Reasons for Gun Ownership Among Demographically Diverse New and Prior Gun Owners.

INTRODUCTION: Pandemic-era social and political tensions may have accelerated pre-existing trends in gun owner diversification and shifts toward protection from people as a primary reason for gun ownership. Specific ownership motivations may shape storage behaviors, use patterns, policy support, and perceptions of safety. This study's objective was to assess the importance of specific reasons for owning guns, including protection from whom and in what circumstances, among demographic subgroups of new and prior gun owners. METHODS: From January 4, 2023 to February 6, 2023, the National Survey of Gun Policy was fielded among a nationally representative sample of U.S. adults (N=3,096), including gun owners (n=1,002). Respondents rated the importance of 10 potential reasons for gun ownership, including at-home protection, out-of-home protection, protection in ideologic conflict, and hunting or recreation. In 2023-2024, respondents' self-report of important and highly important reasons for gun ownership were compared across political affiliation, race, ethnicity, age, sex, location, income, education, and recency of first purchase. RESULTS: Majorities of gun owners from all demographic groups cited at-home protection, out-of-home protection, and hunting or recreation as very or extremely important. At least 10% of every demographic group endorsed at least 1 ideologic reason as extremely important. Newer gun owners more frequently endorsed multiple important reasons. CONCLUSIONS: Concurrent, strongly held motivations may produce ambivalence or resistance to public health messaging that narrowly focuses on preventing violent firearm-related injury. Permissive firearm policies may compound behavioral ambivalence, exacerbating conditions that threaten collective safety and civic expression. These conditions call for more nuanced, multidimensional, societal efforts to assure collective safety.

Officer gunpoint during police stops: Repercussions for youth mental health and perceived safety.

Youth-police contact is increasingly acknowledged as a stressor and a racialized adverse childhood experience that can undermine youths' mental health. The present study investigates a particularly distressing feature of youths' direct and witnessed in-person police stops-officer gunpoint (i.e., officers drawing of firearms and pointing them at youth, their peers, or other community members). We examine patterns of youths' officer gunpoint exposure and associations with youth mental health and safety perceptions. Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a cross-sectional survey of a community-based sample of Black youth ages 12-21 in Baltimore City, Maryland (n = 335), administered from August 2022 to July 2023. Findings indicate that ~33% of youth reporting in-person police stops had been exposed to officer gunpoint during stops. Officer gunpoint was significantly and positively associated with being male, unemployed, having an incarcerated parent, living in a neighborhood with greater disorder, and having been directly stopped by police, in addition to youth delinquency and impulsivity. Net of covariates, experiencing officer gunpoint was associated with a significantly higher rate of youth emotional distress during stops. Significant associations between officer gunpoint and youths' current police violence stress, police avoidance, and diminished safety perceptions also emerged and were largely explained by youths' heightened emotional distress at the time of police stops. Trauma-informed approaches are needed to mitigate the mental health harms of youth experiencing officer gunpoint.

Characteristics of Injurious Shootings by Police Along the Urban-Rural Continuum.

INTRODUCTION: Much research on shootings by police has focused on urban jurisdictions, but most U.S. law enforcement agencies are not located in cities. Prior research suggests that rates of fatal shootings by police are comparable between urban and nonurban areas. Yet, shooting characteristics across the urban-rural continuum are unknown. This study describes and compares fatal and nonfatal injurious shootings by officers in U.S. urban, suburban, and rural areas from 2015 to 2020. METHODS: Characteristics of fatal and nonfatal injurious shootings by police were abstracted from Gun Violence Archive. In 2023-2024, using ZIP-code and county-based rurality designations, the national distribution, incidence, and characteristics of injurious shootings by police were compared across urban, suburban, and rural areas of the U.S. RESULTS: Rates of injurious shootings in rural areas approached or exceeded those of urban rates. As rurality increased, proportionately more injurious shootings involved single responders, sheriffs, or multiple agency types. Across the urban-rural continuum, characteristics of precipitating incidents were similar. Injurious shootings were most frequently preceded by domestic violence incidents, traffic stops, or shots-fired reports; co-occurring behavioral health needs were common. After accounting for local demographic differences, Black, indigenous, and Hispanic residents were injured at higher rates than White residents in all examined areas. CONCLUSIONS: Shootings by police represent an overlooked and inequitable source of injury in rural areas. Broadly similar incident characteristics suggest potential for wide-reaching reforms. To prevent injuries, crisis prevention, dispatch, and response systems must assure proportionate rural-area coverage. In addition, legislative prevention and accountability measures should include sheriffs' offices for optimal rural-area impact.

