Single-year change in views of democracy and society and support for political violence in the USA: findings from a 2023 nationally representative survey.

BACKGROUND: A 2022 survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, of beliefs associated with such violence, and of belief that civil war was likely in the near future. It is important to determine the durability of those findings. METHODS: Wave 2 of a nationally representative cohort survey was conducted May 18-June 8, 2023; the sample comprised all respondents to 2022's Wave 1. Outcomes are expressed as weighted proportions; changes from 2022 to 2023 are for respondents who participated in both surveys, based on aggregated individual change scores. RESULTS: The completion rate was 84.2%; there were 9385 respondents. After weighting, 50.7% (95% confidence interval (CI) 49.4%, 52.1%) were female; weighted mean (SD) age was 48.5 (25.9) years. About 1 in 20 respondents (5.7%, 95% CI 5.1%, 6.4%) agreed strongly/very strongly that "in the next few years, there will be civil war in the United States," a 7.7% decrease. In 2023, fewer respondents considered violence to be usually/always justified to advance at least 1 of 17 specific political objectives [25.3% (95% CI 24.7%, 26.5%), a 6.8% decrease]. However, more respondents thought it very/extremely likely that within the next few years, in a situation where they consider political violence justified, "I will be armed with a gun" [9.0% (95% CI 8.3%, 9.8%), a 2.2% increase] and "I will shoot someone with a gun" [1.8% (95% CI 1.4%, 2.2%), a 0.6% increase]. Among respondents who considered violence usually/always justified to advance at least 1 political objective, about 1 in 20 also thought it very/extremely likely that they would threaten someone with a gun (5.4%, 95% CI 4.0%, 7.0%) or shoot someone (5.7%, 95% CI 4.3%, 7.1%) to advance such an objective. CONCLUSIONS: In this cohort, support for political violence declined from 2022 to 2023, but predictions of firearm use in political violence increased. These findings can help guide prevention efforts, which are urgently needed.

Ghost guns and crime: a tale of two California cities.

BACKGROUND: Privately made firearms (PMFs) or "ghost guns" are homemade, unserialized, untraceable firearms that have been increasingly used in violent crime in the United States. Very little is known about the types of PMFs recovered by law enforcement agencies and the crimes associated with these recoveries. This lack of information limits effective violence prevention policies and practices. Comparative analysis of PMF recoveries in specific cities helps clarify whether local PMF patterns and characteristics vary or reflect more general trends. This research advances epidemiological understanding of emergent violent gun injury prevention challenges by identifying variations in recovered PMF types and use in violent, drug, and weapon-related offenses in Los Angeles and San Diego, California. METHODS: Conjunctive analysis of case configurations (CACC) identifies patterns among observations (i.e., case configurations) and calculates their probability associated with a given outcome. CACC was used to identify the most common types of PMFs recovered by the Los Angeles (LAPD) and San Diego (SDPD) police departments. For each department and offense type, case configurations with above-average probabilities of offense involvement were determined. Comparisons across departments were made to identify similarities and differences in PMF characteristics and usage. RESULTS: PMFs were more likely to be involved in violent and weapon-related offenses in Los Angles but more likely to be involved in drug-related offenses in San Diego. In both cities, the 9 mm Polymer 80 handgun was the dominant PMF. However, 9 mm handguns were most likely to be involved in weapon-related offenses in Los Angeles compared to 0.40 handguns in San Diego. Furthermore, large-caliber handguns tended to display above-average probabilities of involvement in violent and drug offenses in Los Angeles. Long guns were represented in case configurations with above-average probabilities of involvement in substantive crimes, including violence. CONCLUSIONS: Comparative analyses of PMF recovery patterns in Los Angeles and San Diego reveal meaningful contextual variations in PMF characteristics and suggest intentional firearm type selections by offenders. The results support increased regulation of PMFs and highlight the importance of efforts to identify and disrupt the illicit supply of large-caliber PMF handguns and PMF long guns.

Cohort Study of Downgraded Misdemeanor Convictions and Subsequent Violent Crime: Differences by Defendant Race and Ethnicity.

