Pediatrics). ...
Article
Full-text available
Importance Safe firearm storage and other interventions may reduce pediatric firearm deaths and injuries. Objective To compare firearm ownership and storage practices, opinions on firearm injury prevention strategies, and perceptions of safety among adults in California households with and without children and/or adolescents. Design, Setting, and Participants This survey study used data from the 2018 California Safety and Well-being Survey, a California-representative, probability-based internet survey. Respondents were part of the Ipsos KnowledgePanel, an online research panel that uses address-based sampling and provides survey weights to produce estimates representative of the adult population of California. Main Outcomes and Measures Topics included firearm storage practices, opinions on interventions to reduce pediatric firearm injury, and perceptions of household safety related to firearm ownership. Respondents were stratified by firearm ownership and household presence or absence of children and/or adolescents. Weighted percentages and 95% CIs are presented. Results Of 5232 invited panel members, 2558 (48.9%) completed the survey. Among respondents, 52.5% (95% CI, 49.3%-55.7%) were women, 42.9% (95% CI, 39.9%-45.9%) were White, 30.0% (95% CI, 26.8%-32.9%) lived in homes with children, and the mean (SD) age was 48.0 (17.1) years. Among those in homes with children, more than two-thirds of individuals who owned firearms (70.6% [95% CI, 50.1%-85.2%]) and more than half of individuals who did not own firearms but lived in homes with guns (54.9% [95% CI, 37.9%-70.8%]) reported that they believed a firearm in the home made it safer. Half of those who owned firearms (52.3% [95% CI, 34.9%-69.2%]) and more than three-quarters of individuals who did not own firearms but lived in homes with guns (78.4% [95% CI, 57.5%-90.7%]) reported it was always appropriate for parents to inquire about unlocked guns in homes where their children play. Among those who had previously owned at least 1 gun but no longer did, 13.3% (95% CI, 7.1%-23.8%) reported getting rid of guns at least in part due to concern for the safety of a child in the home. Nearly two-thirds of those who owned firearms living with children and/or adolescents (64.5% [95% CI, 46.5%-79.2%]) did not store all firearms in the most secure manner (ie, unloaded and locked up), compared with 36.4% (95% CI, 29.4%-44.1%) of individuals who owned firearms but did not live with children. Conclusions and Relevance In this study, although a substantial percentage of individuals who owned guns and lived with children did not store all firearms as recommended, parents and caregivers who owned firearms reported being amenable to interventions that reduce young people’s risk of firearm-related harm. Future work should investigate acceptable risk reduction and safe storage interventions.
... People who survive a suicide attempt have the chance to receive mental health and other support that can prevent another attempt, and just 10% go on to die by suicide [26]. People living in homes with firearms are no more likely to screen positive for suicidal ideation or to attempt suicide, but their risk of death by suicide is up to three times higher [27]. Firearms are a highly lethal means of suicide; only 10% of people who attempt suicide with a firearm survive [28]. ...
Article
Firearm injury is a disease that is disproportionately prevalent in the United States. When a bullet hits a human being, it brings together multiple structural determinants of health into one acute, life-changing event. Firearm injury can lead to long-term mental and physical challenges for individuals, families, and communities. Despite the impact of this disease, physicians often underestimate their role in not only treating but also preventing firearm injury. Physicians can intervene through screening, counseling, community engagement, and advocacy, and can mobilize the health care systems they serve to engage with injury prevention. Physicians also play a key role in expanding the knowledge base on firearm injury through much-needed research on the epidemiology, context, and outcomes of firearm injury. When we treat firearm injury as a disease, we can develop and implement interventions from the clinic to the statehouse that can curb profound harms. This work and these opportunities belong not only to emergency physicians and trauma surgeons, but to all fields that evaluate and assess patients over the life course.
... Aux Etats-Unis, les personnes âgées, et notamment les hommes blancs, affichent également une probabilité de suicide supérieure lorsqu'ils ont accès à des armes de poing (Conwell et al., 2002). Wiebe (2003aWiebe ( , 2003b) estime quant à lui que les personnes jeunes et moins jeunes -hommes, femmes, blancs et personnes de couleur confondus -sont toutes susceptibles de mourir de mort violente si elles disposent d'armes à la maison. ...
Chapter
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Le débat à propos des relations entre armes à feu et violence est demeuré en grande partie une question académique et politique propre à l’Amérique du Nord. La plupart des données, des méthodologies de recherche et des constats concernent en effet cette région, caractérisée par des aspects culturels et socioéconomiques distincts. Tout en reconnaissant la valeur des analyses que l’on trouve dans cette documentation, le présent chapitre confère une perspective mondiale à ce débat, en s’appuyant à la fois sur les éléments de preuve disponibles au niveau international et sur de nouveaux domaines de recherche. Disponible en ligne sur: https://www.smallarmssurvey.org/sites/default/files/resources/Small-Arms-Survey-2004-Chapter-06-FR.pdf
... Multiple studies have established a consistent association between household firearm ownership and increased suicide rates (Anglemyer et al. 2014;Butterworth et al. 2018;Shenassa et al. 2004;Kposowa et al. 2016;Dahlberg et al. 2004;Wiebe 2003). State laws that have reduced access by high risk individuals such as mandating background checks through purchaser licensing, waiting periods, and child access protection laws have all been found to reduce suicide rates individually and measured together (Anestis and Anestis 2015;Crifasi et al. 2015;Kaufman et al. 2018;Loftin et al. 1991;Webster et al. 2004). ...
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Background: Firearms account for the majority of US suicides, largely due to lethality and accessibility. Under Federal and Maryland law, long guns are less regulated than handguns which is a concern for increased suicide risk. This study uses Maryland data to ascertain the impact of long guns on suicides in the state. We hypothesize that the prevalence of long gun use among firearm suicides will be increased in rural and young populations. Methods: This is a cross sectional study using police and medical examiner narratives to identify firearm type involved in all 3931 Maryland gun suicides from 2003 to 2018. Proportions of firearm suicides utilizing long guns were calculated. Urban-rural differences were determined using the National Center for Health Statistics' classification system. Logistic regression was used to calculate odds ratios of long gun to handgun suicides across the urban-rural spectrum, controlling for decedent demographics. Results: From 2003 to 2018, 28.4% of Maryland gun suicides used long guns. The proportion of long guns used was highest in the most rural counties, where 51.6% of firearm suicides were by long gun, compared to 16.8% in the most urban counties. Long guns were disproportionately used by the young. For decedents 18 or younger, 44.6% used long guns, compared to 20.2% in those 65 or older. Compared to the most urban counties, firearm suicide decedents in the most rural counties were 3.74x more likely to use long guns (OR = 3.74; 95% CI 2.19, 6.40; p < .001) after adjusting for demographics, intoxication, and hunting season. Conclusions: Long guns are used in a large proportion of Maryland firearm suicides, particularly in rural areas and disproportionately in youth suicides. Long guns must be considered as part of access to lethal means or policy strategies in efforts to reduce the burden of firearm suicide.
... Firearms are readily accessible to many; an estimated 35% of American adults live in a household with a firearm, and in a majority of those households firearms are not stored in the most secure manner [2,3]. A substantial body of evidence has found that firearms in the home increase the risk of firearm suicide, homicide, and unintentional injury for those living there, and that safe firearm storage reduces the risk of firearm-related harm [4][5][6][7][8][9][10]. By knowing how to identify risk for firearmrelated harm, knowing possible steps to reduce access by at-risk persons, and talking with patients, parents, or caregivers about the danger of access to firearms in the home when someone is at increased risk, clinicians can help prevent firearm injury and death [11]. ...
