Perspectives on Childhood Lead Exposure Prevention: Looking Back and Looking Ahead.

Lead's neurotoxic properties and potential harmful effects to humans, particularly young children, have been recognized for decades, influencing public health policies to reduce its admixture in house paint and passenger car gasoline. We signal 3 emergent trends: firearm proliferation, complex international food supply chains, and equally complex product marketing strategies, which have opened opportunities for lead exposure to children from guns and ammunition, and lead contamination in children's food and consumer goods. Readers will also be apprised of Childhood Lead Poisoning Prevention Program and education strategies cultivated and advanced by the Centers for Disease Control and Prevention and its lead prevention partners. A national governmental policy update is included, as are future considerations.

Supreme Court Impacts in Public Health Law: 2023-2024.

In a "mixed bag" 2023-2024 session, the U.S. Supreme Court issued a series of decisions both favorable and antithetical to public health and safety. Taking on tough constitutional issues implicating gun control, misinformation, and homelessness, the Court also avoided substantive reviews in favor of procedural dismissals in key cases involving reproductive rights and government censorship.

Are Child Access Prevention Laws Associated With Fewer Pediatric Firearm Injuries?

OBJECTIVE: Firearm injuries are the leading cause of death for children in the United States. Child access prevention (CAP) laws have been passed in some states. This study examines characteristics of children with firearm injuries in states with different types of CAP laws. METHODS: The Pediatric Health Information System database was reviewed to identify all pediatric firearm injury patients between 2016 and 2021. Hospital data were categorized based on state laws as (1) no CAP laws (2) some CAP laws or (3) strict CAP laws. CAP laws that specifically outlined criminal liability for the negligent storage of firearms were considered a strict restriction, whereas any other form of CAP law was considered some restriction. χ-squared and independent-samples median testing were performed to compare restriction levels. RESULTS: Between 2016 and 2021, 12 853 firearm injuries were recorded in the Pediatric Health Information System database. In states with strict CAP laws, patients were significantly older (P < .001) and had a significantly higher household income (P < .001) compared with patients in states with no CAP laws. Gender, race, and the number of firearm injuries differed between the 3 restriction levels. There were less firearm injuries observed than expected in cities with strict CAP laws. CONCLUSIONS: CAP laws are associated with a higher age and household income of pediatric firearm injury patients. Given the disparities seen between cities, a federal CAP law may best protect children nationwide.

Public Mass Shootings: Counterfactual Trend Analysis of the Federal Assault Weapons Ban.

Background: Assault weapon and large-capacity magazine bans are potential tools for policy makers to prevent public mass shootings. However, the efficacy of these bans is a continual source of debate. In an earlier study, we estimated the impact of the Federal Assault Weapons Ban (FAWB) on the number of public mass shooting events in the United States. This study provides an updated assessment with 3 additional years of firearm surveillance data to characterize the longer-term effects. Objective: This study aims to estimate the impact of the FAWB on trends in public mass shootings from 1966 to 2022. Methods: We used linear regression to estimate the impact of the FAWB on the 4-year simple moving average of annual public mass shootings, defined by events with 4 or more deaths in 24 hours, not including the perpetrator. The study period spans 1966 to 2022. The model includes indicator variables for both the FAWB period (1995-2004) and the period after its removal (2005-2022). These indicators were interacted with a linear time trend. Estimates were controlled for the national homicide rate. After estimation, the model provided counterfactual estimates of public mass shootings if the FAWB was never imposed and if the FAWB remained in place. Results: The overall upward trajectory in the number of public mass shootings substantially fell while the FAWB was in place. These trends are specific to events in which the perpetrator used an assault weapon or large-capacity magazine. Point estimates suggest the FAWB prevented up to 5 public mass shootings while the ban was active. A continuation of the FAWB and large-capacity magazine ban would have prevented up to 38 public mass shootings, but the CIs become wider as time moves further away from the period of the FAWB. Conclusions: The FAWB, which included a ban on large-capacity magazines, was associated with fewer public mass shooting events, fatalities, and nonfatal gun injuries. Gun control legislation is an important public health tool in the prevention of public mass shootings.

Predicting Short Time-to-Crime Guns: a Machine Learning Analysis of California Transaction Records (2010-2021).