Introduction: Criminal convictions may be imperfect markers of criminalized behavior, in part because of criminal legal system processes (e.g., plea bargaining). In this retrospective cohort study of individuals convicted of misdemeanors, authors compared the risk of subsequent criminal charges for a violent crime among those initially charged with a felony with that among those initially charged with only misdemeanors, overall and by defendant race and ethnicity. Methods: The study population included individuals aged ≥18 years who were convicted of a misdemeanor in Washington Superior Courts from January 1, 2015 to December 31, 2019. Those with and without initial felony charges were age/gender matched in a 4:1 ratio. The primary outcome was the first subsequent violent crime charge in Washington Superior Courts through December 31, 2020. Data were analyzed with Fine-Gray hazard models from June 2022 to November 2023. Results: There were 3,841 individuals with initial felony charges and 956 with initial misdemeanor charges only. Median follow-up was 2.4 years for both groups. During follow-up, there were 166 new violent crime charges. In multivariable models, White defendants with initial felony charges had a greater risk of subsequent violent crime charges (subdistribution hazard ratio=2.58; 95% CI=1.24, 5.36) than White defendants with initial misdemeanor charges only. Among Black and Hispanic/Latinx defendants, initial felony versus misdemeanor charges were not associated with subsequent violent crime charges (subdistribution hazard ratio=0.93; 95% CI=0.44, 1.97 among Black defendants; subdistribution hazard ratio=0.49; 95% CI=0.15, 1.57 among Hispanic/Latinx defendants). Conclusions: Findings suggest differential associations between downgrading of felony charges to misdemeanor convictions and future violent crime charges by defendant race and ethnicity, with implications for inequitable collateral consequences of criminal convictions.

Firearm Ownership and Support for Political Violence in the United States.

Importance: Little is known about support for and willingness to engage in political violence in the United States. Such violence would likely involve firearms. Objective: To evaluate whether firearm owners' and nonowners' support for political violence differs and whether support among owners varies by type of firearms owned, recency of purchase, and frequency of carrying a loaded firearm in public. Design, Setting, and Participants: This cross-sectional nationally representative survey study was conducted from May 13 to June 2, 2022, among US adult members of the Ipsos KnowledgePanel, including an oversample of firearm owners. Exposure: Firearm ownership vs nonownership. Main Outcomes and Measures: Main outcomes concern (1) support for political violence, in general and to advance specific political objectives; (2) personal willingness to engage in political violence, by severity of violence and target population; and (3) perceived likelihood of firearm use in political violence. Outcomes are expressed as weighted proportions and adjusted prevalence differences, with P values adjusted for the false-discovery rate and reported as q values. Results: The analytic sample comprised 12 851 respondents: 5820 (45.3%) firearm owners, 6132 (47.7%) nonowners without firearms at home, and 899 (7.0%) nonowners with firearms at home. After weighting, 51.0% (95% CI, 49.9%-52.1%) were female, 8.5% (95% CI, 7.5%-9.5%) Hispanic, 9.1% (95% CI, 8.1%-10.2%) non-Hispanic Black, and 62.6% (95% CI, 61.5%-63.8%) non-Hispanic White; the mean (SD) age was 48.5 (18.0) years. Owners were more likely than nonowners without firearms at home to consider violence usually or always justified to advance at least 1 of 17 specific political objectives (owners: 38.8%; 95% CI, 37.3%-40.4%; nonowners: 29.8%; 95% CI, 28.5%-31.2%; adjusted difference, 6.5 percentage points; 95% CI, 4.5-9.3 percentage points; q < .001) but were not more willing to engage in political violence. Recent purchasers, owners who always or nearly always carry loaded firearms in public, and to a lesser extent, owners of assault-type rifles were more supportive of and willing to engage in political violence than other subgroups of firearm owners. Conclusions and Relevance: In this study of support for political violence in the United States, differences between firearm owners and nonowners without firearms at home were small to moderate when present. Differences were greater among subsets of owners than between owners and nonowners. These findings can guide risk-based prevention efforts.

Drugs, guns, and violent crime in California.

