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.

Legal Firearm Sales at State Level and Rates of Violent Crime, Property Crime, and Homicides.

INTRODUCTION: The effects of firearm sales and legislation on crime and violence are intensely debated, with multiple studies yielding differing results. We hypothesized that increased lawful firearm sales would not be associated with the rates of crime and homicide when studied using a robust statistical method. METHODS: National and state rates of crime and homicide during 1999-2015 were obtained from the United States Department of Justice and the Centers for Disease Control and Prevention. National Instant Criminal Background Check System background checks were used as a surrogate for lawful firearm sales. A general multiple linear regression model using log event rates was used to assess the effect of firearm sales on crime and homicide rates. Additional modeling was then performed on a state basis using an autoregressive correlation structure with generalized estimating equation estimates for standard errors to adjust for the interdependence of variables year to year within a particular state. RESULTS: Nationally, all crime rates except the Centers for Disease Control and Prevention-designated firearm homicides decreased as firearm sales increased over the study period. Using a naive national model, increases in firearm sales were associated with significant decreases in multiple crime categories. However, a more robust analysis using generalized estimating equation estimates on state-level data demonstrated increases in firearms sales were not associated with changes in any crime variables examined. CONCLUSIONS: Robust analysis does not identify an association between increased lawful firearm sales and rates of crime or homicide. Based on this, it is unclear if efforts to limit lawful firearm sales would have any effect on rates of crime, homicide, or injuries from violence committed with firearms.

Shifting Peaks and Cumulative Consequences: Disqualifying Convictions in High-security Jobs.

OBJECTIVES: Disqualifying conviction lists (DCLs) bar applicants with certain convictions within specified timeframes from employment. Using proposed federal legislative changes in the aviation sector as a case study, we examine whether convictions under the existing policy are associated with subsequent arrest. Then we consider the implications of proposed expansions-arrests instead of convictions and a longer look-back window-on employment restrictions. METHODS: Since DCLs exclude ineligible applicants with conviction records, we use a large, single-state sample of diverse criminal histories. We compare subsequent arrest rates across offense types, consider variations in hazard patterns, and project exclusion estimates based on current and anticipated policy reforms. RESULTS: Only half of the disqualifying offenses have consistently higher recidivism rates than non-disqualifying offense types. Over 20 percent of the sample would be barred from employment, policy extensions double this estimate, and exclusions are age-graded, shifting a peak conviction age of 20 years old to a peak "consequence age" of 28. CONCLUSIONS: Including a narrower set of offenses would reduce those automatically disqualified in our study context by nearly 20 percent, or 39,000 individuals. Instead of expanding the DCL scope, successful criteria should be both effective in prediction and narrow in application.

Fingerprint-based background checks for personal care workers: Stakeholder views of policy criteria.

Decision makers face difficult choices when tasked with identifying and implementing appropriate mechanisms for protecting the elderly and other vulnerable adults from abuse. A pilot project involving fingerprint-based criminal history background checks for personal care workers in Michigan has supplied an opportunity to examine one such mechanism. In conjunction with the pilot project, we have conducted a stakeholder analysis with the aim of informing decision makers about stakeholder perceptions of standard policy criteria like effectiveness, efficiency, and equity. We employed focus groups and a Web-based survey to collect data from stakeholders. While stakeholders generally see fingerprint-based background checks for personal care workers as potentially effective and as a net benefit, they also point to a variety of contingencies. They also recognize difficulties and constraints for government involvement. This preliminary analysis provides solid foundational information for decision makers and for more extensive benefit-cost analysis.

Patient-centred outcomes research: brave new world meets old institutional policies.

Background: Engaging patients across the research trajectory supports research that is generalizable, high quality, timely and actionable. However, this approach comes with challenges and opportunities as investigators and engaged patient stakeholders encounter institutional policies around patient engagement, privacy and research participant protection. Objective: To describe the resolution and impact of quandaries arising when patient stakeholders' values and preferences conflicted with institutional policies. Methods: Case study from a Patient-Centered Outcomes Research Institute-funded trial. Results: The first example focuses on the tension between the health care organization's requirements for background checks for all patient advisors and the funders' requirement to engage hard-to-reach populations. To create an environment of mutual trust and respect with patient stakeholders, the research team decided against imposing background checks. All 53 patient and parent advisors have served continuously for 2 years and meeting attendance exceeds 95%. The second example describes parent stakeholders' role in revising a letter informing patients about a privacy violation. Among 49 families affected by and informed about this violation, 35 (71%) agreed to participate. The third example focuses on how patient stakeholder preferences about study reminders conflict with the 1996 Health Insurance Portability and Accountability Act rules. While patient stakeholders strongly endorsed text message reminders, regulations and technology do not permit reminders with enough detail to ensure clarity. Although retention rates exceeded 90%, attendance at study appointments was below 75% and below 60% for minority and low socio-economic status families. Conclusion: Patient engagement positively impacts research. Resolving conflicts between patient-engaged research and existing institutional policies and regulations would allow this impact to become fully realized.