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Background Firearm injury and death are significant public health problems in the U.S. and physicians are uniquely situated to help prevent them. However, there is little formal training in medical education on identifying risk for firearm injury and discussing safe firearm practices with patients. This study assesses prior education, barriers to counseling, and needs for improved training on firearm safety counseling in medical education to inform the development of future education on clinical strategies for firearm injury prevention. Method A 2018 survey administered to 218 residents and fellows at a large, academic medical center asked about medical training on firearm injury prevention, frequency of asking patients about firearm access, and perceived barriers. Results The most common barriers cited were not knowing what to do with patients’ answers about access to firearms (72.1%), not having enough time (66.2%), not feeling comfortable identifying patients at-risk for firearm injury (49.2%), and not knowing how to ask patients about firearm access (48.6%). Prior education on firearm injury prevention was more strongly associated with asking than was personal exposure to firearms: 51.5% of respondents who had prior medical education reported asking compared with who had not received such education (31.8%, p =0.004). More than 90% of respondents were interested in further education about interventions, what questions to ask, and legal mechanisms to separate dangerous people from their firearms. Conclusions Education on assessing risk for firearm-related harm and, when indicated, counseling on safe firearm practices may increase the likelihood clinicians practice this behavior, though additional barriers exist.
... Homicide outcomes were influenced by social network [54,80], incarceration [81], and firearm ownership statuses [82,83]. Additionally, firearm-related homicide probability increased due to firearm ownership [83,84] and carrying statuses [82]. When a homicide occurred, it was determined to be firearm-related if the victimized agent was a potential firearm-related homicide victim and the victim or perpetrator owned, carried, or had access to a firearm through their social network. ...
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Background Firearm violence remains a persistent public health threat. Comparing the impact of targeted high-risk versus population-based approaches to prevention may point to efficient and efficacious interventions. We used agent-based modeling to conduct a hypothetical experiment contrasting the impact of high-risk (disqualification) and population-based (price increase) approaches on firearm homicide in New York City (NYC). Methods We simulated 800,000 agents reflecting a 15% sample of the adult population of NYC. Three groups were considered and disqualified from all firearm ownership for five years, grouped based on prevalence: low prevalence (psychiatric hospitalization, alcohol-related misdemeanor and felony convictions, 0.23%); moderate prevalence (drug misdemeanor convictions, domestic violence restraining orders, 1.03%); and high prevalence (all other felony/misdemeanor convictions, 2.30%). Population-level firearm ownership was impacted by increasing the price of firearms, assuming 1% price elasticity. Results In this hypothetical scenario, to reduce firearm homicide by 5% in NYC, 25% of the moderate prevalence group, or 12% of the high prevalence group needed to be effectively disqualified; even when all of the low prevalence group was disqualified, homicide did not decrease by 5%. An 18% increase in price similarly reduced firearm homicide by 5.37% (95% CI 4.43–6.31%). Firearm homicide declined monotonically as the proportion of disqualified individuals increased and/or price increased. A combined intervention that both increased price and effectively disqualified “high-risk” groups achieved approximately double the reduction in homicide as any one intervention alone. Increasing illegal firearm ownership by 20%, a hypothetical response to price increases, did not meaningfully change results. Conclusion A key takeaway of our study is that adopting high-risk versus population-based approaches should not be an “either-or” question. When individual risk is variable and diffuse in the population, “high-risk approaches” to firearm violence need to focus on relatively prevalent groups and be highly efficacious in disarming people at elevated risk to achieve meaningful reductions in firearm homicide, though countering issues of social justice and stigma should be carefully considered. Similar reductions can be achieved with population-based approaches, such as price increases, albeit with fewer such countering issues.
... In the United States, the elderly, and in particular white men, are also at a higher risk of suicide when they have access to handguns (Conwell et al., 2002). Wiebe (2003aWiebe ( , 2003b finds that younger and older people, men and women, whites and non-whites are all at an increased risk of violent death if guns are kept at home. ...
Chapter
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The debate over the relationship between firearms and violence has, for the most part, remained a North American academic and public policy issue. Most of the relevant data, research methodologies, and findings have emerged from that region, with its distinct cultural and socio-economic characteristics. While acknowledging the valuable insights included in such literature, this chapter brings a global perspective to the debate, drawing both on existing international evidence and new field research. available at https://www.smallarmssurvey.org/sites/default/files/resources/Small-Arms-Survey-2004-Chapter-06a-EN.pdf
... Segundo Campbell at al. (2003), por exemplo, vários fatores concorrem para que uma mulher venha a ser assassinada pelo marido ou pelo namorado, mas o acesso a uma arma de fogo aumenta o risco em cinco vezes. Já ter de uma arma de fogo em casa aumenta o risco de um homicídio doméstico em 41%, mas para as mulheres o risco aumenta em 272% (Wiebe, 2003). ...
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Trata-se de estudo de revisão dos estudos internacionais a respeito das evidências sobre políticas de controle de armas de fogo e seus efeitos no controle da letalidade.
... Rates of civilian gun ownership are far higher in the USA than in any other country 1 and rates of firearm-related death and injury in the USA are among the world's highest. 2 Over the last 30 years, evidence linking access to firearms to elevated risks of death and injury has grown. Nearly all of this evidence comes from ecological [3][4][5] and casecontrol [6][7][8][9][10][11][12][13] studies. Only one cohort study 14 has been conducted; this should not be surprising given the substantial data demands of the cohort design, legal barriers to the collection of population-wide information on firearm purchasing and ownership (ie, exposure data) 15 and the dearth of funding in the USA for large-scale research on firearm violence. ...
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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.
... Four in ten adults in the United States live in a home with a gun, and one in three children live in a home with a gun (Van Green, 2021;Schuster et al., 2000). Meanwhile, a large body of evidence demonstrates that the presence of firearms in the home is associated with increased likelihood of suicide (Wintemute et al., 1999;Kellermann et al., 1992;Miller et al., 2007), homicide (Cummings et al., 1997;Wiebe, 2003;Dahlberg et al., 2004;Kellermann et al., 1993), and unintentional injuries (Miller et al., 2001). A nationally representative survey of U.S. firearm owners found that fewer than 20% of respondents rated physicians as effective messengers about safe storage practices (Crifasi et al., 2018). ...
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The 5 A’s of Firearm Safety Counseling is a novel framework by which clinicians can approach firearm injury prevention counseling. To evaluate this methodology as a tool for clinicians, a single-center, simulation-based randomized controlled trial was performed with clinical trainees in psychiatry, medicine, and pediatrics in an urban quaternary care center. Participants received didactic education on firearm injury epidemiology and evidence-based policies and training on a specific counseling framework, the 5 A’s of Firearm Safety Counseling which they then implemented in a simulation setting with standardized patients. Of the 29 participants who were randomized, 28 completed the trial. Most participants were psychiatry trainees (residents or subspecialty fellows). While over 60% of participants were uncomfortable or extremely uncomfortable counseling on firearm injury prior to the interventions, only 4% reported being uncomfortable after receiving education and participating in simulated encounters. There was no significant difference between the quality and content of the counseling provided before and after the didactic-only session. There was a significant difference between the quality and content of the counseling provided before and after the specific training on the 5 A’s for Firearm Safety Counseling strategy. The 5 A’s for Firearm Safety Counseling is a promising educational tool to improve quality, content, and comfort delivering patient-centered counseling on firearm injury prevention in a simulation-based setting. These findings suggest that further validation in a clinical setting is warranted given there is an urgent need for feasible and effective firearm injury prevention strategies among clinicians.
... A third possible explanation for this study's finding of similarities in life circumstance profiles, but dissimilar diagnostic profiles, is that the lack of mental health disorder diagnoses in the less-diagnosed class could reflect a true absence of underlying conditions. Mental health disorders have long been considered one of a number of risk factors for suicidal behaviors, but other risk factors have been established, including genetic predisposition, early life experiences, cognitive and personality characteristics, stressful life events, access to lethal means, and others [31][32][33][34][35][36]. These also likely interact within the context of additional societal and environmental factors [37]. ...
