Past Firearm Research Projects

Researchers at the Firearm Injury & Policy Research Program have decades of experience bringing a public health approach to firearm research.

Our published research goes back to 1982, including projects around alcohol and firearms, suicide, homicide, firearm access, firearm storage, firearm policy, and much more.

Completed Research Projects

Alcohol & Firearms

2018

Firearm storage and adult alcohol misuse among Washington State households with children – Children living in a household with an adult who misuses alcohol may be more likely to live with an unsafely stored firearm, which is concerning given the association between adult alcohol misuse and children’s risk for sustaining injury.

Prior arrest, substance use, mental disorder, and intent-specific firearm injury – Individuals with intent-specific firearm injuries have distinct patterns of prior substance use, mental disorder, and arrest. Many injuries occur after a series of encounters with institutions meant to help individuals during crises that can fail to provide longer-term solutions.

State-level beer excise tax and firearm homicide in adolescents and young adults – Among individuals aged 15–34 years, price-sensitive consumption of beer may represent one feasible tool for policymakers seeking to reduce rates of firearm homicide.

Suicide

2019

Household firearm ownership and storage, suicide risk factors, and memory loss among older adults: Results from a statewide survey – In this statewide representative study of older adults in Washington, the prevalence of mental health or memory loss indicators did not vary by household firearm ownership or storage practices. Given the association between firearm ownership and suicide, limiting access to lethal weapons for the older adult population represents an important avenue for suicide prevention. This is especially important among aging adults with firearms in the home who are beginning to show symptoms of depression or dementia.

2018

Firearm ownership, storage practices, and suicide risk factors in Washington State, 2013-2016 – Variability in mental health does not explain the substantial increased suicide risk among individuals in firearm-owning households. Greater prevalence of alcohol misuse among adults in firearm-owning households not practicing safe storage highlights the need for suicide prevention interventions.

Reducing youth firearm suicide risk: Evidence for opportunities (Commentary) – The increased rate of youth firearm suicide over two decades indicates failure of both health care and public health systems to adequately address prevention of these tragic injuries and deaths. The article by Scott et al. tells us that we have much more to learn about how to successfully engage families in reducing access to guns in the home.

2015

Psychiatric comorbidity, suicidality, and in-home firearm access among a nationally representative sample of adolescents – Adolescents with risk factors for suicide were just as likely to report in-home firearm access as those without such risk factors. Given that firearms are the second most common means of suicide among adolescents, further attention to developing and implementing evidence-based strategies to decrease firearm access in this age group is warranted.

2005

An evaluation of state firearm regulations and homicide and suicide death rates – A “shall issue” law that eliminates most restrictions on carrying a concealed weapon may be associated with increased firearm homicide rates. No law was associated with a statistically significant reduction in firearm homicide or suicide rates.

Gun storage practices and risk of youth suicide and unintentional firearm injuries – The practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.

1997

The association between the purchase of a handgun and homicide or suicide – For both suicide and homicide, the elevated relative risks persisted for more than five years after the purchase. Legal purchase of a handgun appears to be associated with a long-lasting increased risk of violent death.

1992

Suicide in the home in relation to gun ownership – 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.

Risk and prevention of youth suicide – The rate of fatal suicide attempts among males rose dramatically between 1950 and 1980 and has continued to rise significantly during the 1980s among 15- to 19-year-old youth. Nonfatal suicide attempts, although far more frequent among females, appear to share similar risk factors with completed suicide (e.g., a history of a previous attempt, major affective and conduct disorders, chronic substance abuse, and a history of personal losses, including experience of suicide attempts by peers and family members, acute disruption of an interpersonal relationship, alcohol intoxication, and access to firearms). Families with household firearms should be counseled regarding the risk of firearm injury and death, particularly in a home with an individual with other risk factors. Community campaigns to improve the mental health of youth and to reduce firearm ownership may hold future promise for the reduction of the unacceptable morbidity and mortality associated with adolescent suicide attempts.

1990

Firearm regulations and rates of suicide – A comparison of two metropolitan areas – The risk of death from suicide was not found to differ significantly between King County and the Vancouver area. The rate of suicide by firearms, however, was higher in King County, because the rate of suicide by handguns was 5.7 times higher there. The difference in the rates of suicide by firearms was offset by a 1.5-fold higher rate of suicide by other means in the Vancouver area. Persons 15 to 24 years old had a higher suicide rate in King County than in the Vancouver area. Virtually all the difference was due to an almost 10-fold higher rate of suicide by handguns in King County. Restricting access to handguns might reduce the suicide rate in persons 15 to 24 years old, but would probably not reduce the overall suicide rate.

Homicide

2019

State-level beer excise tax and firearm homicide in adolescents and young adults – Among individuals aged 15–34 years, price-sensitive consumption of beer may represent one feasible tool for policymakers seeking to reduce rates of firearm homicide.

Long-lasting consequences of gun violence and mass shootings (Viewpoint) – Mass shootings are gradually changing the character of US public life. Continued efforts on policy and practice fronts to prevent these events from occurring in the first place are needed. In the meantime, it is also imperative to appropriately invest in posttraumatic health and mental health service utilization to reduce the heavy toll of both short-term and long-term consequences of these tragedies for US society.