BACKGROUND: There is evidence linking use of controlled substances with perpetration of interpersonal violence. While the United States constitution protects the right to own a firearm, federal law prohibits firearm purchase and possession by persons believed to be at high risk for violence, including those who use controlled substances unlawfully. METHODS: We report here the results of a 13-year prospective observational study on the risk of violent crime associated with a history of criminal drug charges in a cohort of 79,678 legal purchasers of handguns in California in 2001. The main outcomes were post-purchase charges for any violent crime, violent Crime Index crimes (murder, rape, robbery, aggravated assault), and firearm-related violent crimes. The main exposure of interest was a history of pre-purchase charge(s) for drug-related offenses; we examined as a secondary exposure a history of marijuana-related charges. We estimated adjusted hazard ratios (aHR) with 95 % confidence intervals (CI) using Cox proportional hazards multiple events models. RESULTS: We found that legal handgun purchasers in California with a history of drug-related charges, even those with marijuana charges only, had triple the risk of a post-purchase violent crime charge compared to purchasers with no criminal charges (drug charges only: aHR=2.9, 95 % CI 2.2-3.8; marijuana charges only: aHR=3.3, 95 % CI 1.8-6.0). In addition, a criminal history of drug charges only vs. no criminal history was associated with increased risk of one or more violent crime charges after the first post-purchase arrest event (aHR=1.6, 95 % CI 1.2-2.3). CONCLUSION: It is incumbent on researchers and policy makers to understand the nature and causes of this risk in order to take effective steps towards mitigation.

Purchaser, firearm, and retailer characteristics associated with crime gun recovery: a longitudinal analysis of firearms sold in California from 1996 to 2021.

BACKGROUND: Firearm violence is a major cause of death and injury in the United States. Tracking the movement of firearms from legal purchase to use in crimes can help inform prevention of firearm injuries and deaths. The last state-wide studies analyzing crime gun recoveries used data from over 20 years ago; thus, an update is needed. METHODS: We used data for 5,247,348 handgun and 2,868,713 long gun transactions and law enforcement recoveries from California crime gun recovery (2010-2021) and California's Dealer Records of Sales records. Covariates included characteristics of dealership sales, firearms and their transactions, and purchaser's demographic characteristics, purchasing history, criminal history (from firearm purchaser criminal history records), and neighborhood socioeconomic status. Analyses for handguns and long guns was conducted separately. In multivariable analysis, we included correlates into a Cox proportional hazard model accounting for left truncation and clustering between the same firearm, purchaser, dealerships, and geographic location. Covariates that remained significant (P < 0.05) were retained. For handguns, we evaluated associations of violent and weapons crimes separately. In supplementary analyses, we examined interactions by purchasers' race and ethnicity. RESULTS: In total, 38,441 handguns (0.80%) and 6,806 long guns (0.24%) were recovered in crimes. A firearm dealer's sales volume, percent of transactions that were denials, pawns, pawn redemptions, and firearms that became crime guns were each positively associated with firearm recovery in crime. Handguns that were inexpensive, larger caliber, and that had been reported lost or stolen were positively associated with recovery in crimes. Purchaser characteristics associated with crime gun recovery included: being younger, female, Black, Hispanic, Native American or Pacific Islander, or other race/ethnicity (vs white), having previous arrests, living in close proximity to the firearm dealership, and living in a more socially vulnerable census tract. Associations with race and ethnicity were modified by previous infraction-only arrests. CONCLUSIONS: This study confirms that many previously studied correlates of firearm recovery are still relevant today. We were able to expand on previous research by examining novel associations including purchasers' criminal history and previous firearm transaction history. These results provide evidence that can be used to disrupt firearm use in crimes.

MAGA Republicans' views of American democracy and society and support for political violence in the United States: Findings from a nationwide population-representative survey.