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Background There is a well-established need for population-based screening strategies to identify people at risk of suicide. Because only about half of suicide decedents are ever diagnosed with a behavioral health condition, it may be necessary for providers to consider life circumstances that may also put individuals at risk. This study described the alignment of medical diagnoses with life circumstances by identifying suicide typologies among decedents. Demographics, stressful life events, suicidal behavior, perceived and diagnosed health problems, and suicide method contributed to the typologies. Methods This study linked North Carolina Medicaid and North Carolina Violent Death Reporting System (NC-VDRS) data for analysis in 2020. For suicide decedents from 2014 to 2017 aged 25–54 years, we analyzed 12 indicators of life circumstances from NC-VDRS and 6 indicators from Medicaid claims, using a latent class model. Separate models were developed for men and women. Results Most decedents were White (88.3%), with a median age of 41, and over 70% had a health care visit in the 90 days prior to suicide. Two typologies were identified in both males (n = 175) and females (n = 153). Both typologies had similar profiles of life circumstances, but one had high probabilities of diagnosed behavioral health conditions (45% of men, 71% of women), compared to low probabilities in the other (55% of men, 29% of women). Black beneficiaries and men who died by firearm were over-represented in the less-diagnosed class, though estimates were imprecise (odds ratio for Black men: 3.1, 95% confidence interval: 0.8, 12.4; odds ratio for Black women: 5.0, 95% confidence interval: 0.9, 31.2; odds ratio for male firearm decedents: 1.6, 95% confidence interval: 0.7, 3.4). Conclusions Nearly half of suicide decedents have a typology characterized by low probability of diagnosis of behavioral health conditions. Suicide screening could likely be enhanced using improved indicators of lived experience and behavioral health.
... Approximately 15,000 children and adolescents aged 18 years or younger were injured or killed by firearms in the United States (U.S.) in 2017 ("Web-based Injury Statistics Query and Reporting System") (WISQARS, n.d.). The presence of a firearm in the home is an independent risk factor for suicide and unintentional firearm death and injury among children (Anglemyer et al., 2014;Grossman et al., 2005;Miller et al., 2013;Wiebe, 2003). Almost 90% of firearm-related fatalities of young children (0-14 years) occur in the home (Hemenway and Solnick, 2015), and a majority of all unintentional, firearm-related child and adolescent (0-18 years) fatalities involve a firearm found in the home (Grossman and Reay, 1999). ...
... The age of the victim has obvious implications for the probability of survival, but the other demographic factors may also be associated with the nature of the shooting incident (Hipple and Magee 2017). Subsequently they are potentially important to control for to prevent confounds when examining other factors (Wiebe 2003). Finally, we calculated the number of clustered arrivals as the number of shootings within the prior 15 min and being closest to the same hospital based on drive time distances (Beard et al. 2019). ...
Article
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Despite nation-wide decreases in crime, urban gun violence remains a serious and pressing issue in many cities. Victim survival in these incidents is often contingent on the speed and quality of care provided. Increasingly, new research has identified the role that specialized trauma care plays in victim survival from firearm-related injuries. Using nearly four years of data on shooting victimizations in Philadelphia we test whether distance to the nearest level 1 trauma center is associated with victim survival. We employ different distance measures based on straight-line Euclidian distance, street network distances, and drive-time estimates—comparing the predictive accuracy of each. Our results find that victims who are shot farther from trauma centers have an increased likelihood of death, and drive time distances provide the most accurate predictions. We discuss the practical implications of this research as it applies to urban public health.
Article
This study examines 1) how female personal gun owners, female household gun owners, and female non-owners differ in demographic characteristics, handgun exposure and gun-related attitudes; and 2) how these differences vary from those for males. Data were obtained from a nationwide web survey, involving 390 female respondents and 134 male respondents, in 2016. Results indicated that female personal gun owners hold more pro-gun attitudes than female household gun owners and non-owners. Female non-owners had less exposure to guns than female household gun owners while female household owners had less exposure to guns than female personal owners. Variations by type of gun exposure, namely exposure to known persons with guns versus strangers with guns, were observed. Prior victimization was influential for female gun attitudes, but not male gun attitudes. Exposure to a known-person with a handgun was related to female gun attitudes, but not male gun attitudes.
Article
Objective: The main objective of this study was to investigate the association between alcohol consumption (use and bingeing) and the desire to own a firearm for protection. Study design: We used data from three random cross-sectional victimisation surveys conducted in São Paulo city, Brazil, in 2003, 2008 and 2013 with people aged ≥16 years. Methods: We performed tests for equality of proportions. Our analysis was performed separately for each victimisation survey to check the robustness of the results. We also used probit models, estimated by the maximum likelihood method, to analyse the relationship between desire to own a firearm and alcohol consumption, controlling for many other variables. Results: In 2013, although only 1.5% of the population surveyed reported living in a household with a firearm, 15.7% report that they would possess a firearm if they could, and 13.0% believed they would be safer/more protected from violence if they had a firearm. The desire to own a firearm is higher among people who consume alcoholic beverages than among those who do not and is higher as alcohol binge frequency increases. Conclusion: In São Paulo city, alcohol consumption and binge drinking are positively associated with the desire to own a firearm.
Article
Objectives: To review the public health approach to preventing and treating firearm violence. Data sources: Peer-reviewed, published scholarship and federal data systems. Study selection: English-language, indexed research articles on the epidemiology, risk, prevention, and consequences of firearm violence. Data extraction: This narrative review includes findings related to the epidemiology and impact of firearm violence, focusing on short- and long-term outcomes. Evidence supporting interventions at the individual, agent, and environmental level to reduce firearm-related harm was examined. Data synthesis: Firearm violence is a major public health challenge in the Unites States. The consequences of firearm violence reach beyond the nearly 40,000 firearm-related deaths and 90,000 firearm-related injuries each year. Firearm violence, including self-harm, assault, and unintentional injury, affects the health of individuals, families, communities, and health systems. Data sources remain inadequate, however, to fully capture these impacts. Treating firearm violence as a disease and taking a public health approach to prevention and treatment is key to reducing the harms of firearm violence. Using a public health framework not only recognizes the physical and mental consequences of firearm violence but also focuses our attention on underlying causes and on innovative, multi-level interventions to reduce the harms of firearm violence. Conclusions: The public health approach positions clinicians to change the conversation from political diatribe of pro-gun and anti-gun to systematically reducing injury and death. To achieve comparable success, we must design, test, and implement effective interventions at the environmental, policy, technological, and individual levels to prevent firearm violence. We must collect robust data on firearm violence and its consequences. And we must reckon with the conditions of inequality and disadvantage that feed violence through all means.
Article
In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathic physicians have a unique opportunity to affect this public health concern through patient education. Several evidenced-based recommendations can be incorporated at the bedside to reduce firearm injuries and deaths, including gun education, safe storage, and proper disposal.
Article
Objective: Firearm means safety strategies, such as safe storage, are effective in reducing suicide rates but are not widely implemented in the United States. This study examined the association between reason for firearm ownership, beliefs about firearm ownership and storage and suicide risk, willingness to engage in means safety, and current firearm storage practices. Method: A sample of 300 American firearm owners (53.0% male; 82.3% White; Mage = 36.11, age range = 20-69) completed an online survey via Amazon's Mechanical Turk (mTurk) program. Results: Firearm owners who own a firearm for protection, compared to owning a firearm for other reasons, (1) endorsed decreased belief in the relationship between firearm ownership and storage and suicide risk, (2) were less willing to engage in the means safety measures of storing firearms safely and allowing a trusted individual to temporarily remove firearms from the home, and (3) were more likely to store their firearms loaded. Conclusions: Reason for firearm ownership influences views regarding firearms and suicide, willingness to engage in firearm means safety, and firearm storage practices. It is essential to understand how differences in reason for firearm ownership impact these outcomes so appropriate, efficacious messaging can be developed and implemented.