Intimate partner homicide of adolescents – In this multistate study of homicides of 2188 individuals aged 11 to 18 years, 150 were perpetrated by an intimate partner. Intimate partner homicide victims were largely female and killed by a firearm, and homicides often involved broken relationships or jealousy. Intimate partner homicide of adolescents is an important problem that warrants further study and proactive intervention.

Income inequality and firearm homicide in the US: A county-level cohort study – The Gini Index was associated with firearm homicide rates among all races/ethnicities. After accounting for contextual determinants of firearm homicide, the association persisted among African–Americans. Exploratory spatial analyses did not materially change the results. Policies addressing the gap between the rich and the poor deserve further considerations for reducing firearm homicide rates. Incorporating income inequality to refine measures of socioeconomic position may advance public health and clinical research and practice for firearm violence prevention.

2018

A retrospective time trend study of firearm and non-firearm homicide in Cape Town from 1994 to 2013 – The strong association between firearm availability and homicide, and the reversal of a decreasing firearm homicide trend during a period of lax enforcement, provide further support for the association between reduced firearm homicide and stricter regulation.

2005

An evaluation of state firearm regulations and homicide and suicide death rates – A “shall issue” law that eliminates most restrictions on carrying a concealed weapon may be associated with increased firearm homicide rates. No law was associated with a statistically significant reduction in firearm homicide or suicide rates.

2000

Firearm safety counseling in primary care pediatrics: A randomized, controlled trial – A single firearm safety-counseling session during well-child care, combined with economic incentives to purchase safe storage devices, did not lead to changes in household gun ownership and did not lead to statistically significant overall changes in storage patterns.

The rise and decline of homicide – and why – A dramatic rise in homicide in the latter half of the 1980s peaked during the 1990s and then declined at an equally dramatic rate. Such trends in homicide rates can be understood only by examining rates in specific age, sex, and racial groups. The increase primarily involved young males, especially black males, occurred first in the big cities, and was related to the sudden appearance of crack cocaine in the drug markets of the big cities around 1985. This development led to an increased need for and use of guns and was accompanied by a general diffusion of guns into the larger community. The decline in homicide since the early 1990s has been caused by changes in the drug markets, police response to gun carrying by young males, especially those under 18 years old, the economic expansion, and efforts to decrease general access to guns, as well as an increase in the prison population and a continued decline in homicide among those over age 24. The lessons learned from the recent homicide trends and the factors associated with them have important implications for public health and the criminal justice system.

1997

The association between the purchase of a handgun and homicide or suicide – For both suicide and homicide, the elevated relative risks persisted for more than five years after a family handgun purchase. Legal purchase of a handgun appears to be associated with a long-lasting increased risk of violent death.

Risk factors for violent death of women in the home – Among women, mental illness and living alone increase the risk of suicide in the home, and household use of illicit drugs and prior domestic violence increase the risk of homicide. Instead of conferring protection, keeping a gun in the home is associated with increased risk of both suicide and homicide of women. Household use of illicit drugs, domestic violence, and readily available firearms place women at particularly high risk of homicide at the hands of a spouse, an intimate acquaintance, or a close relative. Many factors place women at increased risk of violent death in the home. Community- and clinic-based interventions should target those with identifiable risk factors.

1993

Gun ownership as a risk factor for homicide in the home – 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.

1988

Handgun regulations, crime, assaults, and homicide – A tale of two cities – 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. 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. 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. Restricting access to handguns may reduce the rate of homicide in a community.

Lethality of Firearms

2018

Trends in firearm injury and motor vehicle crash case fatality by age group, 2003-2013 – In this repeated cross-sectional measures analysis of data on patients treated at level I or II trauma centers from 2003 to 2013, firearm assault and self-inflicted firearm injury were highly lethal in terms of case-fatality percentage and the percentage of out-of-hospital deaths. Annual trends significantly declined for motor vehicle crashes in all age groups but not for firearms in any intent or age group. Seen alongside trends in case-fatality percentage for motor vehicle crashes, it appears that injuries resulting from firearms may be worsening in severity.

Public perceptions of firearm- and non-firearm-related violent death in the United States: A national study – Using data from the National Firearms Survey, a nationally representative Web-based survey of U.S. adults was conducted by Growth for Knowledge in April 2015. A total of 3,949 participants were presented with four options on the intent and means of violent death (i.e., homicide with a gun, homicide with a weapon other than a gun, suicide with a gun, and suicide by a method other than a gun) and asked to rank order the frequency of these outcomes in their state in an average year.

Prior arrest, substance use, mental disorder, and intent-specific firearm injury – Individuals with intent-specific firearm injuries have distinct patterns of prior substance use, mental disorder, and arrest. Many injuries occur after a series of encounters with institutions meant to help individuals during crises that can fail to provide longer-term solutions.

Global mortality from firearms, 1990-2016 – Using a combination of deidentified aggregated data from vital registration, verbal autopsy, census and survey data, and police records in models for 195 countries and territories, this study estimated 251,000 people died globally from firearm injuries in 2016, compared with 209,000 deaths in 1990. There was an annualized decrease of 0.9% in the global rate of age-standardized firearm deaths from 1990 to 2016. This study provides an estimate of the global burden of firearms deaths in 2016, change in this burden from 1990, and variation in levels and rates among countries.