BACKGROUND: Identifying groups at increased risk for political violence can support prevention efforts. We determine whether "Make America Great Again" (MAGA) Republicans, as defined, are potentially such a group. METHODS: Nationwide survey conducted May 13-June 2, 2022 of adult members of the Ipsos KnowledgePanel. MAGA Republicans are defined as Republicans who voted for Donald Trump in the 2020 presidential election and deny the results of that election. Principal outcomes are weighted proportions of respondents who endorse political violence, are willing to engage in it, and consider it likely to occur. FINDINGS: The analytic sample (n = 7,255) included 1,128 (15.0%) MAGA Republicans, 640 (8.3%) strong Republicans, 1,571 (21.3%) other Republicans, and 3,916 (55.3%) non-Republicans. MAGA Republicans were substantially more likely than others to agree strongly/very strongly that "in the next few years, there will be civil war in the United States" (MAGA Republicans, 30.3%, 95% CI 27.2%, 33.4%; strong Republicans, 7.5%, 95% CI 5.1%, 9.9%; other Republicans, 10.8%, 95% CI 9.0%, 12.6%; non-Republicans, 11.2%, 95% CI 10.0%, 12.3%; p < 0.001) and to consider violence usually/always justified to advance at least 1 of 17 specific political objectives (MAGA Republicans, 58.2%, 95% CI 55.0%, 61.4%; strong Republicans, 38.3%, 95% CI 34.2%, 42.4%; other Republicans, 31.5%, 95% CI 28.9%, 34.0%; non-Republicans, 25.1%, 95% CI 23.6%, 26.7%; p < 0.001). They were not more willing to engage personally in political violence. INTERPRETATION: MAGA Republicans, as defined, are more likely than others to endorse political violence. They are not more willing to engage in such violence themselves; their endorsement may increase the risk that it will occur.

Comparison of record linkage software for deduplicating patient identities in California's Prescription Drug Monitoring Program.

BACKGROUND: To help prevent overdose deaths involving prescription drugs, accurate linkage of prescription drug monitoring program (PDMP) records for individual patients is essential. OBJECTIVES: To compare the accuracy of the linkage program used by California's PDMP against various record linkage programs with respect to accuracy in deduplicating patient identities in the PDMP, with implications for identifying high-risk opioid use and outlier behaviors. RESEARCH DESIGN: We evaluated California's program, Link Plus, LinkSolv, and The Link King on 557 861 PDMP identity records with addresses in two 3-digit zip code areas for patients who filled a controlled substance prescription in 2013. Manual review was performed on a stratified sample of 720 paired records identified as matches by at least one program. MEASURES: We estimated sensitivity and positive predictive value, and computed PDMP patient alerts for the patient entities identified by each program. RESULTS: Sensitivity was 95% for LinkSolv and The Link King, 84% for Link Plus, and 73% for California's program; positive predictive value was ≥93% for all programs. The number of patient entities prompting a PDMP alert was similar among the programs for all alerts except multiple provider episodes (obtaining prescriptions from ≥6 prescribers or ≥6 pharmacies in the last 6 months), which were 10.9%, 26.6%, and 16.9% greater using The Link King, Link Plus, and LinkSolv, respectively, compared to California's program. CONCLUSIONS: PDMPs should assess the accuracy of record linkage algorithms and the impacts of these algorithms on patient safety alerts and develop national best practices for PDMP record linkage.

Impact of 30-day prescribed opioid dose trajectory on fatal overdose risk: A population-based, statewide cohort study.

BACKGROUND: Both increases and decreases in patients' prescribed daily opioid dose have been linked to increased overdose risk, but associations between 30-day dose trajectories and subsequent overdose risk have not been systematically examined. OBJECTIVE: To examine the associations between 30-day prescribed opioid dose trajectories and fatal opioid overdose risk during the subsequent 15 days. DESIGN: Statewide cohort study using linked prescription drug monitoring program and death certificate data. We constructed a multivariable Cox proportional hazards model that accounted for time-varying prescription-, prescriber-, and pharmacy-level factors. PARTICIPANTS: All patients prescribed an opioid analgesic in California from March to December, 2013 (5,326,392 patients). MAIN MEASURES: Dependent variable: fatal drug overdose involving opioids. Primary independent variable: a 16-level variable denoting all possible opioid dose trajectories using the following categories for current and 30-day previously prescribed daily dose: 0-29, 30-59, 60-89, or ≥90 milligram morphine equivalents (MME). KEY RESULTS: Relative to patients prescribed a stable daily dose of 0-29 MME, large (≥2 categories) dose increases and having a previous or current dose ≥60 MME per day were associated with significantly greater 15-day overdose risk. Patients whose dose decreased from ≥90 to 0-29 MME per day had significantly greater overdose risk compared to both patients prescribed a stable daily dose of ≥90 MME (aHR 3.56, 95%CI 2.24-5.67) and to patients prescribed a stable daily dose of 0-29 MME (aHR 7.87, 95%CI 5.49-11.28). Patients prescribed benzodiazepines also had significantly greater overdose risk; being prescribed Z-drugs, carisoprodol, or psychostimulants was not associated with overdose risk. CONCLUSIONS: Large (≥2 categories) 30-day dose increases and decreases were both associated with increased risk of fatal opioid overdose, particularly for patients taking ≥90 MME whose opioids were abruptly stopped. Results align with 2022 CDC guidelines that urge caution when reducing opioid doses for patients taking long-term opioid for chronic pain.