Gun-related crime continues to be an urgent public health and safety problem in cities across the US. A key question is: how are firearms diverted from the legal retail market into the hands of gun offenders? With close to 8 million legal firearm transaction records in California (2010-2020) linked to over 380,000 records of recovered crime guns (2010-2021), we employ supervised machine learning to predict which firearms are used in crimes shortly after purchase. Specifically, using random forest (RF) with stratified under-sampling, we predict any crime gun recovery within a year (0.2% of transactions) and violent crime gun recovery within a year (0.03% of transactions). We also identify the purchaser, firearm, and dealer characteristics most predictive of this short time-to-crime gun recovery using SHapley Additive exPlanations and mean decrease in accuracy variable importance measures. Overall, our models show good discrimination, and we are able to identify firearms at extreme risk for diversion into criminal hands. The test set AUC is 0.85 for both models. For the model predicting any recovery, a default threshold of 0.50 results in a sensitivity of 0.63 and a specificity of 0.88. Among transactions identified as extremely risky, e.g., transactions with a score of 0.98 and above, 74% (35/47 in the test data) are recovered within a year. The most important predictive features include purchaser age and caliber size. This study suggests the potential utility of transaction records combined with machine learning to identify firearms at the highest risk for diversion and criminal use soon after purchase.

Universal Background Checks, Permit Requirements, and Firearm Homicide Rates.

Importance: A loophole in US gun policy is that people can purchase guns from private sellers without going through any background check. Some states have addressed this loophole by requiring universal background checks for all gun sales, either at the point of sale or through a permit system; however, most studies on the effectiveness of universal background checks have not analyzed these 2 policy mechanisms separately. Objective: To assess the association of point-of-sale background check law and gun permit law, separately, with firearm homicide rates from 1976 through 2022 using the same methods and model specification. Design, Setting, and Participants: This cross-sectional study used a difference-in-differences, fixed-effects regression model to evaluate firearm laws and firearm homicide rates in 48 states from 1976 through 2022. Data were obtained for 48 states except New Hampshire and Vermont and were analyzed in January 2024. Exposures: Implementation of either the law requiring a universal background check at point of sale for all firearms without a permit or the laws combining universal background checks and a state permit requirement for all gun purchasers. Main Outcomes and Measures: Annual, state-specific rates of firearm homicide per 100 000 people. Results: From 1976 through 2022, 12 states adopted the universal background check laws without permitting requirements and 7 states implemented gun permit laws covering all firearms. The mean (SD) firearm homicide rate was 4.3 (0.1) per 100 000 people. Universal background checks for all firearms alone (without a state permitting system) were not associated with overall homicide rates (percentage change, 1.3%; 95% CI, -6.9% to 10.4%) or firearm homicide rates (percentage change, 3.7%; 95% CI, -5.3% to 13.6%). A law requiring a permit for the purchase of all firearms was associated with significantly lower overall homicide rates (percentage change, -15.4%; 95% CI, -28.5% to -0.01%) and firearm homicide rates (percentage change, -18.3%; 95% CI, -32.0% to -1.9%). Conclusions and Relevance: This cross-sectional study found that universal background checks alone were not associated with firearm homicide rates, but a permit requirement for the purchase and possession of firearms was associated with substantially reduced rates of firearm homicide. The findings suggest that combining universal background checks and permit-to-purchase requirements is an effective strategy for firearm-related fatality reduction.

Legislative Advocacy in Illinois for Firearm Injury Prevention.

The leading cause of death in children in the United States is injury caused by firearm violence. States that enact stricter laws related to firearm injury prevention have lower rates of mortality in children. In Illinois, we formed a coalition with medical professionals, medical organizations, community partners, and legislators to craft legislation to reduce the burden of firearm violence on children. These laws can be politically charged. Therefore, we decided to focus on a safe storage education law. We met regularly as a group to draft the bill and an information sheet to support it. Pediatricians and pediatric providers worked with the government relations teams in children's hospitals throughout the state to garner supporting organizations. We also worked to garner cosponsors, provided written and oral testimony to the legislative body, and wrote op-eds to support the bill. Shortly after the bill was passed and signed into law in June of 2022, there was a mass shooting at Highland Park in Illinois. After the shooting, there was a mandate from the Illinois governor to work on passing an assault weapons ban. Pediatricians again provided input into the bill about how the weapons affect children, testified before the House Judiciary Committee, and wrote op-eds. Governor Pritzker signed the Protect Illinois Communities Act into law in January of 2023. Pediatricians actively worked in the passage of both bills, which highlights the importance of medical professionals as experts who can combine powerful stories and evidence based medicine to influence policy.

Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States.

More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil court process to pose an imminent risk of harm to themselves or others. Research with large multistate study populations has been lacking to determine effectiveness of these laws. This study assembled records pertaining to 4,583 ERPO respondents in California, Connecticut, Maryland, and Washington. Matched records identified suicide decedents and self-injury method. Researchers applied case fatality rates for each suicide method to estimate nonfatal suicide attempts corresponding to observed deaths. Comparison of counterfactual to observed data patterns yielded estimates of the number of lives saved and number of ERPOs needed to avert one suicide. Estimates varied depending on the assumed probability that a gun owner who attempts suicide will use a gun. Two evidence-based approaches yielded estimates of 17 and 23 ERPOs needed to prevent one suicide. For the subset of 2,850 ERPO respondents with documented suicide concern, comparable estimates were 13 and 18, respectively. This study's findings add to growing evidence that ERPOs can be an effective and important suicide prevention tool.

Florida's Red Flag Gun Law and Firearm and Nonfirearm Homicide and Suicide Rates.

This study estimates the association between Florida's red flag law enactment and firearm and nonfirearm homicide and suicide rates.

The Supreme Court Decision on Firearm Ownership for People Subject to Restraining Orders.

This Viewpoint explicates the complex reasoning the US Supreme Court has used in rulings on gun control and raises concerns that the recent Rahimi decision poses more questions than it settled on the future of the Second Amendment.

Gunshot injuries in Central Europe - Epidemiology and outcome in Germany, Switzerland and Austria - an analysis based on the TraumaRegister DGU®.

BACKGROUND: Firearms are of special interest in trauma research due to high lethality and criminal value. Strong correlation between guns per capita and fire-arm related deaths has been shown. Most of existing literature regarding gun-shot fatalities are from the U.S. and data for Central Europe is lacking. Thus, the aim of this study was to assess the legal frameworks regarding gun-ownership in Germany (DE), Austria (A) and Switzerland (CH), and to retrospectively analyze data from the TraumaRegister DGU® regarding the epidemiology, injury severity, intention and outcome of gunshot-related deaths in these countries. METHODS: All patients from TR-DGU who sustained a gunshot injury in the time period from 1st January 2009 to 31st December 2019 were considered for analysis. Only cases admitted to level 1 or 2 trauma center in Germany, Switzerland, or Austria were included. Predicted mortality was calculated using the RISC-II. Further, the legal framework for firearm posession were explored. RESULTS: The legal frameworks do not differ significantly between the countries. However, only ex-military men from Switzerland are allowed to keep their automatic (military) weapon at home. We assessed 1312 gunshot fatalities (DE 1,099, A 111, CH 102) of which most were due to suspected suicide (A 72.1 %, CH 64.7 %, and DE 56.6 %, p = 0.003). Act of suspected violent crime or accidental gunshots were rare in all three countries. Amongst all gunshot fatalities, Austria showed the highest mean age (57.6 years), followed by DE (53.4 years) and CH (49.4 years; p < 0.01). Gunshot fatalities amongst all assessed countries due to suspected suicide showed a peak at the age of 60 years and above, whereas suspected violent crime delicts with gunshots were mainly seen in younger age groups. The highest mortality was found in suspected suicide cases, showing a mortality of 82.1 % (predicted 65.2 %) in Switzerland, 75.3 % (predicted 65.8 %) in Austria and 63.7 % (predicted 56.2 %) in Germany. CONCLUSION: Gunshot wounds are still rare in central Europe, but gunshot-related suicide rates are high. Gun ownership laws may have an impact on gunshot wounds due to suspected suicide. Injury patterns differ compared to countries where a high incidence of gun ownership is seen.

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.