Firearm-related mortality: A global public health problem (Editorial) – In the United States, research on firearm violence has been impeded by the Dickey amendment, which has largely prevented the Centers for Disease Control and Prevention and other federal agencies from funding such research since 1996. In the absence of this funding, several private foundations have stepped in to fill the void. However, real progress in addressing the vast public health problem that the Global Burden of Injury Collaborators document will depend on sustained action from governments in both research and policy.

2017

Death by gun violence – A public health crisis (Editorial) – Guns kill people. More background checks; more hotel, school, and venue security; more restrictions on the number and types of guns that individuals can own; and development of “smart guns” may help decrease firearm violence. But the key to reducing firearm deaths in the United States is to understand and reduce exposure to the cause, just like in any epidemic, and in this case that is guns.

Firearm injury after gun shows: Evidence to gauge the potential impact of regulatory interventions (Editorial) – The data in Matthay and colleagues’ study may suggest some association between gun shows and self-directed and unintentional firearm injuries, but the estimates were not statistically significant. It is often forgotten that about two thirds of firearm deaths in the United States are suicides. A prior study by Wintemute and colleagues showed that purchasers of a handgun had a 57-fold and seven-fold increased risk for firearm suicide in the first week and first year, respectively, after purchase . Evidence indicates that the means available to commit self-harm matter and that restricting the most lethal means (that is, firearms) can prevent the loss of lives due to suicide. Also, future research should examine whether gun shows affect unintentional firearm injuries, and if so, what plausible explanations might exist.

Use of firearms in terrorist attacks: Differences between the United States, Canada, Europe, Australia, and New Zealand – Although firearms were used in fewer than 10% of terrorist attacks between 2002 and 2016, they accounted for about 55% of the fatalities. Among countries with 10 or more attacks, the proportion involving firearms in the United States was higher than in any other nation. Moreover, the risk of fatality was considerably higher in attacks committed with firearms than in attacks using other weapons. In the United States and other countries, government policies and legislative efforts to protect citizens from terrorism should consider the proportions and lethality of terrorist attacks committed with firearms.

Guns and violent media—A toxic mix with an available antidote (Editorial) – Three-quarters of parents believe that pediatricians should advise about the safe storage of firearms. The 11th Circuit Court of Appeals has recently ruled that laws such as Florida’s that restrict the ability of pediatricians to ask families about guns in the home are unconstitutional based on their restriction of the First Amendment rights of physicians.

2016

Violence perpetration among patients hospitalized for unintentional and assault-related firearm injury: A case-control study and a cohort study – Patients with unintentional firearm injuries were more likely than those with other unintentional injuries and no injuries to have been arrested for a violent crime before hospitalization. Prior violence-related arrest did not differ between patients with assault-related firearm injuries and those with other assault-related injuries. During follow-up, the cumulative incidence of violence-related arrest for patients with unintentional and assault-related firearm injuries was 10% and 15%, respectively, compared with 1% for those without injuries. Some firearm injuries classified as accidental may indicate involvement in the cycle of violence and present an opportunity for intervention.

Gunshot-induced aorto-left atrial fistula diagnosed by intraoperative transesophageal echocardiography (TEE) – This article described a case of traumatic aorto-left atrial fistula caused by a gunshot injury, for which diagnostic intraoperative TEE played a pivotal role. In gunshot-induced thoracic injury, a comprehensive TEE should be considered to fully inspect the cardiopulmonary system. This might be especially relevant in cases where hemodynamic compromise remains largely unexplained by findings provided by other imaging modalities such as TTE.

Unsafe and understudied: The US gun problem (Editorial) – Gun violence is unequally distributed in the US and elsewhere. Research, prevention, and resources should be focused on those communities that bear the greatest burden of violence. By taking basic steps to permit public health research, we can finally begin to understand the sources of the current epidemic of violence and how best to control it. Only hard evidence will cool the heat of gun rhetoric and address this critical worldwide problem.

A geospatial analysis of severe firearm injuries compared to other injury mechanisms: Event characteristics, location, timing and outcomes – Severe firearm events tend to occur within a patient’s own neighborhood, often at home, and generally outside of geospatial clusters. Public health efforts should focus on the home in all types of neighborhoods to reduce firearm violence.

2015

Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: A cohort study – Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted.

1999

Self-inflicted and unintentional firearm injuries among children and adolescents: The source of the firearm – Of 56 fatal injuries and 68 nonfatal firearm injuries, 59 were intentionally self-inflicted deaths and injuries and 65 were unintentional deaths and injuries. A firearm owned by a household member living with the victim was used in 33 of 51 suicides and suicide attempts and 11 of 47 unintentional injuries and deaths. Additionally, a firearm owned by another relative, friend, or parent of a friend of the victim was used in 4 of the 51 suicides and suicide attempts and 23 of the 47 unintentional injuries and deaths. Parental ownership accounted for 29 of the 51 suicides and suicide attempts and 9 of the 47 unintentional injuries and deaths. More than 75% of the guns used in suicide attempts and unintentional injuries were stored in the residence of the victim, a relative, or a friend. Most guns involved in self-inflicted and unintentional firearm injuries originate either from the victim’s home or the home of a friend or relative.

1998

Injuries and deaths due to firearms in the home – Guns kept in homes are more likely to be involved in a fatal or nonfatal accidental shooting, criminal assault, or suicide attempt than to be used to injure or kill in self-defense.