Optimism Bias in Firearm-Related Risk Perceptions.

This survey study assesses the perceptions of California adults about the safety and risk of personal firearm use or access vs firearm use or access by others.

Importance of categories of crime for predicting future violent crime among handgun purchasers in California.

BACKGROUND: Prohibiting the purchase and possession of firearms by those at risk of violence is an established approach to preventing firearm violence. Prior studies of legal purchasers have focused on convictions for specific crimes, such as violent misdemeanors and driving under the influence (DUI). We broaden that line of inquiry by investigating and comparing the associations between prior arrests for most categories of crime and subsequent arrest for violent offenses among legal handgun purchasers in California. METHODS: In this longitudinal cohort study of 79,678 legal handgun purchasers in California in 2001, we group arrest charges prior to their first purchases in 2001 according to categories defined by the Uniform Crime Report (UCR) Handbook. We use a gradient boosting machine to identify categories of offenses that are most important for predicting arrest for violent crime following firearm purchase. For each category identified, we then estimate the difference in risk of subsequent arrest for a violent offense using survival regression models. RESULTS: We identified eight crime categories with high predictive importance: simple assaults, aggravated assaults, vehicle violations, weapon, other crimes, theft, drug abuse, and DUI. Compared to purchasers with no prior arrests, those with a prior arrest for any one of the eight important categories and no other categories were found to be at increased risk of arrest for a Crime Index-listed violent crime (murder, rape, robbery, aggravated assault), with the greatest estimated risk corresponding to the simple assault UCR category (adjusted hazard ratio 4.0; 95% CI 2.8-5.9). Simple assault was also associated with the greatest risk for subsequent arrest for firearm violence (adjusted hazard ratio 4.6; 95% CI 2.4-9.0) and any violent offense (adjusted hazard ratio 3.7; 95% CI 2.7-5.0). CONCLUSION: The findings of this study suggest that prior arrests for a broad array of crimes, both violent and non-violent, are associated with risk of subsequent violent crimes, including Crime Index-listed violent crimes and firearm violence, among legal purchasers of firearms. Current policies aimed at restricting access to firearms for individuals at increased risk of violence should be re-examined considering these findings.

Trends and Sources of Crime Guns in California: 2010-2021.

Firearm-related interpersonal violence is a leading cause of death and injury in cities across the United States, and understanding the movement of firearms from on-the-books sales to criminal end-user is critical to the formulation of gun violence prevention policy. In this study, we assemble a unique dataset that combines records for over 380,000 crime guns recovered by law enforcement in California (2010-2021), and more than 126,000 guns reported stolen, linked to in-state legal handgun transactions (1996-2021), to describe local and statewide crime gun trends and investigate several potentially important sources of guns to criminals, including privately manufactured firearms (PMFs), theft, and "dirty" dealers. We document a dramatic increase over the decade in firearms recovered shortly after purchase (7% were recovered within a year in 2010, up to 33% in 2021). This corresponds with a substantial rise in handgun purchasing over the decade, suggesting some fraction of newly and legally acquired firearms are likely diverted from the legal market for criminal use. We document the rapid growth of PMFs over the past 2-3 years and find theft plays some, though possibly diminishing, role as a crime gun source. Finally, we find evidence that some retailers contribute disproportionately to the supply of crime guns, though there appear to be fewer problematic dealers now than there were a decade ago. Overall, our study points to temporal shifts in the dynamics of criminal firearms commerce as well as significant city variation in the channels by which criminals acquire crime guns.

Views of democracy and society and support for political violence in the USA: findings from a nationally representative survey.