Common Sense or Gun Control? Political Communication and News Media Framing of Firearm Sale Background Checks after Newtown.

Gun violence is a critical public health problem in the United States, but it is rarely at the top of the public policy agenda. The 2012 mass shooting in Newtown, Connecticut, opened a rare window of opportunity to strengthen firearm policies in the United States. In this study, we examine the American public's exposure to competing arguments for and against federal- and state-level universal background check laws, which would require a background check prior to every firearm sale, in a large sample of national and regional news stories (n = 486) published in the year following the Newtown shooting. Competing messages about background check laws could influence the outcome of policy debates by shifting support and political engagement among key constituencies such as gun owners and conservatives. We found that news media messages in support of universal background checks were fact-based and used rational arguments, and opposing messages often used rights-based frames designed to activate the core values of politically engaged gun owners. Reframing supportive messages about background check policies to align with gun owners' and conservatives' core values could be a promising strategy to increase these groups' willingness to vocalize their support for expanding background checks for firearm sales.

Insider Threats to the Military Health System: A Systematic Background Check of TRICARE West Providers.

Background: To address the pandemic, the Defense Health Agency (DHA) expanded its TRICARE civilian provider network by 30.1%. In 2022, the DHA Annual Report stated that TRICARE's provider directories were only 80% accurate. Unlike Medicare, the DHA does not publicly reveal National Provider Identification (NPI) numbers. As a result, TRICARE's 9.6 million beneficiaries lack the means to verify their doctor's credentials. Since 2013, the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) has excluded 17,706 physicians and other providers from federal health programs due to billing fraud, neglect, drug-related convictions, and other offenses. These providers and their NPIs are included on the OIG's List of Excluded Individuals and Entities (LEIE). Patients who receive care from excluded providers face higher risks of hospitalization and mortality. Objective: We sought to assess the extent to which TRICARE screens health care provider names on their referral website against criminal databases. Methods: Between January 1-31, 2023, we used TRICARE West's provider directory to search for all providers within a 5-mile radius of 798 zip codes (38 per state, ≥10,000 residents each, randomly entered). We then copied and pasted all directory results' first and last names, business names, addresses, phone numbers, fax numbers, degree types, practice specialties, and active or closed statuses into a CSV file. We cross-referenced the search results against US and state databases for medical and criminal misconduct, including the OIG-LEIE and General Services Administration's (GSA) SAM.gov exclusion lists, the HHS Office of Civil Rights Health Insurance Portability and Accountability Act (HIPAA) breach reports, 15 available state Medicaid exclusion lists (state), the International Trade Administration's Consolidated Screening List (CSL), 3 Food and Drug Administration (FDA) debarment lists, the Federal Bureau of Investigation's (FBI) list of January 6 federal defendants, and the OIG-HHS list of fugitives (FUG). Results: Our provider search yielded 111,619 raw results; 54 zip codes contained no data. After removing 72,156 (64.65%) duplicate entries, closed offices, and non-TRICARE West locations, we identified 39,463 active provider names. Within this baseline sample group, there were 2398 (6.08%) total matches against all exclusion and sanction databases, including 2197 on the OIG-LEIE, 2311 on the GSA-SAM.gov list, 2 on the HIPAA list, 54 on the state Medicaid exclusion lists, 69 on the CSL, 3 on the FDA lists, 53 on the FBI list, and 10 on the FUG. Conclusions: TRICARE's civilian provider roster merits further scrutiny by law enforcement. Following the National Institute of Standards and Technology 800, the DHA can mitigate privacy, safety, and security clearance threats by implementing an insider threat management model, robust enforcement of the False Claims Act, and mandatory security risk assessments. These are the views of the author, not the Department of Defense or the US government.

Firearm assaults against US law enforcement officers in the line-of-duty: Associations with firearm ownership and state firearm laws.