Chapter
While gun violence continues to be a leading killer of U.S. children and adolescents, there remains little evidence-based public policy directed at this epidemic, a disparity largely stemming from the 1996 National Rifle Association-supported Dickey Amendment. Though the federal government has only recently begun funding public policy research on gun violence prevention, available data suggest that pediatric firearm morbidity and mortality are impacted by specific policies. This chapter will review those policies including child access prevention, extreme risk protection orders, minimum age requirements, mandatory waiting periods, universal background checks, campus carry restrictions, and stand-your-ground laws.
Article
Firearm violence, including both homicide and suicide, is a major public health problem in the US (United States). To decrease firearm mortality, US states have implemented laws to restrict firearm availability. We evaluated ten state firearm laws using configurational comparative methods (CCMs) designed to uncover how multiple factors are linked to a given outcome. We applied coincidence analysis, a novel CCM, to ten firearm laws in US states in 2016, to assess how different combinations of firearm laws distinguished states with low firearm homicide or suicide rates from those states with higher rates. The suicide analysis included all 50 US states; the homicide analysis involved the 47 US states with homicide rates reported by the Center for Disease Control and Prevention (CDC) in 2016. For low firearm suicide rates, we identified three solution pathways - the presence of universal background checks OR the presence of under 21 firearm possession restrictions OR the presence of junk gun bans - which were sufficient for low firearm suicide rates with high consistency (0.87) and coverage (0.76). For low firearm homicide rates, we identified three solution pathways - presence of under 21 firearm possession restrictions OR the presence of universal background checks together with the absence of trafficking prohibited laws OR membership in the Northern Great Plains – which were sufficient for low firearm homicide rates with high consistency (0.87) and coverage (0.81). We conclude that CCM analysis can add new insights to how multiple firearm laws work together to reduce firearm violence.
Article
Objectives: In 2013, the state of Maryland passed the Firearms Safety Act limiting the private sales of handguns, which did not apply to long guns often used for hunting (e.g., rifles and shotguns). This decreased the accessibility of handguns relative to long guns. We assessed the frequency of long gun suicides in the years before and after the policy change during winter season, which encompasses hunting season in Maryland. Methods: We performed a retrospective analysis on all 4107 well-characterized adult suicides caused by firearms in Maryland from 2003 through 2019. Logistic regression was performed, stratifying by decedent sex, race, and age. Results: While handgun suicides decreased in the period after 2013's Firearm Safety Act (p < 0.008), wintertime long gun suicides increased after 2013 (p < 0.004). Caucasian race (p < 0.006), male sex (p < 0.005), and middle age (p < 0.001) were significantly associated with wintertime long gun suicides after 2013. Conclusion: Our findings suggest that while the 2013 Firearms Safety Act decreased handgun suicides significantly, it did not reduce long gun suicides and there may even have been replacement with long guns during hunting season, when rifles are out and accessible. This association was most prominent among the demographics most likely to hunt (Caucasian, middle-aged, and male).
Article
Despite its rarity, school-associated violent death (SAVD) has wide-ranging implications on school safety, education quality, public health, politics, and more. This review article summarizes the data sources most used to surveil and study SAVD, the novel findings and recurring themes of original SAVD research, and the persisting gaps in SAVD research today. Overall, we found that academic attention and productivity related to SAVD has not focused on the most prevalent subtype – single-victim homicides occurring in urban, public schools and involving Black and Hispanic offenders and victims. Instead, the majority of SAVD research has focused on the much less frequent yet more conspicuous “rampage” multiple-victim homicides. Similarly, we identified an extraordinary dearth of both surveillance and research on all other types of SAVD, especially suicide and non-firearm violent death.
Article
Importance: Little is known about the extent to which secondhand exposure to household firearms is associated with risk of suicide in adults who do not own guns, most of whom are women. Objective: To evaluate changes in risk of suicide among women living in gun-free households after one of their cohabitants became a handgun owner. Design, setting, and participants: This cohort study observed participants for up to 12 years and 2 months from October 18, 2004, to December 31, 2016. Data were analyzed from April to November 2021. The study population included 9.5 million adult women in California who did not own guns and who entered the study while living with 1 or more adults in a handgun-free home. Exposures: Secondhand exposure to household handguns. Main outcomes and measures: Suicide, firearm suicide, nonfirearm suicide. Results: Of 9.5 million women living in handgun-free homes, 331 968 women (3.5% of the study population; mean [SD] age, 41.6 [18.0] years) became exposed to household handguns during the study period. In the entire study population, 294 959 women died: 2197 (1%) of these were by suicide, 337 (15%) of which were suicides by firearm. Rates of suicide by any method during follow-up were higher among cohort members residing with handgun owners compared with those residing in handgun-free homes (hazard ratio, 1.43; 95% CI, 1.11-1.84). The excess suicide rate was accounted for by higher rates of suicide by firearm (hazard ratio, 4.32; 95% CI, 2.89-6.46). Women in households with and without handguns had similar rates of suicide by nonfirearm methods (hazard ratio, 0.90; 95% CI, 0.63-1.27). Conclusions and relevance: In this study, the rate of suicide among women was significantly higher after a cohabitant of theirs became a handgun owner compared with the rate observed while they lived in handgun-free homes.
Article
Editor's note: This is the eighth article in a series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will be accompanied by a podcast offering more insight and context from the authors. To see all the articles in the series, go to https://links.lww.com/AJN/A204.
Article
Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019–12/23/2019) of 2048 older adults (age 50–80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%–28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9–73.1]) and safety counseling (63.2% [95%CI = 58.8–67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1–82.3]), comprehensive background checks (85.0% [95%CI = 81.5–87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9–90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8–84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.
Article
Introduction There has been little research into at-home suicide cases globally, and particularly in Asian regions. This study aimed to investigate the differences in characteristics between suicide cases in Hong Kong that occurred at home and elsewhere; identify at-home suicide hotspots in the community and compare the differences in area-level characteristics between suicide hotspots and other areas. Methods Suicide cases (2013–2017) were identified from Hong Kong Coroner’s Court reports. Area-level socioeconomic data were retrieved from the 2016 Hong Kong census. Wilcoxon signed-rank tests, χ ² tests and multiple logistic regression models were applied to compare differences in characteristics between people committing suicide at home and elsewhere. Global hotspot tests (Moran’s I and Getis-Ord General G) and local analysis (Getis-Ord Gi*) identified at-home suicide community hotspots. The Wilcoxon signed-rank test was used to compare differences in area-level characteristics between at-home suicide hotspots and non-hotspots. Results About 60% of suicide cases in Hong Kong occurred at home. Being female, widowed and/or living alone were significant predictors of at-home suicide cases. A U-shaped association between age and at-home suicide was identified, with 32 years of age being the critical turning point. An at-home suicide hotspot was identified in the north-western region of Hong Kong, which had lower median household income, higher income inequality and higher percentages of households with single elderly people, and new arrivals, compared with other areas. Conclusion Suicide prevention should start at home by restricting access to suicide methods. Community-based suicide prevention interventions with improvement of social services should target vulnerable members in identified suicide hotspots.
Chapter
Intimate partner violence can culminate in the death of one or both individuals. Firearms have been at the center of intimate partner homicide. Studies have shown that firearms are involved in the majority of intimate partner slayings. In recent years, efforts have been made to restrict gun ownership to those previously involved in domestic violence. This has been coupled with increased advocacy and awareness for victims of intimate partner violence. Indeed, the homicide rate among intimate partners has dropped. However, aspects of this drop may be both surprising and unsettling.