National Burden of Injury and Deaths From Shootings by Police in the United States, 2015‒2020.

Objectives. To describe all-outcome injurious shootings by police and compare characteristics of fatal versus nonfatal injurious shootings nationally. Methods. From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by US police, identified from Gun Violence Archive. We estimated injury frequency, case fatality rates, and relative odds of death by incident and victim characteristics. Results. A total of 1769 people were injured annually in shootings by police, 55% fatally. When a shooting injury occurred, odds of fatality were 46% higher following dispatched responses than police-initiated responses. Injuries associated with physically threatening or threat-making behaviors, behavioral health needs, and well-being checks were most frequently fatal. Relative to White victims, Black victims were overrepresented but had 35% lower odds of fatal injury when shot. Conclusions. This first multiyear, nationwide analysis of injurious shootings by US police suggests that injury disparities are underestimated by fatal shootings alone. Nonpolicing responses to social needs may prevent future injuries. Public Health Implications. We call for enhanced reporting systems, comprehensive evaluation of emerging reforms, and targeted investment in social services for equitable injury prevention. (Am J Public Health. 2024;114(4):387-397. https://doi.org/10.2105/AJPH.2023.307560).

The association between permit-to-purchase laws and shootings by police.

BACKGROUND: Fatal and nonfatal shootings by police are a public health issue that warrants additional research. Prior research has documented associations between fatal shootings by police and gun ownership, legislative strength scores, and lax concealed carry weapons laws. Despite research on other firearm-related outcomes, little is known about the impact of permit-to-purchase (PTP) laws on shootings by police. We generated counts of fatal and nonfatal OIS from the Gun Violence Archive from 2015 to 2020. We conducted cross-sectional regression modeling with a Poisson distribution and robust standard errors. In addition to PTP, we included several state-level policies that may be associated with shootings by police: comprehensive background check only (CBC-only) laws, concealed carry licensing laws, stand your ground laws, violent misdemeanor prohibitions, and extreme risk protection orders (ERPO). We controlled for state-level demographic characteristics and included a population offset to generate incidence rate ratios (IRR). FINDINGS: PTP laws were associated with a 28% lower rate in shootings by police [IRR = 0.72, 95% confidence interval (CI) 0.64-0.81]. Shall Issue (IRR = 1.34, 95% CI 1.17-1.53) and Permitless (IRR = 1.61, 95% CI 1.35-1.91) concealed carry laws and CBC-only laws (IRR = 1.12, 95% CI 1.01-1.25) were associated with higher rates of shootings by police. Stand your ground, violent misdemeanor prohibitions, and ERPO laws were not associated with shootings by police. CONCLUSIONS: Our study found that PTP laws were associated with significantly lower rates of shootings by police. Removing restrictions on civilian concealed carry was associated with significantly higher rates. State-level firearm policies may be a lever to address shootings by police.

Differences in Perceptions of Gun-Related Safety by Race and Gun Ownership in the United States.

Motivated by disparities in gun violence, sharp increases in gun ownership, and a changing gun policy landscape, we conducted a nationally representative survey of U.S. adults (n=2,778) in 2021 to compare safety-related views of white, Black, and Hispanic gun owners and non-owners. Black gun owners were most aware of homicide disparities and least expecting of personal safety improvements from gun ownership or more permissive gun carrying. Non-owner views differed. Health equity and policy opportunities are discussed.

Impact of Changes to Concealed-Carry Weapons Laws on Fatal and Nonfatal Violent Crime, 1980-2019.