BACKGROUND: Current conditions in the USA suggest an increasing risk for political violence. Little is known about the prevalence of beliefs that might lead to political violence, about support for and personal willingness to engage in political violence, and about how those measures vary with individual characteristics, lethality of violence, political objectives that violence might advance, or specific populations as targets. METHODS: This cross-sectional US nationally representative survey was conducted on May 13 to June 2, 2022, of adult members of the Ipsos KnowledgePanel. Outcomes are weighted, population-representative proportions of respondents endorsing selected beliefs about American democracy and society and violence to advance political objectives. RESULTS: The analytic sample included 8620 respondents; 50.5% (95% confidence interval (CI) 49.3%, 51.7%) were female; and weighted mean (± standard deviation) age was 48.4 (± 18.0) years. Nearly 1 in 5 (18.9%, 95% CI 18.0%, 19.9%) agreed strongly or very strongly that "having a strong leader for America is more important than having a democracy"; 16.2% (95% CI 15.3%, 17.1%) agreed strongly or very strongly that "in America, native-born white people are being replaced by immigrants," and 13.7% (95% CI 12.9%, 14.6%) agreed strongly or very strongly that "in the next few years, there will be civil war in the United States." One-third of respondents (32.8%, 95% CI 31.7%, 33.9%) considered violence to be usually or always justified to advance at least 1 of 17 specific political objectives. Among all respondents, 7.7% (95% CI 7.0%, 8.4%) thought it very or extremely likely that within the next few years, in a situation where they believe political violence is justified, "I will be armed with a gun"; 1.1% (95% CI 0.9%, 1.4%) thought it very or extremely likely that "I will shoot someone with a gun." Support for political violence and for the use of firearms in such violence frequently declined with increasing age, education, and income. CONCLUSIONS: Small but concerning proportions of the population consider violence, including lethal violence, to be usually or always justified to advance political objectives. Prevention efforts should proceed urgently based on the best evidence available.

Community-Level Risk Factors for Firearm Assault and Homicide: The Role of Local Firearm Dealers and Alcohol Outlets.

BACKGROUND: Identifying community characteristics associated with firearm assault could facilitate prevention. We investigated the effect of community firearm dealer and alcohol outlet densities on individual risk of firearm assault injury. METHODS: In this density-sampled case-control study of Californians, January 2005-September 2015, cases comprised all residents with a fatal or nonfatal firearm assault injury. For each month, we sampled controls from the state population in a 4:1 ratio with cases. Exposures were monthly densities of county-level pawn and nonpawn firearm dealers and ZIP code-level off-premises alcohol outlets and bars and pubs ("bars/pubs"). We used case-control-weighted G-computation to estimate risk differences (RD) statewide and among younger Black men, comparing observed exposure densities to hypothetical interventions setting these densities to low. We estimated additive interactions between firearm and alcohol retailer density. Secondary analyses examined interventions targeted to high exposure density or outcome burden areas. RESULTS: There were 67,850 cases and 268,122 controls. Observed (vs. low) densities of pawn firearm dealers and off-premises alcohol outlets were individually associated with elevated monthly risk of firearm assault per 100,000 people (RD pawn dealers : 0.06, 95% CI: 0.05, 0.08; RD off-premises outlets : 0.01, 95% CI: 0.01, 0.03), but nonpawn firearm dealer and bar/pub density were not; models targeting only areas with the highest outcome burden were similar. Among younger Black men, estimates were larger. There was no interaction between firearm and alcohol retailer density. CONCLUSIONS: Our results are consistent with the hypothesis that limiting pawn firearm dealers and off-premises alcohol outlet densities can reduce interpersonal firearm violence.

Extreme Risk Protection Orders in Older Adults in Six U.S. States: A Descriptive Study.

OBJECTIVES: Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals ("respondents") at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia. METHODS: We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment. RESULTS: Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1-160). CONCLUSIONS: Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness. CLINICAL IMPLICATIONS: ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.

The origins of California's gun violence restraining order law: a case study using Kingdon's multiple streams framework.

BACKGROUND: Firearm violence is a major public health problem in the United States, yet most states lack a mechanism to temporarily remove firearms from individuals who are at high and imminent risk of harming themselves or others and are not otherwise prohibited. Extreme risk protection order (ERPO) laws are intended to close this gap. The current study examines the passage of California's gun violence restraining order (GVRO) bill using Kingdon's multiple streams framework. METHODS: This study was based on an analysis of interview data from six key informants involved in the passage of the GVRO legislation. RESULTS: Findings indicate policy entrepreneurs framed the problem and designed the policy to target individuals at behavioral risk of imminent firearm violence. Policy entrepreneurs comprised an integrated policy network that engaged in a lengthy period of collaboration and bargained with interest groups to yield a bill that satisfied diverse concerns. CONCLUSIONS: This case study may inform efforts in other states to pass ERPO policies and other firearm safety laws.