Preventing youth violence: What works? – Between 1985 and 1992, serious youth violence in the United States surged to unprecedented levels. The growing use of firearms to settle disputes has contributed to this phenomenon. Youth are most often victimized by one of their peers. In response to this problem, a wide variety of programs have been implemented in an attempt to prevent youth violence or reduce its severity. Few have been adequately evaluated. In general, interventions applied between the prenatal period and age six appear to be more effective than interventions initiated in later childhood or adolescence. Community-based programs that target certain high-risk behaviors may be beneficial as well. A sustained commitment to evaluation research is needed to identify the most effective approaches to youth violence prevention.

1997

State gun safe storage laws and child mortality due to firearms – State safe storage laws intended to make firearms less accessible to children appear to prevent unintentional shooting deaths among children younger than 15 years.

1996

Injuries due to firearms in three cities – Injuries due to firearms, most involving handguns, are a major cause of morbidity and mortality in U.S. urban areas. The incidence varies greatly from city to city. The crude rate of firearm injury per 100,000 person-years was 222.6 in Memphis, 143.6 in Galveston, and 54.1 in Seattle. Approximately 88% of the injuries were incurred during confirmed or probable assaults; 7% were sustained in the course of suicide or attempted suicide; unintentional injuries accounted for 4% of the cases. Handguns were used in 88% of the cases in which the type of weapon was recorded. Five percent of the victims who were brought to a hospital emergency department could not be resuscitated; 53% were hospitalized, and 42% were treated and released. Ninety-seven percent of the deaths occurred within 24 hours of the injury.

Pediatric amputation injuries: Etiology, cost, and outcome – Over a 10-year period at a regional Level 1 trauma center, there were 47 injuries to the upper extermity, and 30 to the lower extremity. The average length of stay for these injured children was 11.3 days, with a mean of 4.3 procedures in 2.3 surgeries and average charges of $22,015. Twenty-two percent of the injuries were caused by power lawn mowers; all of these patients had amputations. Motor vehicle related crashes accounted for 16% of all injuries; 77% of these ultimately had amputations. Gunshot wounds had the highest mean length of hospital stay, surgery days, number of procedures, and charges. Out of 32 extremities that were revascularized for attempted salvage, 27 were successful, all in the upper extremity, and all but one were digits.

Prevention of traumatic deaths to children in the United States: How far have we come and where do we need to go? – Although great strides have been made in preventing deaths from trauma, the application of currently available prevention strategies could save a large number of additional lives. However, the increasing problem of intentional injury will partly counterbalance the success in unintentional injury control.

1992

Injury control in childhood – This article examines injuries from a behavioral perspective and provides information to the clinician to use in his or her practice or community. The authors consider behavior from a broad perspective and discuss not only the child’s behavior but that of the parents and the community at large.

1985

Traumatic deaths of children in the United States: Currently available prevention strategies – With the implementation of only 12 currently available prevention strategies, childhood deaths from trauma could be reduced by 29% in the United States. The implications of these strategies are discussed in this article, as well as the areas for which no effective countermeasures exist and which require further epidemiologic and investigative research.

1983-1985

Epidemiology of violent deaths in children and adolescents in the United States – Injuries are the largest cause of death in children and adolescents after the first year of life. Injuries more than any other disease result in 3.5 million years of potential life lost. Poor children are particularly at risk of dying from trauma, particularly fires and drownings. The patterns of different types of childhood injuries are discussed, including motor vehicle occupants, pedestrian, bicycle and motorcycle injuries, fire and flame injuries, drownings, and firearm deaths. The article outlines areas where few effective strategies are available and where further research should be concentrated.

1982

Handguns and children: A dangerous mix – Injuries are the leading causes of death from some months before the first birthday to age 34. Many pediatricians and health care providers are unaware that firearms are important contributors to this morbidity and mortality among children and adolescents. The data which have become available demonstrate the increasing prevalence of the problem and should concern those involved in improving child health in the United States.

Access to Firearms & Safe Storage

2019

Prevention of Firearm Injuries Among Children and Adolescents: Consensus-Driven Research Agenda from the Firearm Safety Among Children and Teens (FACTS) Consortium – Overall, 26 priority agenda items with examples of specific research questions were identified across five major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement. These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next five years.

Limiting Access to Firearms as a Suicide Prevention Strategy Among Adults: What Should Clinicians Recommend? – The most evidence-based and conceptually sound recommendation for suicide prevention remains the same for adults with elevated suicide risk who reside in homes with firearms: removing firearms from the home is likely to offer the greatest suicide risk reduction. However, studies have not delineated to what extent adults will follow this advice. In that scenario, Dempsey and colleagues have provided additional support for recommending changes in other firearm behaviors to potentially reduce suicide risk.

Household firearm ownership and storage, suicide risk factors, and memory loss among older adults: Results from a statewide survey – In this statewide representative study of older adults in Washington, the prevalence of mental health or memory loss indicators did not vary by household firearm ownership or storage practices. Given the association between firearm ownership and suicide, limiting access to lethal weapons for the older adult population represents an important avenue for suicide prevention. This is especially important among aging adults with firearms in the home who are beginning to show symptoms of depression or dementia.

2018

Firearm storage and adult alcohol misuse among Washington State households with children – Children living in a household with an adult who misuses alcohol may be more likely to live with an unsafely stored firearm, which is concerning given the association between adult alcohol misuse and children’s risk for sustaining injury.