Article
Purpose: Population-based surveys are possible sources from which to draw representative control data for case-control studies. However, these surveys involve complex sampling that could lead to biased estimates of measures of association if not properly accounted for in analyses. Approaches to incorporating complex-sampled controls in density-sampled case-control designs have not been examined. Methods: We used a simulation study to evaluate the performance of different approaches to estimating incidence density ratios (IDR) from case-control studies with controls drawn from complex survey data using risk-set sampling. In simulated population data, we applied four survey sampling approaches, with varying survey sizes, and assessed the performance of four analysis methods for incorporating survey-based controls. Results: Estimates of the IDR were unbiased for methods that conducted risk-set sampling with probability of selection proportional to survey weights. Estimates of the IDR were biased when sampling weights were not incorporated, or only included in regression modeling. The unbiased analysis methods performed comparably and produced estimates with variance comparable to biased methods. Variance increased and confidence interval coverage decreased as survey size decreased. Conclusions: Unbiased estimates are obtainable in risk-set sampled case-control studies using controls drawn from complex survey data when weights are properly incorporated.
Chapter
By some estimates, it is reckoned that there are close to 1 billion firearms in existence in the world today and 85%
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Firearm injuries are the second leading cause of child and adolescent death in the United States, with homicides currently responsible for 1915, or nearly 60%, of all firearm deaths occurring in the pediatric population. Rates of pediatric firearm homicide have increased over 20% in the past 4 years, and significant disparities persist with regard to age, sex, race/ethnicity, and urbanicity. In the present chapter, we review the current state of our knowledge about the epidemiology of firearm homicide and non-fatal firearm assaults, trends in such injuries over time, global comparisons, contextual factors associated with firearm homicides, and what is known about risk and protective factors associated with interpersonal firearm violence. Finally, we outline a pathway forward for the prevention of interpersonal firearm violence among children and adolescents.
Article
Background More than 20,000 firearm suicides occur every year in America. Firearm restrictive legislation, firearm access, demographics, behavior, access to care, and socioeconomic metrics have been correlated to firearm suicide rates. Research to date has largely evaluated these contributors singularly. We aimed to evaluate them together as they exist in society. We hypothesized that state firearm laws would be associated with reduced firearm suicide rates. Methods We acquired the 2013 to 2016 data for firearm suicide rates from The Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research. Firearm laws were obtained from the State Firearms Law Database. Depression rates and access to care were obtained from the Behavioral Risk Factor Surveillance System and Occupational Employment and Wage Statistics program. Population demographics, poverty, and access to social support were obtained from the American Community Survey. Firearm access estimates were retrieved from the National Instant Criminal Background Check System. We used a univariate panel linear regression with fixed effect for state and firearm suicide rates as the outcome. We created a final multivariable model to determine the adjusted associations of these factors with firearm suicide rates. Results In univariate analysis, firearm access, heavy drinking behavior, demographics, and access to care correlated to increased firearm suicide rates. The state proportion identifying as white and the proportion of those in poverty receiving food benefits correlated to decreased firearm suicide rates. In multivariable regression, only heavy drinking (β, 0.290; 95% confidence interval, 0.092–0.481; P = .004) correlated to firearm suicides rates increases. Conclusions During our study, few firearm laws changed. Heavy drinking behavior association with firearm suicide rates suggests an opportunity for interventions exists in the health care setting.
Article
The authors compare cases of female intimate partner homicide–suicide to female intimate partner homicide alone to describe risk factors and suggest prevention strategies, including strategies in the medical setting. Differences are found between the types of cases in marital relationship, age, blood alcohol, and the use of firearms. Physicians and other health care providers who treat victims of intimate partner violence and patients at risk for suicide should be aware of the interwoven risk factors within these populations. Interventions aimed at suicide prevention as well as targeted removal of firearms should be investigated as tools in the prevention of intimate partner homicide.
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Among US geographic regions classified as rural, death rates are significantly higher for children and teens as compared with their urban peers; the disparity is even greater for Alaskan Native/American Indian and non-Hispanic black youth. Violence-related injuries and death contribute significantly to this finding. This article describes the epidemiology of violence-related injuries, with a limited discussion on child abuse and neglect and an in-depth analysis of self-inflicted injuries including unintentional firearm injuries and adolescent suicide. Potential interventions are also addressed, including strategies for injury prevention, such as firearm safe storage practices.
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Does gun ownership increase the likelihood that a person will commit a homicide? Findings from a recent case-control study (Kellermann et al. 1993) were interpreted as indicating that persons who lived in households with guns were 2.7 times as likely to become homicide victims as persons in households without guns. Problems with that study are identified, and a different approach is described. Survey data on a nationally representative sample of persons in prison for criminal homicide were compared with data on a nationally representative sample of the general population, in the first national case-control study of homicide. A logistic regression analysis was performed on the data, with the dependent variable measuring whether the subject was a killer, and the key independent variable being whether the person owned a gun. Control variables included age, sex, race, Hispanic ethnicity, income, education, marital status, region, veteran status, and whether the subject had children. Results indicated that gun ownership had a weak (odds ratio = 1.36) and unstable relationship with homicidal behavior, which was at least partly spurious. The promise and pitfalls of case-control research are discussed.
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Using a case-control design comparing homicide victims with matched nonvictims, Kellermann et al. (1993) concluded that keeping a gun in one's home increased the risk of being murdered by a factor of 2.7. The authors' underlying assumption was that a significant elevation in homicide risk derived from the risk of being murdered with a gun kept in the victim's home. This article shows that homicides are rarely committed with guns belonging to members of the victim's home and that such killings could be responsible for no more than a 2.4% increase in the relative risk of being murdered. Guns in one's own home have little to do with homicide risk. Scholars need to attend more closely to the mechanisms by which an alleged causal effect is supposed to operate and to consider their plausibility before concluding that an association reflects a causal effect.
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Amelia is a complete R package for multiple imputation of missing data. The pack-age implements a new expectation-maximization with bootstrapping algorithm that works faster, with larger numbers of variables, and is far easier to use, than various Markov chain Monte Carlo approaches, but gives essentially the same answers. The program also im-proves imputation models by allowing researchers to put Bayesian priors on individual cell values, thereby including a great deal of potentially valuable and extensive information. It also includes features to accurately impute cross-sectional datasets, individual time series, or sets of time series for different cross-sections. A full set of graphical diagnostics are also available. The program is easy to use, and the simplicity of the algorithm makes it far more robust; both a simple command line and extensive graphical user interface are included.
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Whether restricting access to handguns will reduce firearm-related homicides and suicides is currently a matter of intense debate. In 1976 the District of Columbia adopted a law that banned the purchase, sale, transfer, or possession of handguns by civilians. We evaluated the effect of implementing this law on the frequency of homicides and suicides. Homicides and suicides committed from 1968 through 1987 were classified according to place of occurrence (within the District of Columbia or in adjacent metropolitan areas where the law did not apply), cause (homicide or suicide), mechanism of death (firearms or other means), and time of occurrence (before or after the implementation of the law). The number of suicides and homicides was calculated for each month during the study period, and differences between the mean monthly totals before and after the law went into effect were estimated. In Washington, D.C., the adoption of the gun-licensing law coincided with an abrupt decline in homicides by firearms (a reduction of 3.3 per month, or 25 percent) and suicides by firearms (reduction, 0.6 per month, or 23 percent). No similar reductions were observed in the number of homicides or suicides committed by other means, nor were there similar reductions in the adjacent metropolitan areas in Maryland and Virginia. There were also no increases in homicides or suicides by other methods, as would be expected if equally lethal means were substituted for handguns. Restrictive licensing of handguns was associated with a prompt decline in homicides and suicides by firearms in the District of Columbia. No such decline was observed for homicides or suicides in which guns were not used, and no decline was seen in adjacent metropolitan areas where restrictive licensing did not apply. Our data suggest that restrictions on access to guns in the District of Columbia prevented an average of 47 deaths each year after the law was implemented.