The role of firearm and alcohol availability in firearm suicide: A population-based weighted case-control study.

Firearm availability has been linked to firearm self-harm, but the joint relationship with alcohol availability, while supported by theory, has not been examined. This study sought to quantify the separate and joint relations of community firearm and alcohol availability with individual-level risk of (fatal and nonfatal) firearm self-harm. We conducted a case-control study of California residents, 2005-2015, using statewide mortality, hospital, firearm transfer, and alcohol license data. We estimated monthly marginal risk differences per 100,000 in the overall population and in white men aged 50+ under various hypothetical changes to firearm and alcohol availability and assessed additive interactions using case-control-weighted g-computation. In the overall population, non-pawn shop firearm dealer density was associated with firearm self-harm (RD: 0.02, 95% CI: 0.003, 0.04) but pawn shop firearm dealer and alcohol outlet densities were not. Secondary analyses revealed a relationship between firearm sales density and firearm self-harm (RD: 0.07, 95% CI: 0.04, 0.10). There were no additive interactions between measures of firearm and alcohol availability. Among older white men, generally the same exposures were related to self-harm as in the overall population, but point estimates were substantially larger. Findings suggest community-level approaches to reducing firearm sales may help mitigate suicide risk.

Anticipatory concerns about violence within social networks: Prevalence and implications for prevention.

Most research on exposure to violence focuses on direct victimization, offending, or witnessed violence, yet many people also experience concerns about potential violence in their environments and social networks. Using a state-representative survey of California adults (n = 2870) administered in July 2020, we estimate the prevalence of anticipatory concerns about violence within respondents' social networks and describe characteristics of the persons at perceived risk of violence, reasons for respondents' concerns, and actions undertaken by respondents to reduce that risk. Approximately 1 in 5 respondents knew at least one person, usually a friend or extended family member, whom they perceived to be at risk of other- or self-directed violence. Among respondents living with the person at perceived risk, about one-quarter reported household firearm ownership. Alcohol and substance misuse and a history of violence were among respondents' top reasons for concern; serious mental illness and firearm access also contributed to concerns. About one-quarter of respondents with such concerns said harm was likely or very likely to occur in the next year. Most respondents reported having taken action to reduce the risk of violence, including providing resources and asking family or friends to help; few acted to reduce access to lethal means. The most common reasons for inaction were the perception that a dangerous situation was unlikely and that it was a personal matter. Our findings can help inform a broader understanding of exposure to violence and interventions that leverage the knowledge of those close to persons at risk to prevent violence.

Effects of Comprehensive Background-Check Policies on Firearm Fatalities in 4 States.

Despite promising results from individual-level studies, state-level studies of the effectiveness of comprehensive background-check (CBC) policies in reducing firearm fatalities have yielded null results in multiple states. These prior studies focused on CBC laws adopted in the 1990s, when record keeping was far less complete. We estimated the effect of the implementation of CBC policies on state-level firearm homicide and suicide rates in states implementing CBC policies from 2013 to 2015 (Colorado, Delaware, Oregon, and Washington). We compared age-adjusted firearm homicide and suicide rates, measured annually from 15 years prior to policy implementation until 2019, in each treated state to rates in control groups constructed using the synthetic control group method. Differences in firearm homicide rates for Colorado, Oregon, and Washington post treatment were all small (0.09 to 0.18 per 100,000 residents per year) and not well distinguished from natural variation. Oregon had on average 0.80 per 100,000 fewer firearm suicides per year than did synthetic Oregon post treatment. However, these results were inconsistent across modeling approaches and not well distinguished from natural variation. Our models produced poor fit for Delaware. Coupled with previous null results from Indiana, California, Maryland, Pennsylvania, and Tennessee, the present results suggest that extending background check requirements to private transfers alone and implementing these policies as is currently done is not sufficient to achieve significant state-level reductions in firearm fatalities.