Firearm storage practices among American Veterans – Storing a firearm loaded and unlocked is common among Veterans. Storage practices are strongly related to reasons for ownership and potentially malleable perceptions including beliefs about firearm-related risks. Suicide prevention initiatives among Veterans should incorporate communication strategies that address common misperceptions about household firearm risk and whether safe storage practices may better align with reasons most Veterans own firearms (i.e., safety)—especially when someone in their home is at increased risk for suicide.

Firearm ownership, storage practices, and suicide risk factors in Washington State, 2013-2016 – Variability in mental health does not explain the substantial increased suicide risk among individuals in firearm-owning households. Greater prevalence of alcohol misuse among adults in firearm-owning households not practicing safe storage highlights the need for suicide prevention interventions.

2017

Loaded handgun carrying among US adults, 2015 – We estimate that nine million US adult handgun owners carry loaded handguns monthly, three million do so every day, and most report protection as the main carrying reason. Proportionally fewer handgun owners carry concealed loaded handguns in states that allow issuing authorities substantial discretion in granting carrying permits.

Firearm storage practices in households of adolescents with and without mental illness – Adolescents with mental illness were present in 141 of 279 study households. Their mean age was 14.5 years, and 54.8% were male. The mean age of parent/guardian respondents was 47 years, and 17.9% were male. Respondents from nearly 70% of households reported that all household firearms were stored locked and unloaded. There were no significant differences in the prevalence of three firearm storage practices or in beliefs relevant to those practices between households of adolescents with and without mental illness. These findings add to a growing body of evidence suggesting that firearm storage practices do not differ based on household mental health risk factors for self-harm.

Evaluation of a community-based safe firearm and ammunition storage intervention – This intervention that included distribution of a free, participant-selected locking device improved safe firearm storage practices among participants. Differences in participant preferences for devices and safety counsellors suggest that a “one size fits all” approach may be inadequate in affecting population-level storage practices.

Access to a loaded gun without adult permission and school-based bullying – Adolescents who experience bullying, particularly those who report both traditional bullying and cyberbullying, are more likely to report access to a loaded gun without adult permission. These findings highlight the importance of developing interventions focused on these modifiable risk factors for preventing self-directed or interpersonal violence among youth.

2016

Effectiveness of interventions to promote safe firearm storage – Despite supportive evidence for an association between safe firearm storage and lower risk of firearm injury, the effectiveness of interventions that promote such practices remains unclear. Although additional studies are needed, the totality of evidence suggests that counseling augmented by device provision can effectively encourage individuals to store their firearms safely.

2015

Psychiatric comorbidity, suicidality, and in-home firearm access among a nationally representative sample of adolescents – Adolescents with risk factors for suicide were just as likely to report in-home firearm access as those without such risk factors. Given that firearms are the second most common means of suicide among adolescents, further attention to developing and implementing evidence-based strategies to decrease firearm access in this age group is warranted.

2012

Improving firearm storage in Alaska native villages: A randomized trial of household gun cabinets – Gun cabinet installation in rural Alaskan households improved the storage of guns and ammunition. If these gains are sustained over time, it may lead to a reduction in gun-related injuries and deaths in this population.

2005

Evaluation of a community-based handgun safe-storage campaign – In both the study’s intervention (i.e., King County) and control counties, households were more likely to lock all handguns in 2001 compared with 1996. After accounting for temporal trends, an educational campaign, combined with economic incentives to purchase lock boxes, did not seem to significantly change safe storage practices in households with handguns and children. Even if the campaign did result in small improvements in firearm safe storage, simultaneous national and state-specific gun-safety activities or legislative efforts may have drawn increasing attention to gun-related issues in the control counties, thereby making it more difficult to identify effects of our specific handgun storage intervention.

Gun storage practices and risk of youth suicide and unintentional firearm injuries – The practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.

2003

Community based program to improve firearm storage practices in rural Alaska – A community-based program demonstrated that Alaska Native gun owners accepted and used gun safes when they were installed in their homes, leading to substantial improvements in gun storage practices. Trigger locks were much less likely to be used.

1998

Handgun purchase trends, Washington state: Differences by age of buyer – The greatest increase in rate of legal handgun purchases in Washington State from 1983 through 1992 was among the youngest purchasers. Sales of nine millimeter handguns increased most rapidly, especially among the youngest buyers.

1997

State gun safe storage laws and child mortality due to firearms – State safe storage laws intended to make firearms less accessible to children appear to prevent unintentional shooting deaths among children younger than 15 years.

1996

Safe storage of handguns – What do the police recommend? – Trigger locks are frequently recommended but infrequently used by police themselves at home. Portable lockboxes are frequently recommended as well as used by police.

1992

Urban high school youth and handguns – A school-based survey – The availability of handguns to the urban high school students surveyed is pervasive, and it is not limited to high-risk groups. Thirty-four percent of the students reported easy access to handguns (47% of males, 22% of females) and 6.4% reported owning a handgun (11.4% of males, 1.5% of females). Reported firearm experiences indicated a high rate of handgun utilization: 33% of handgun owners had fired at someone, 9.7% of female students reported a firearm homicide or suicide in family members or close friends, and 6% of male students reported carrying a handgun to school sometime in the past. Handgun ownership was more common among students who reported deviant behaviors. Gang membership, sentencing by a judge, selling drugs, suspension or expulsion from school, and assault and battery were associated with handgun ownership.

