Challenging Pennsylvania's Firearm Preemption Law as a Public Health Danger: The Case of Philadelphia.

Firearm violence has soared in American cities, but most states statutorily preempt municipal firearm regulation. This article describes a unique collaboration in Philadelphia among elected officials, public health researchers, and attorneys that has led to litigation based on original quantitative analyses and grounded in innovative constitutional theories and statutory interpretation.

Updated Estimate of the Number of Extreme Risk Protection Orders Needed to Prevent 1 Suicide.

Importance: Extreme risk protection orders (ERPOs)-also known as red flag, risk warrant, and gun violence restraining orders-authorize law enforcement, family members, and sometimes others to petition a court to remove firearms from and prevent the acquisition of new firearms by a person judged to pose an immediate danger to themselves or others. Previous estimates suggest that 1 suicide is prevented for every 10 ERPOs issued, a number needed to treat that depends critically on the counterfactual estimate of the proportion of suicidal acts by ERPO respondents that would have involved firearms in the absence of ERPOs. Objective: To empirically inform updated estimates of the number of ERPOs needed to prevent 1 suicide. Design, Setting, and Participants: This cohort study used data from California for method-specific suicides by handgun ownership (October 18, 2004, to December 31, 2015). Handgun-owning suicide decedents in California were identified using individual-level registry data about lawful handgun ownership linked to cause-specific mortality for a cohort of more than 25 million adults. The study also used data from Connecticut for method-specific suicides among ERPO respondents who died by suicide, extracted from published data (October 1999 to June 2013). Data analysis was performed in December 2023. Exposure: Handgun ownership. Main Outcomes and Measures: The primary outcomes were the number and distribution of suicidal acts by handgun owners in California, estimated using method-specific suicide mortality data and published case fatality ratios, and the counterfactual number and distribution of suicidal acts and deaths among ERPO respondents in Connecticut had no ERPOs been issued. Results: A total of 1216 handgun owners (mean [SD] age, 50 [18] years; 1019 male [83.8%]) died by suicide during the study period. Among male handgun owners in California, 28% of suicidal acts involved firearms, 54% involved drug poisoning, 9% involved cutting or piercing, 3% involved hanging or suffocation, 2% involved poisoning with solids and/or liquids, and the remaining 4% involved other methods. Assuming this distribution approximates the counterfactual distribution among ERPO respondents in Connecticut in the absence of ERPOs, 1 suicide death was prevented for every 22 ERPOs issued. Conclusions and Relevance: The estimates produced by this cohort study of California handgun owners suggest that ERPOs can play an important role in averting deaths among high-risk individuals.

Firearm-Related Juvenile Death Rates Correlate With Gun Ownership Rates, Measures of Guns in Circulation, and Leniency of Existing Firearm Laws Among U.S. States.

INTRODUCTION: Firearms now represent the leading cause of death in U.S. children. Therefore, this study aimed to determine if state-level rates of gun ownership, guns in circulation, and strictness of firearm-related laws are related to firearm-related mortality among both juveniles and overall populations. MATERIALS AND METHODS: State firearm mortality rates among the juvenile and overall populations were obtained from 2010 to 2020. The number of weapons registered with the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF) and federal firearms licensees for each state were also recorded. Giffords Law Center Scorecard Rankings, a relative measure of the restrictiveness of each state's gun laws, were also collected. Unadjusted linear regressions modeled the relationships between firearm-associated mortality and ATF-registered weapons, federal firearm licensees, Giffords Center rankings, and gun ownership rates. Multivariable (adjusted) analyses were performed to control for poverty, unemployment, and poor mental health. RESULTS: Unadjusted analyses demonstrated that higher gun ownership rates and more lenient gun laws were associated with increased firearm-associated mortality among juveniles. Similarly, these measures as well as increased ATF-registered weapons and ATF federal firearm licensees were associated with increased firearm mortality in the overall population. In the adjusted analyses, more ATF-registered weapons, more ATF federal firearm licensees, higher gun ownership rates, and more lenient firearm laws were associated with increased firearm-related mortality in the overall population, while increased gun ownership and higher Giffords Center rankings were associated with increased firearm-associated mortality in the pediatric population. CONCLUSIONS: To reduce the toll of gun violence in the United States, policymakers should focus on implementing more restrictive firearm laws and reducing the prevalence of guns in their communities.

Nearly 20 Years Since the Federal Ban: Can State-Level Assault Weapon Prohibitions Fill the Void? Comparative Analysis of Case Fatality and Assault Weapon Recovery in States With and Without an Assault Weapon Ban.

INTRODUCTION: Few states established assault weapon bans (AWBs) after the federal AWB expired. The effectiveness of state AWBs as well as neighboring state legislation, in reducing the local prevalence of assault weapons (AWs) or in reducing overall shooting lethality is unknown. METHODS: We queried the Gun Violence Archive (2014-2021) to identify US firearm injuries and fatalities. Shooting case fatality rates were compared among states with and without AWBs, as reported in the State Firearm Laws Database. Data on recovered firearms was obtained from the ATF Firearms Trace Database and used to estimate weapon prevalence. Recovered firearms were classified as AWs based on caliber (7.62 mm, 5.56 mm, 0.223 cal). We performed spatially weighted linear regression models, with fixed effects for state and year to assess the association between geographically clustered state legislation and firearm outcomes. RESULTS: From 2014 to 2021, the US shooting victim case fatality rate was 8.06% and did not differ among states with and without AWBs. The proportion of AWs to total firearms was 5.0% in states without an AWB and 6.0% in states with an AWB (mean difference [95% CI] = -0.8% [-1.6% to -0.2%], P = 0.03). Most recovered firearms in AWB states originated from non-AWB states. On adjusted models, there was no association between state-level AWB and firearm case fatality; however, adjacency to states with an AWB was associated with lower case fatality (P < 0.001). Clustered AWB states with shared borders had lower AW prevalence and fatality rates than the rest of the US. CONCLUSIONS: Isolated state AWBs are not inversely associated with shooting case fatality rates nor the prevalence of AWs, but AWBs among multiple neighboring states may be associated with both outcomes.