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PHYSICIANS have an understandable interest in the likely health consequences of keeping a gun in the home, so much so that some physicians have even urged that their fellow practitioners use their positions as guardians of health to persuade patients not to own guns, just as they might discourage drinking to excess, smoking cigarettes, or a sedentary lifestyle.1 Unfortunately, both a narrow focus on the home environment and a decidedly one-sided view of the violence-related uses to which guns are put has skewed the portrayal of this issue in medical journals. This article is intended to broaden the focus and introduce readers to relevant information that has not heretofore been presented, or has been presented in a misleading fashion, in the medical and public health literature on firearms and violence.
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This study examined errors in estimating household gun ownership that result from interviewing only 1 adult per household. Data from 2 recent telephone surveys and a series of in-person surveys were used to compare reports of household gun ownership by husbands and wives. In the telephone surveys, the rate of household gun ownership reported by husbands exceeded wives' reports by an average of 12 percentage points; husbands' reports also implied 43.3 million more guns. The median "gender gap" in recent in-person surveys is 7 percentage points. Future research should focus on respondents' reports about personally owned guns.
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Statistical power in matched case-control studies depends on both the correlation coefficient between cases and their matched controls (phi) and the prevalence of exposure among controls (P0). To examine the hypothesis that the value of increasing the control-to-case ratio beyond 5 varies with both phi and P0, the authors estimated statistical power for a hypothetical case-control study under different assumptions. The effect of increasing the control-to-case ratio depended on phi and, to a lesser extent, on P0. The results suggest that investigators consider including more than five controls per case when either phi is greater than about 0.2 or P0 is less than about 0.15. Am J Epidemiol 1999;149:195–7.
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To determine gun storage practices in gun-owning households with children. National random digit-dial telephone survey of 2521 households conducted in March 1999 through July 1999. This study uses a subsample of 434 households with children <18 years old in which a respondent reported either: 1) personally owning a gun, or 2) living in a gun-owning household but not owning a gun themselves. Respondents were asked whether any household gun was currently stored loaded, and, if yes, whether any gun was currently stored loaded and unlocked. Twenty-one percent of gun owners compared with 7% of non-owners reported that a household gun was stored loaded, while 9% and 2%, respectively, reported that a household gun was stored loaded and unlocked. Non-gun owners were significantly more likely than were gun owners to be female (87% vs 22%) and to report that they lived in a house with only 1 gun (70% vs 57%) and no handguns (51% vs 31%). Based on the reports of actual gun owners (n = 252), households with children <13 years old were significantly less likely to store a gun loaded and unlocked (multivariate odds ratio:.1; 95% confidence interval:.0,.4) than were households with teenagers only. We find that among gun-owning households with children, non-gun owners report significantly lower rates of guns stored loaded and unlocked than do gun owners. These findings are consistent with recent studies that have found that married men are far more likely to report household gun ownership than are married women, and that gun users are far more likely to report that a gun is stored loaded or loaded and unlocked than are never users. Our findings suggest that non-gun owners, the vast majority of whom are women (87%), may be unaware that guns in their homes are stored in a manner that experts agree is unsafe. Our findings reinforce the importance of many pediatricians' current efforts to offer anticipatory guidance about firearms to gun-owning families, and, in addition, suggest that this guidance can be adapted depending on whether the physician is speaking with a gun-owning or non-gun-owning parent. In particular, because gun owners (mostly fathers) are less likely to bring children to the pediatrician's office than are non-owners (mostly mothers), physicians should take advantage of any opportunities that they have to address gun-related issues with parents who personally own guns. More commonly, physicians can encourage non-gun owners to participate more fully in household decision-making about gun storage by letting them know not only about recommended storage practices, but also that many non-owners may not know how guns are actually stored in their own homes. firearm, storage, children, survey.
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This study examined incidence rates of medically identified suicide acts (self-inflicted injuries, either fatal or nonfatal) and case fatality rates by age, sex, race, and method used. The authors analyzed data on 10,892 suicides and 57,439 attempted suicides among hospital-admitted individuals in 8 states, along with 6219 attempted suicides among individuals released from emergency departments in 2 states. The 8 states experienced a mean of 11 suicides and 119 attempted suicides per 100,000 residents each year. Groups with high suicide rates were men, the elderly, and Whites; groups with high attempted suicide rates were teenagers, young adults, women, and Blacks and Whites aged 25 to 44 years. Blacks aged 15 to 44 years evidenced high attempted suicide rates undocumented in previous studies. Poisoning and firearm were the most common methods used among those attempting suicide and those completing suicide acts, respectively. The most lethal method was firearm. The characteristics of suicides and attempted suicides differ dramatically. Method used is important in the lethality of the act.
Article
This article has no abstract; the first 100 words appear below. Benneyan — Robert Noel Benneyan, M.D., of Greenfield, died on February 22. He was 56. Dr. Benneyan received his degree from Cornell University Medical College in 1958. He was a member of the American Medical Association and a fellow of the American College of Surgeons. Borenstein — Morris V. Borenstein, M.D., formerly of Springfield, died on March 4 at the age of 82. Dr. Borenstein received his degree from Universitaet Wien, Medizinische Fakultaet in 1936. He was a member of the American Physicians Fellowship, Inc., the American Psychiatric Association, and the American Society of Law and Medicine. Delisle — Antonio . . .
Article
Objectives. —To examine statewide data on exposure of adults and children to loaded and unlocked household firearms, and to estimate the prevalence of firearm carrying among adults in Oregon.Design. —Analyses of 1992 and 1993 telephone survey data from 6202 adults aged 18 years and older using the Oregon Behavioral Risk Factor Surveillance System.Main Outcome Measures. —Number of adults and children exposed to household firearms always or sometimes stored loaded and unlocked. Adjusted odds ratios (ORs) for exposure to loaded and unlocked firearms and firearm carrying among adults by demographic and alcohol use patterns.Results. —Ten percent of adults (197 400 persons) lived in households with firearms that were always or sometimes stored loaded and unlocked. An estimated 6.2% of households with children had firearms that were loaded and unlocked, and about 40 000 children lived in these households. Overall, 4.4% of adults carried loaded firearms in the past month. Rural residence, male sex, and less than a college education were associated with living in a household with loaded and unlocked firearms and with firearm carrying. Drinking 5 or more alcoholic beverages on 1 or more occasions in the past month (OR, 1.7; 95% confidence interval, 1.3-2.3) or drinking 60 or more alcoholic beverages in the past month (OR, 1.8; 95% confidence interval, 1.2-2.7) were independently associated with living in households with loaded and unlocked firearms.Conclusions. —Many adults and children are exposed to unsafely stored firearms in Oregon, and many adults carry loaded firearms. Improved public health surveillance of firearm storage and firearm carrying using standardized questions and definitions is needed at the national, state, and local levels.(JAMA. 1996;275:1744-1748)
Article
Objective. —To compare the risk of death and the risk of nonfatal injury during firearm-associated family and intimate assaults (FIAs) with the risks during non-firearm-associated FIAs.Design. —Records review of police incident reports of FIAs that occurred in 1984. Victim outcomes (death, nonfatal injury, no injury) and weapon involvement were examined for incidents involving only one perpetrator.Setting. —City of Atlanta, Ga, within Fulton County.Participants. —Stratified sample (n=142) of victims of nonfatal FIAs, drawn from seven nonfatal crime categories, plus all fatal victims (n=23) of FIAs.Main Outcome Measures. —Risk of death (vs nonfatal injury or no injury) during FIAs involving firearms, relative to other types of weapons; risk of nonfatal injury (vs all other outcomes, including death) during FIAs involving firearms, relative to other types of weapons.Results. —Firearm-associated FIAs were 3.0 times (95% confidence interval, 0.9 to 10.0) more likely to result in death than FIAs involving knives or other cutting instruments and 23.4 times (95% confidence interval, 7.0 to 78.6) more likely to result in death than FIAs involving other weapons or bodily force. Overall, firearmassociated FIAs were 12.0 times (95% confidence interval, 4.6 to 31.5) more likely to result in death than non-firearm-associated FIAs.Conclusions. —Strategies for limiting the number of deaths and injuries resulting from FIAs include reducing the access of potential FIA assailants to firearms, modifying firearm lethality through redesign, and establishing programs for primary prevention of violence among intimates.(JAMA. 1992;267:3043-3047)
Article
Background It is unknown whether keeping a firearm in the home confers protection against crime or, instead, increases the risk of violent crime in the home. To study risk factors for homicide in the home, we identified homicides occurring in the homes of victims in three metropolitan counties. Methods After each homicide, we obtained data from the police or medical examiner and interviewed a proxy for the victim. The proxies' answers were compared with those of control subjects who were matched to the victims according to neighborhood, sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. Results During the study period, 1860 homicides occurred in the three counties, 444 of them (23.9 percent) in the home of the victim. After excluding 24 cases for various reasons, we interviewed proxy respondents for 93 percent of the victims. Controls were identified for 99 percent of these, yielding 388 matched pairs. As compared with the controls, the victims more often ...