1982

Handguns and children: A dangerous mix – Injuries are the leading causes of death from some months before the first birthday to age 34. Many pediatricians and health care providers are unaware that firearms are important contributors to this morbidity and mortality among children and adolescents. The data which have become available demonstrate the increasing prevalence of the problem and should concern those involved in improving child health in the United States.

Policy

State-level beer excise tax and firearm homicide in adolescents and young adults – Among individuals aged 15–34 years, price-sensitive consumption of beer may represent one feasible tool for policymakers seeking to reduce rates of firearm homicide.

2017

Firearm injury after gun shows: Evidence to gauge the potential impact of regulatory interventions (Editorial) – The data in Matthay and colleagues’ study may suggest some association between gun shows and self-directed and unintentional firearm injuries, but the estimates were not statistically significant. It is often forgotten that about two thirds of firearm deaths in the United States are suicides. A prior study by Wintemute and colleagues showed that purchasers of a handgun had a 57-fold and seven-fold increased risk for firearm suicide in the first week and first year, respectively, after purchase . Evidence indicates that the means available to commit self-harm matter and that restricting the most lethal means (that is, firearms) can prevent the loss of lives due to suicide. Also, future research should examine whether gun shows affect unintentional firearm injuries, and if so, what plausible explanations might exist.

Pediatricians, firearms, and the First Amendment (Viewpoint) – Because of the 11th Circuit, the First Amendment rights of physicians and their duty embodied in the Hippocratic Oath have been protected against those who would rather see these freedoms and obligations restricted. This is especially important now, when for more than 20 years, Congress has denied the ability of the Centers for Disease Control and Prevention to fund research on a problem that has caused more deaths in the past 50 years in the United States than have occurred on US battlefields in the country’s entire history.

2015

State firearm legislation and nonfatal firearm injuries – There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total, assault-related, self-inflicted, and unintentional nonfatal firearm injuries.

2005

An evaluation of state firearm regulations and homicide and suicide death rates – A “shall issue” law that eliminates most restrictions on carrying a concealed weapon may be associated with increased firearm homicide rates. No law was associated with a statistically significant reduction in firearm homicide or suicide rates.

1999

Effectiveness of denial of handgun purchase to persons believed to be at high risk for firearm violence – Relative to those denied a firearm purchase, handgun purchasers were found to be at greater risk for subsequent offenses involving a gun or violence, after adjustment for number of prepurchase weapon/violence charges. Denial of handgun purchase to persons with a prior felony conviction may lower their rate of subsequent criminal activity.

1997

State gun safe storage laws and child mortality due to firearms – State safe storage laws intended to make firearms less accessible to children appear to prevent unintentional shooting deaths among children younger than 15 years.

1994

Money for guns: Evaluation of the Seattle Gun Buy-Back Program – Community involvement in local firearms policy is advocated to be an important component of efforts to curtail violence. This report describes the first evaluation of one such effort, a gun buy-back program conducted in Seattle, WA, during the fall of 1992. Comparing firearm-related events per month before and after the program, crimes and deaths increased, and injuries decreased, but the changes were not statistically significant. Gun buy-back programs are a broadly supported means to decrease voluntarily the prevalence of handguns within a community, but their effect on decreasing violent crime and reducing firearm mortality is unknown.

1993

Gun laws (Editorial) – The magnitude of this public health problem demands that it be discussed in the pages of medical journals, and not confined to sociological or criminology publications. Any other cause of death of this magnitude – whether it be AIDS, meningitis, or motor-vehicle crashes – would, and does, receive the attention of the medical community. The role of medical journals is to present the results of scientific research to the medical and public health community and provide a forum for discussion of its importance and public policy implications.

1990

Firearm regulations and rates of suicide – A comparison of two metropolitan areas – The risk of death from suicide was not found to differ significantly between King County and the Vancouver area. The rate of suicide by firearms, however, was higher in King County, because the rate of suicide by handguns was 5.7 times higher there. The difference in the rates of suicide by firearms was offset by a 1.5-fold higher rate of suicide by other means in the Vancouver area. Persons 15 to 24 years old had a higher suicide rate in King County than in the Vancouver area. Virtually all the difference was due to an almost 10-fold higher rate of suicide by handguns in King County. Restricting access to handguns might reduce the suicide rate in persons 15 to 24 years old, but would probably not reduce the overall suicide rate.

1988

Handgun regulations, crime, assaults, and homicide – A tale of two cities – 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. 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. 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. Restricting access to handguns may reduce the rate of homicide in a community.

Reviews & Other Publications

2019

School shootings in the U.S.: What is the state of evidence? (Editorial) – Since the Columbine High School shooting, about 223,000 students attending 229 K-12 schools have experienced a shooting on campus during school hours. School shootings can have profound direct and indirect traumatic consequences for both youth and the broader society. Time will judge the yield of the recent surge in spending on safety measures to make schools “hard targets.” In the meantime, enacting and enforcing gun policy measures (e.g., universal background checks, permit to purchase laws, firearm access restrictions, and extreme risk protection order policies) as well as further mental health and education expenditure couched in a public health approach may play a more important role in averting these tragedies, preventing injuries, and saving lives.