Law enforcement officers are disproportionately affected by occupational injury. Firearm violence is the second leading cause of occupational mortality for this group behind motor vehicle crashes. In the general population, greater firearm ownership and weaker firearm laws are associated with increased firearm violence incidence. It is plausible that a high prevalence of firearms could also be associated with a greater incidence of LEO assault with a firearm. Using data from the Federal Bureau of Investigation's, Uniform Crime Reporting, Police Employee Data for 2006-2016, we conducted a panel analysis to estimate the association between state-level estimates of household firearm ownership and LEO assault with a firearm. We additionally examined if effect modification by universal background check law status was present. Higher state-level firearm ownership was associated with an increased odds of LEO assault with a firearm in multi-level models. This association was modified by universal background check law status. In states without a universal background check law, for every 1% increase in state-level firearm ownership per agency-year, there was a 12.4% increase in the odds of an LEO assault with a firearm when adjusting for confounders (OR:1.124; 95% CI:1.018,1.240). In states with a universal background check law, there was no association. Findings, though small in magnitude, suggest aggregate firearm ownership may contribute to LEO assault with a firearm in states without a universal background check law. Future research to prevent LEO assault with a firearm should combine measures to address high rates of firearm ownership with other evidence-based prevention strategies.

Promoting the Public's Health with Personal Commitment and Gun Safety Policies.

The high level of gun violence in the United States is unique. Self-harm is the leading reason for death from a gun in the white population, and homicide is the leading reason for death from a gun in the Black population. Because three-quarters of gun owners say they could never see themselves not owning a gun, and half of gun owners say owning a gun is important to their overall identity, the path to reducing deaths and other harm from guns is narrow and must be tread with knowledge and skill. The experience of other countries and that of states like Connecticut and Indiana is evidence that gun safety laws - in particular, universal background checks and extreme risk protection orders - can reduce deaths and injury due to gun violence. Safe storage for firearms, preferably out of the home, also reduces the risk of death and injury from guns. The goal of this article, after briefly describing the intensity and causes of gun violence in the United States, is to give the reader some basic tools to become an effective advocate for gun safety and gun violence reduction.

Background Checks For Firearm Purchases: Problem Areas And Recommendations To Improve Effectiveness.

Mandatory background checks on firearm purchasers receive widespread support from the general public and firearm owners. Background checks appear to reduce the risk of violence substantially among prohibited persons whose purchases are denied. However, population-level studies, including studies of comprehensive background check policies, have often shown no clear evidence of benefit. There is one notable exception: Permit-to-purchase policies have consistently been associated with beneficial population-level effects. The findings of no benefit may in part be an artifact of history, as the completeness of the data on which background checks are run has improved substantially since the periods examined by those studies. Nonetheless, significant problems with implementation and design still limit the population-level effectiveness of background check policies. In this article I review nine of these problem areas and suggest actions that could substantially improve the effectiveness of background check policies in preventing firearm-related violence.

Gun Violence Following Inpatient Psychiatric Treatment: Offense Characteristics, Sources of Guns, and Number of Victims.

OBJECTIVE: This study presents data on the relative contribution to gun violence by people with a history of inpatient psychiatric treatment and on federal efforts to deter presumptively dangerous persons from obtaining firearms, information useful for analyzing the potential public health benefits of gun policies targeting people with serious mental illness. The study also estimates the reduction in gun violence victims that would be expected if individuals with a previous psychiatric hospitalization were prohibited from purchasing firearms. METHODS: Data from 838 violent gun offenders from a nationally representative sample of state prison inmates were analyzed. Those with and without a history of psychiatric hospitalization were compared on a range of offense characteristics, including relationship to the victim, number of victims, location of the offense, and source of firearms. RESULTS: Inmates with a history of hospitalization constituted 12% of all violent gun offenders and accounted for 13% of the sample's victims. They were less likely than those without a previous hospitalization to victimize strangers (odds ratio=.52) and were no more likely to commit gun violence in public or to have multiple victims. Among those with previous hospitalizations, 78% obtained guns from sources not subject to federal background checks. Of the total 1,041 victims of gun violence, only 3% were victimized by participants with a history of hospitalization who obtained guns from currently regulated sources. CONCLUSIONS: Prohibiting all individuals with a history of psychiatric hospitalization from purchasing firearms, absent expanded background checks, was estimated to reduce the number of gun violence victims by only 3%.