Examining the Impact of Minimum Handgun Purchase Age and Background Check Legislation on Young Adult Suicide in the United States, 1991-2020.

Objectives. To examine the independent and joint effects of state legislation on minimum age for purchasing handguns and background checks on the suicide of young adults aged 18 to 20 years. Methods. We used negative binomial regressions with fixed effects for year and generalized estimating equations for state to estimate the effects of state legislation on annual counts of firearm, nonfirearm, and total young adult suicides in all 50 US states from 1991 to 2020. Results. Minimum age laws decreased the incidence rate of firearm suicide among young adults, an effect that was amplified in states with permit to purchase laws; there was no effect on the nonfirearm or total suicide rate. Permit to purchase laws significantly decreased the young adult firearm suicide incidence rate by 39% (incidence rate ratio [IRR] = 0.61; 95% confidence interval [CI] = 0.51, 0.74) and the overall suicide incidence rate by 14% (IRR = 0.86; 95% CI = 0.75, 0.99), with no effect on the nonfirearm suicide rate. Conclusions. Permit to purchase laws are a more promising avenue for reducing young adult suicides than are age-based restrictions. (Am J Public Health. 2024;114(8):805-813. https://doi.org/10.2105/AJPH.2024.307689).

Extreme Risk Protection Orders in Connecticut, 2013-2020.

Twenty-one states and the District of Columbia have enacted Extreme Risk Protection Order (ERPO) statutes, which allow temporary removal of firearms from individuals who pose an imminent risk of harm to themselves or others. Connecticut was the first state to enact such a law in 1999. The law's implementation and use between 1999 and 2013 were previously described, finding that ERPOs were pursued rarely for the first decade and that most orders were issued in response to concerns about suicide or self-harm rather than about interpersonal violence. The current study analyzes over 1,400 ERPOs in Connecticut between 2013 and 2020 in several domains: respondent demographics, circumstances leading to ERPO filing, type of threat (suicide, violence to others, or both), number and type of firearms removed, prevalence of mental illness and drug and alcohol use, and legal outcomes. Results are similar to the earlier study, indicating that ERPO respondents in Connecticut are primarily White, male, middle-aged residents of small towns and suburbs who pose a risk of harm to themselves (67.9%) more often than to others (42.8%). Significant gender differences between ERPO respondents are discussed, as are state-specific trends over time and differences between Connecticut and other states with published ERPO data.

A Trigger Warning: Red Flag Laws are Still Constitutionally Permissible and Could Reduce the Suicide Rates in the Country's Most Vulnerable States.

Montana, Alaska, and Wyoming lead the United States in a category coveted by no one: the suicide rate. Firearm ownership drives the rate to the disproportionate level it reaches year after year and the states are left with little recourse. This article argues the usefulness and constitutionality of narrowly tailored red-flag laws aimed exclusively at reducing the rate of suicide in these mountain states. The article follows Supreme Court jurisprudence leading up to New York Rifle and Pistol Association v. Bruen and offers an analysis that complies with the hyper textualist history and tradition test laid out by Scalia in District of Columbia v. Heller and McDonald v. City of Chicago. The analysis demonstrates that narrowly tailored red flag laws are a constitutional means of reducing the suicide rate in these at-risk states and references statutory and cultural avenues for the implementation of the legislation.

A call for open science in forensics.

The modern canon of open science consists of five "schools of thought" that justify unfettered access to the fruits of scientific research: i) public engagement, ii) democratic right of access, iii) efficiency of knowledge gain, iv) shared technology, and v) better assessment of impact. Here, we introduce a sixth school: due process. Due process under the law includes a right to "discovery" by a defendant of potentially exculpatory evidence held by the prosecution. When such evidence is scientific, due process becomes a Constitutional mandate for open science. To illustrate the significance of this new school, we present a case study from forensics, which centers on a federally funded investigation that reports summary statistics indicating that identification decisions made by forensic firearms examiners are highly accurate. Because of growing concern about validity of forensic methods, the larger scientific community called for public release of the complete analyzable dataset for independent audit and verification. Those in possession of the data opposed release for three years while summary statistics were used by prosecutors to gain admissibility of evidence in criminal trials. Those statistics paint an incomplete picture and hint at flaws in experimental design and analysis. Under the circumstances, withholding the underlying data in a criminal proceeding violates due process. Following the successful open-science model of drug validity testing through "clinical trials," which place strict requirements on experimental design and timing of data release, we argue for registered and open "forensic trials" to ensure transparency and accountability.

Variations by State in Firearm Suicide Among US Children and Young Adults, 2016-2021.

This cross-sectional study examines variations by state in firearm suicide rates in US children and young adults from 2016 to 2021 using data from the Centers for Disease Control and Prevention.

Evaluating Firearm Violence After New Jersey's Cash Bail Reform.

Importance: Reducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence. Objective: To evaluate changes in firearm violence after New Jersey's 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention. Design, Setting, and Participants: This case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024. Exposure: Implementation of New Jersey's cash bail reform law in 2017. Main Outcomes and Measures: Quarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people. Results: Although New Jersey's pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, -0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, -0.24 deaths per 100 000), or within racialized groups during the postpolicy period. Conclusions and Relevance: Incarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.