Proceedings from the medical summit on firearm injury prevention: A public health approach to reduce death and disability in the US

The following were the objectives of this Summit:

  1. Identify opportunities for the medical community to reach a consensus-based, non-partisan approach to firearm injury prevention
  2. Discuss the key components of a public health approach and define interventions this group will support
  3. Develop consensus on actionable items for firearm injury prevention using the public health framework

Firearm injury research and epidemiology: A review of the data, their limitations and how trauma centers can improve firearm injury research – Despite the fact that firearm injury is one of the leading causes of death among young people and has the highest fatality rate for injuries treated in trauma centers, research dedicated to the causes and prevention of firearm injury is disproportionately minimal compared to other causes of injury and death. This review provides an overview of the existing sources of firearm injury data and their limitations to quantify and characterize non-fatal firearm injuries, and to describe the burden of firearm injuries on patients and society. These data are imperative to informing prevention and intervention efforts and the ability to evaluate them. Trauma centers are in opportune positions to improve the surveillance and characterization of risks and circumstances contributing to firearm injuries.

Firearm assault injuries by residence and injury occurrence location – Research on spatial injury patterns is limited by a lack of precise injury occurrence location data. Three-quarters of injuries occurred outside the census tract where the victim resided. Median distance between locations was 3.9 miles, with victims 18–34 having the greatest distances between residence and injury location. Forty of 398 tracts had a ratio of injury incidents to injured residents of >1. Routine collection of injury location data and homelessness status could decrease misclassification and bias. Researchers should consider whether residential address is an appropriate proxy for injury location, based on data quality and their specific research question.

2018

Risk factors on hospital arrival for acute respiratory distress syndrome following pediatric trauma – This article provides the first description of the incidence of and risk factors for acute respiratory distress syndrome among pediatric trauma patients. Improved understanding of the risk factors associated with acute respiratory distress syndrome following pediatric trauma may help providers anticipate its development and intervene early to improve outcomes for severely injured children.

2017

Formal firearm training among adults in the USA: results of a national survey – Despite broad support for policies requiring that prospective firearm owners receive training before acquiring a firearm, little is known about the scope and content of firearm training in the USA. Results of a nationally representative survey in 2015 showed that 61% of firearm owners and 14% of non-owners living with a firearm owner reported having received formal firearm training. The most commonly reported combination of training topics was safe handling, safe storage, and preventing accidents. Fifteen percent of firearm owners reported that their training included information about suicide prevention. The proportion of the US firearm owners with formal firearm training has not meaningfully changed in two decades. Training program contents vary widely. Efforts to standardize and evaluate the effectiveness of firearm training are warranted.

The cumulative burden of mental, substance use, and general medical disorders and rehospitalization and mortality after an injury – Increasing cumulative burden of disorders was associated with greater postinjury risk of recurrent hospitalization and death. Orchestrated investigative and policy efforts could introduce screening and intervention procedures that target this spectrum of comorbidity.

A consensus-driven agenda for emergency medicine firearm injury prevention research – Fifty-nine final emergency medicine-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional (“accidental”) injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings.

Review of the book Confronting Gun Violence in America by Thomas Gabor – Numerous sobering statistics in the book, especially those that compare the rates of gun violence in the USA with rates in other high-income countries, remind us of the enormity of the challenges ahead of us in preventing death and suffering due to the use of firearms. Confronting Gun Violence in America is an excellent, well-researched and in-depth resource for those who take on such challenges.

The road ahead for personalized firearms (Viewpoint) – Personalized firearm technology is an encouraging development that complements ongoing, multifaceted efforts to decrease firearm injuries in the United States. If personalized firearms are to be both feasible products and effective at reducing firearm-related injuries, researchers and policymakers will have important roles to play. If the federal government succeeds in expanding the development and early adoption of personalized firearms within local, state, and federal agencies, it would be an important step toward normalizing the technology and allaying stigma and concerns about reliability. Leveraging the purchasing power of these agencies might also help to bring prices down and catalyze research and development.

2016

A consensus-driven agenda for emergency medicine firearm injury prevention research – Fifty-nine final emergency medicine-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional (“accidental”) injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings.

2013

The role of research in addressing the public health problem of gun violence (Editorial) – Research is certainly not the whole answer to preventing gun violence in this country, but we often hear policymakers ask about the “best” ways to use limited resources. We cannot know what is effective if we cannot study the effects of policy and programs, develop new ones and test their impact. In the debate over gun control legislation, the lack of information on what will work has been very apparent. Policy makers need this information to develop appropriate steps to curb gun violence. Considering the over $40 billion annual cost to the United States for injuries and deaths from gun violence, funding research will save money in the long run. Many nations, including the United States, have relied on science to inform public policy, and by doing so, have improved the safety, health and lives of all our citizens. We need to do the same for the problem of firearm violence.

Silencing the science on gun research (Viewpoint) – The United States has long relied on public health science to improve the safety, health, and lives of its residents. Perhaps the same straightforward, problem-solving approach that worked well in other circumstances can help the nation meet the challenge of firearm violence. Otherwise, the heartache that the nation and perhaps the world are feeling over the senseless gun violence in Newtown will likely be repeated, again and again.