Background: In the United States, only motor vehicle crashes and cancer claim more lives among children than do firearms. This national study attempts to determine whether firearm prevalence is related to rates of unintentional firearm deaths, suicides, and homicides among children. Methods: Pooled cross-sectional time-series data (1988-1997) were used to estimate the association between the rate of violent death among 5-14 year olds and four proxies of firearm availability, across states and regions. Results: A statistically significant association exists between gun availability and the rates of unintentional firearm deaths, homicides, and suicides. The elevated rates of suicide and homicide among children living in states with more guns is not entirely explained by a state's poverty, education, or urbanization and is driven by lethal firearm violence, not by lethal nonfirearm violence. Conclusion: A disproportionately high number of 5-14 year olds died from suicide, homicide, and unintentional firearm deaths in states and regions where guns were more prevalent.
Article
More guns mean more deaths from crime and accidents. Yet in the u.s. many laws that regulate firearms are misdirected and ineffective. What we don Jt know about gun control can hurt us
Article
Objective. —The presence of guns in the home, the type of gun, and the method of storage were all hypothesized to be associated with risk for adolescent suicide.
Article
Background: Between 1979 and 1997, almost 30,000 Americans died from unintentional firearm injuries, half of whom were under 25 years of age and 4,600 of whom were less than 15 years old. Purpose: To explore the association between state firearm levels and rates of unintentional firearm deaths by age group, accounting for several potential confounders. Methods: The study used a proxy for firearm availability and pooled cross-sectional time-series data on unintentional firearm deaths for the 50 United States from 1979 to 1997. Negative binomial models were used to estimate the association between firearm availability and unintentional firearm deaths. Results: A statistically significant and robust association exists between gun availability and unintentional firearm deaths for the US as a whole and within each age group. Multivariate analysis found that, compared to states with the lowest gun levels, states with the highest gun levels had, on average, 9 times the rate of unintentional firearm deaths. These results hold among men and women, for Whites and African Americans. Conclusion: Of the almost 30,000 people who died in unintentional firearm deaths over the 19-year study period, a disproportionately high number died in states where guns are more prevalent. The results suggest that the increased risk of unintentional violent death among all age groups is not entirely explained by a state's level of poverty, urbanization, or regional location.
Article
It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period. For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5). Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.
Article
To study the potential differences that distinguish homicides involving women as victims or offenders from those involving men, we analyzed Federal Bureau of Investigation Uniform Crime Reports data on homicides that occurred in the United States between 1976 and 1987. Only cases that involved victims aged 15 years or older were included. Persons killed during law enforcement activity and cases in which the victim's gender was not recorded were excluded. A total of 215,273 homicides were studied, 77% of which involved male victims and 23% female victims. Although the overall risk of homicide for women was substantially lower than that of men (rate ratio [RR] = 0.27), their risk of being killed by a spouse or intimate acquaintance was higher (RR = 1.23). In contrast to men, the killing of a woman by a stranger was rare (RR = 0.18). More than twice as many women were shot and killed by their husband or intimate acquaintance than were murdered by strangers using guns, knives, or any other means. Although women comprise more than half the U.S. population, they committed only 14.7% of the homicides noted during the study interval. In contrast to men, who killed nonintimate acquaintances, strangers, or victims of undetermined relationship in 80% of cases, women killed their spouse, an intimate acquaintance, or a family member in 60% of cases. When men killed with a gun, they most commonly shot a stranger or a non-family acquaintance.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The logistic regression model is being used with increasing frequency in all areas of public health research. In the calendar year 1989, over 30% of the articles published in the American Journal of Public Health employed some form of logistic regression modeling. In spite of this increase, there has been no commensurate increase in the use of commonly available methods for assessing model adequacy. We review the current status of the use of logistic regression modeling in the American Journal of Public Health. We present a brief overview of currently available and easily used methods for assessing the adequacy of a fitted logistic regression model. An example is used to demonstrate the methods as well as a few of the adverse consequences of failing to assess the fit of the model. One important adverse consequence illustrated in the example is the inclusion of variables in the model as a result of the influence of one subject. Failure to address model adequacy may lead to misleading or incorrect inferences. Recommendations are made for the use of methods for assessing model adequacy and for future editorial policy in regard to the review of articles using logistic regression.
Article
An ultimate goal of human genetics is the generation of a complete physical and ''functional'' map of the human genome. Twenty-five percent of human DNA, however, consists of repetitive DNA sequences. These repetitive DNA sequences are thought to arise by many mechanisms, from direct sequence amplification by the unequal recombination of homologous DNA regions to the reverse flow of genetic information. A general outline of the chromosomal organization of these repetitive sequences will be discussed. Our working hypothesis is that certain classes of human repetitive DNA sequences ''encode'' the information necessary for defining long-range genomic structure. Evidence will be presented that the first goal of this research, the identification and cloning of the human telomere, has been achieved. A human repetitive DNA library was constructed from randomly sheared, reassociated, and oligo(G/center dot/C)-tailed DNA, a method that minimizes the potential loss of sequences devoid of a given restriction enzyme site. Sequences too large to clone efficiently in cosmid or /lambda/ vectors, such as centromeric repeats, or telomeric sequences with an end incompatible for cloning, should be present in this library. In order to isolate highly conserved repetitive DNA sequences, this library was screened with radiolabeled hamster Cot50 repetitive DNA. Two clones,more » containing tandem arrays of the sequence (TTAGGG), were isolated by this method. 30 refs., 1 fig., 2 tabs.« less
Article
We conducted a two-part study of unintentional firearm deaths in California. First, we analyzed death certificate data for the 688 unintentional firearm deaths of California residents occurring during 1977-1983. Mortality rates were 7.5 for males, 0.9 for females, 4.8 for whites, and 5.3 for blacks, all per million persons per year. Males ages 15-24 had the highest rate (17 per million persons per year). We then investigated the 131 childhood deaths in greater detail, using coroners' or medical examiners' reports. Most of these shootings occurred at a residence. Handguns were involved more frequently than predicted by their reported availability in homes in the region. Almost two thirds of child deaths resulted from head wounds, reinforcing the importance of primary prevention. At least 40% of child deaths in this study appeared in part to be attributable to defects in firearm performance or current firearm design practices, suggesting that improvements should be sought and mandated.
Article
To investigate the associations among handgun regulations, assault and other crimes, and homicide, we studied robberies, burglaries, assaults, and homicides in Seattle, Washington, and Vancouver, British Columbia, from 1980 through 1986. Although similar to Seattle in many ways, Vancouver has adopted a more restrictive approach to the regulation of handguns. During the study period, both cities had similar rates of burglary and robbery. In Seattle, the annual rate of assault was modestly higher than that in Vancouver (simple assault: relative risk, 1.18; 95 percent confidence interval, 1.15 to 1.20; aggravated assault: relative risk, 1.16; 95 percent confidence interval, 1.12 to 1.19). However, the rate of assaults involving firearms was seven times higher in Seattle than in Vancouver. Despite similar overall rates of criminal activity and assault, the relative risk of death from homicide, adjusted for age and sex, was significantly higher in Seattle than in Vancouver (relative risk, 1.63; 95 percent confidence interval, 1.28 to 2.08). Virtually all of this excess risk was explained by a 4.8-fold higher risk of being murdered with a handgun in Seattle as compared with Vancouver. Rates of homicide by means other than guns were not substantially different in the two study communities. We conclude that restricting access to handguns may reduce the rate of homicide in a community.
Article
The characteristics of adolescent suicide victims (n = 27) were compared with those of a group at high risk for suicide, suicidal psychiatric inpatients (n = 56) who had either seriously considered (n = 18) or actually attempted (n = 38) suicide. The suicide victims and suicidal inpatients showed similarly high rates of affective disorder and family histories of affective disorder, antisocial disorder, and suicide, suggesting that among adolescents there is a continuum of suicidality from ideation to completion. However, four putative risk factors were more prevalent among the suicide victims: (1) diagnosis of bipolar disorder; (2) affective disorder with comorbidity; (3) lack of previous mental health treatment; and (4) availability of firearms in the homes, which taken together accurately classified 81.9% of cases. In addition, suicide completers showed higher suicidal intent than did suicide attempters. These findings suggest a profile of psychiatric patients at high risk for suicide, and the proper identification and treatment of such patients may prevent suicide in high-risk clinical populations.
Article
To assess the association between firearms in the home and adolescent suicide. Matched, case-control. Population-based community sample. Sixty-seven adolescent suicide victims and a demographically matched group of 67 living community controls. The series of adolescent suicide victims was consecutive, with an overall participation rate of 74% (67/91). The presence, type (hand-gun vs long-gun), number, and method of storage (locked vs unlocked, loaded vs unloaded) of firearms in the home were compared between the suicide victims and controls. Even after adjusting for differences in rates of psychiatric disorders between suicide victims and controls, the association between suicide and both any gun (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 1.1 to 17.5) and handguns (OR = 9.4, 95% CI = 1.7 to 53.9) in the home were both highly significant. Long-guns in the home were associated with suicide only in rural areas, whereas handguns were more closely associated with suicide in urban areas. Handguns (OR = 12.9, 95% CI = 1.5 to 110.9) and loaded guns (OR = 32.3, 95% CI = 2.5 to 413.4) in the home were particularly significant risk factors for suicide in those with no apparent psychiatric disorder. When pediatricians are faced with a suicidal adolescent, they should insist on the removal of firearms from the home. Pediatricians should also inform parents that the presence of firearms may be associated with adolescent suicide even in the absence of clear psychiatric illness.
Article
It is unknown whether keeping a firearm in the home confers protection against crime or, instead, increases the risk of violent crime in the home. To study risk factors for homicide in the home, we identified homicides occurring in the homes of victims in three metropolitan counties. After each homicide, we obtained data from the police or medical examiner and interviewed a proxy for the victim. The proxies' answers were compared with those of control subjects who were matched to the victims according to neighborhood, sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. During the study period, 1860 homicides occurred in the three counties, 444 of them (23.9 percent) in the home of the victim. After excluding 24 cases for various reasons, we interviewed proxy respondents for 93 percent of the victims. Controls were identified for 99 percent of these, yielding 388 matched pairs. As compared with the controls, the victims more often lived alone or rented their residence. Also, case households more commonly contained an illicit-drug user, a person with prior arrests, or someone who had been hit or hurt in a fight in the home. After controlling for these characteristics, we found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide (adjusted odds ratio, 2.7; 95 percent confidence interval, 1.6 to 4.4). Virtually all of this risk involved homicide by a family member or intimate acquaintance. The use of illicit drugs and a history of physical fights in the home are important risk factors for homicide in the home. Rather than confer protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance.
Article
To examine statewide data on exposure of adults and children to loaded and unlocked household firearms, and to estimate the prevalence of firearm carrying among adults in Oregon. Analyses of 1992 and 1993 telephone survey data from 6202 adults aged 18 years and older using the Oregon Behavioral Risk Factor Surveillance System. Number of adults and children exposed to household firearms always or sometimes stored loaded and unlocked. Adjusted odds ratios (ORs) for exposure to loaded and unlocked firearms and firearm carrying among adults by demographic and alcohol use patterns. Ten percent of adults (197 400 persons) lived in households with firearms that were always or sometimes stored loaded and unlocked. An estimated 6.2% of households with children had firearms that were loaded and unlocked, and about 40 000 children lived in these households. Overall, 4.4% of adults carried loaded firearms in the past month. Rural residence, male sex, and less than a college education were associated with living in a household with loaded and unlocked firearms and with firearm carrying. Drinking 5 or more alcoholic beverages on 1 or more occasions in the past month (OR, 1.7; 95% confidence interval, 1.3-2.3) or drinking 60 or more alcoholic beverages in the past month (OR, 1.8; 95% confidence interval, 1.2-2.7) were independently associated with living in households with loaded and unlocked firearms. Many adults and children are exposed to unsafely stored firearms in Oregon, and many adults carry loaded firearms. Improved public health surveillance of firearm storage and firearm carrying using standardized questions and definitions is needed at the national, state, and local levels.
Article
This study examined the association between access to a firearm and risk of suicide in a consecutive sample of individuals who had made serious suicide attempts. The study used a case control design in which a sample of 197 individuals who died by suicide and 302 individuals who made medically serious suicide attempts was contrasted with 1028 randomly selected community control subjects. Suicide attempts by gunshot accounted for 1.3% of all serious suicide attempts (with non-fatal outcome) and 13.3% of suicides. However, among those making serious suicide attempts, gunshot had a high rate of fatality (83.3%). While access to a firearm was associated with increased risks that gunshot would be chosen as the method of suicide attempt (OR = 107.9; CI = 24.8-469.5), this access was not associated with significant increases in the risk of suicide (OR = 1.4; CI = 0.96-1.99). For this sample, access to a firearm was not associated with a significant increase in the risk of suicide, although such access was associated with an increased probability that gunshot would be chosen as the method of suicide attempt.
Article
The purpose of this study was to determine whether purchase of a handgun from a licensed dealer is associated with the risk of homicide or suicide and whether any association varies in relation to time since purchase. A case-control study was done among the members of a large health maintenance organization. Case subjects were the 353 suicide victims and 117 homicide victims among the members from 1980 through 1992. Five control subjects were matched to each case subject on age, sex, and zip code of residence. Handgun purchase information was obtained from the Department of Licensing. The adjusted relative risk of suicide was 1.9 (95% confidence interval [CI] = 1.4, 2.5) for persons with a history of family handgun purchase from a registered dealer. The adjusted relative risk for homicide, given a history of family handgun purchase, was 2.2 (95% CI = 1.3, 3.7). For both suicide and homicide, the elevated relative risks persisted for more than 5 years after the purchase. Legal purchase of a handgun appears to be associated with a long-lasting increased risk of violent death.
Article
To the Editor: An independent review of the data from a case–control study of gun ownership as a risk factor for homicide in the home, reported by my colleagues and me (Oct. 7, 1993, issue),1 has identified an inaccuracy in our response to the letters to the editor about the study (Feb. 3, 1994, issue).2 In the fourth paragraph of our response, we reported, “Ninety-three percent of the homicides involving firearms occurred in homes where a gun was kept, according to the proxy respondents.” What we should have said was that 93 percent of proxy respondents for victims of homicide . . .