2000

The history of injury control and the epidemiology of child and adolescent injuries – Unintentional injuries claim the lives of more children each year than any other cause of death. A substantial proportion of child hospitalizations and emergency department visits also are attributable to unintentional injuries. The conceptualization of unintentional injuries as a public health problem that is preventable has gained credibility over the past few decades, as effective solutions to reduce the burden of injuries have been identified. Although adequate data on risk factors is available for some causes of injury, such as motor vehicle crashes, it is almost nonexistent for others, such as unintentional firearm injuries. Overall, unintentional injury rates are highest among adolescents ages 15 to 19, males, children from impoverished families, and minorities. Also, some injuries occur more often in rural areas. Although these demographic risk factors cannot be modified, environmental and behavioral risks, such as unsafe roads, alcohol intoxication, unfenced swimming pools, and the absence of a smoke detector in the home, can be modified successfully with appropriate strategies. Child injury death rates across most age categories and mechanisms of injury have declined during the past 20 years, yet the reasons for these declines are poorly understood. Additional research about risk and protective factors, and efforts to implement successful injury prevention strategies among populations at highest risk for injuries, are necessary to further reduce the toll on children’s lives.

1999

Gun safety and the family physician (Commentary) – This is a comment on family practice patients’ attitudes toward firearm safety as a preventive medicine. issue.

1997

Injury prevention – Second of two parts – This is a discussion of injury and injury prevention in relation to falls, poisoning, fires and scalding, drowning, and firearm injuries.

1996

Injury research and violence: what’s our contribution? (Editorial) – We need to be inclusive in our approach to child and adolescent injury control and examine both intentional and unintentional injuries. Appropriate caution should be used when dealing with the problem of intentional injuries, however. We should neither ignore nor deny the substantial contributions made to this area by the criminal justice community, sociologists, or criminologists. We should also not take complete ownership of a problem that has it underlying roots in the social, economic, and cultural fabric of a community and nation. We should continue to focus on the issues in which we have expertise: research into the etiology and prevention of injuries to children and adolescents, regardless of whether these injuries are intentional or not. To forbid the scientific communities to do research on one of the most important causes of morbidity and mortality is equivalent to the burning of books.

1995

Firearm injury prevention counseling by pediatricians and family physicians: Practices and beliefs – Few primary care physicians who see children and adolescents currently counsel families about firearm safety, although many agree that they have such a responsibility. At least half of these physicians would potentially benefit from an intervention to improve their knowledge of and counseling skills on this topic.

Fighting as a marker for multiple problem behaviors in adolescents – Thirty says before this study’s survey was conducted, one in every 12 students was in a fight. Reported problem behaviors were prevalent among fighters: during the previous 12 months, 24% attempted suicide; during the previous 30 days, 26% carried a firearm, 13% used cocaine, and 39% drove a motor vehicle while intoxicated; during the previous 3 months 41% had two or more sex partners; and 45% had sexual intercourse and did not use a condom the last time they had sex. Of all students, fighters accounted for 22% of those who reported attempting suicide, 49% carrying a firearm, 46% using cocaine, 18% driving while intoxicated, 25% having sex with multiple partners, and 11% not using condoms. Three or more of these six problem behaviors were reported by 26% of the fighters. The problem behaviors were all positively correlated, and the first principal component accounted for 35% of the total variation among the individual variables. Serious fighting heralds multiple problem behaviors in need of intensive, multifaceted interventions.

1993

Youth in detention and handguns – A convenience sample of 89 males detained in the King County Youth Services Center, a short-term holding facility, voluntarily completed an anonymous survey. Results showed that 59% of the youth reported owning a handgun. Firearm experiences included carrying a gun to school (46%); firing at another person (68% of handgun owners); firearm injury to self (27%); death of a close friend or family member to firearm homicide or suicide (35%). Personal safety far exceeded recreational use of guns as motivation for self-arming (52% versus 4%). Handgun ownership was more common among youth who reported problem behaviors. Adjusting for age and controlling for covariation of the problem behaviors, gang membership, committing assault and battery and selling drugs were associated with handgun ownership. Firearm experiences for youth in detention pose health risks equal to or far exceeding other high-risk behaviors in this population.

Pediatric injury prevention – Pediatric injuries are the leading cause of childhood death and disability and are responsible for more childhood deaths than all other diseases combined. The panel summarized the principles of pediatric injury prevention and reviewed the incidence, epidemiology, and prevention of six common pediatric injuries.

1990

Validating survey responses to questions about gun ownership among owners of registered handguns – While survey-based data on firearm ownership are essential for epidemiologic studies of the relation between gun ownership and injuries, the validity of respondent answers to questions about gun ownership has not been confirmed. In order to assess the accuracy of interview data about firearms, in June to August 1987, the investigators attempted to contact residents of 75 homes in the cities of Memphis, Tennessee and Seattle, Washington listed as the address of the owner of a recently registered handgun. Despite problems with inaccurate registration data, contact was ultimately made with 55 households, 35 of which consented to a general interview that included a series of questions about gun ownership. Respondents in 31 of these 35 households readily acknowledged that one or more guns were kept in their home. Respondents in three of the remaining four households stated that guns were recently kept in their homes but were no longer kept there. At least among registered gun owners, respondent answers to questions about gun ownership are generally valid and that survey data of this type can be utilized with confidence.

For more on our current firearm research, return to the FIPRP Homepage.