The United States faces rapidly rising rates of violent crime committed with firearms. In this study, we sought to estimate the impact of changes to laws that regulate the concealed carrying of weapons (concealed-carry weapons (CCW) laws) on violent crimes committed with a firearm. We used augmented synthetic control models and random-effects meta-analyses to estimate state-specific effects and the average effect of adopting shall-issue CCW permitting laws on rates of 6 violent crimes: homicide with a gun, homicide by other means, aggravated assault with a gun, aggravated assault with a knife, robbery with a gun, and robbery with a knife. The average effects were stratified according to the presence or absence of several shall-issue permit provisions. Adoption of a shall-issue CCW law was associated with a 9.5% increase in rates of assault with a firearm during the first 10 years after law adoption and was associated with an 8.8% increase in rates of homicide by other means. When shall-issue laws allowed violent misdemeanants to acquire CCW permits, the laws were associated with higher rates of gun assaults. It is likely that adoption of shall-issue CCW laws has increased rates of nonfatal violent crime committed with firearms. Harmful effects of shall-issue laws are most clear when provisions intended to reduce risks associated with civilian gun-carrying are absent.

National support for gun policies among U.S. adults in 2019 and 2021.

Gun-related deaths and gun purchases were at record highs in 2020. In light of the COVID-19 pandemic, public protests against police violence, and a tense political environment, which may influence policy preferences, we aimed to understand the current state of support for gun policies in the U.S. We fielded a national public opinion survey in January 2019 and January 2021 using an online panel to measure support for 34 gun policies among U.S. adults. We compared support over time, by gun ownership status, and by political party affiliation. Most respondents supported 33 of the 34 gun regulations studied. Support for seven restrictive policies declined from 2019 to 2021, driven by reduced support among non-gun owners. Support declined for three permissive policies: allowing legal gun carriers to bring guns onto college campuses or K-12 schools and stand your ground laws. Public support for gun-related policies decreased from 2019 to 2021, driven by decreased support among Republicans and non-gun owners.

The association between vacant housing demolition and safety and health in Baltimore, MD.

We measured the association between vacant housing demolitions and changes in crime and emergency department (ED) visits in Baltimore, MD. We included 646 block groups in Baltimore, 224 of which experienced at least one demolition from 2012 to 2019. The exposure was the number of demolitions completed in a block group during the previous quarter. Crime (all, property, and violent) and ED visits (all, adults, children, and for specific causes) were examined as the change in the rate per 1000 people from the previous quarter to the current quarter and analyzed using multivariable mixed effects regression models. Demolitions were associated with a small decrease in total ED visits (difference = -0.068 per 1000 people from the previous quarter to the current quarter, 95% CI -0.119, -0.018) but no significant change in crime. For each demolition, the rate of total child ED visits was 0.452 lower compared to the previous quarter (95% CI -0.777, -0.127). Demolitions were associated with small decreases in adult injury-related ED visits in the short term.

Nonfatal Violence Involving Days Away From Work Following California's 2017 Workplace Violence Prevention in Health Care Safety Standard.

Objectives. To examine the impact of the California Occupational Safety and Health Administration's (Cal/OSHA's) 2017 workplace violence (WPV) prevention in health care safety standard on nonfatal violent injuries among health care workers (HCWs). Methods. We accessed estimated counts of WPV from the survey of occupational injuries and illness from 2011 to 2019 specific to HCWs. We used the Current Population Survey estimates of HCWs to create rates per 10 000. We conducted a longitudinal panel analysis and a comparative interrupted time-series analysis to examine the change in incidence and in rates associated with California's new standard. Results. Adoption of the 2017 safety standard led to an additional 3.48 reported WPV injuries per 10 000 HCWs in California, or an additional 473 injuries. Sensitivity analyses suggest other injuries did not change in the same period. Conclusions. It appears that the Cal/OSHA standard increased reporting of WPV injuries among HCWs in the first year of its adoption compared with the United States. Mandating reporting of all WPV incidents in the health care setting may be a means to ensure a more complete understanding of this public health problem. (Am J Public Health. 2022;112(11):1668-1675. https://doi.org/10.2105/AJPH.2022.307029).

National support for gun policies among U.S. adults in 2019 and 2021.

Gun-related deaths and gun purchases were at record highs in 2020. In light of the COVID-19 pandemic, public protests against police violence, and a tense political environment, which may influence policy preferences, we aimed to understand the current state of support for gun policies in the U.S. We fielded a national public opinion survey in January 2019 and January 2021 using an online panel to measure support for 34 gun policies among U.S. adults. We compared support over time, by gun ownership status, and by political party affiliation. Most respondents supported 33 of the 34 gun regulations studied. Support for seven restrictive policies declined from 2019 to 2021, driven by reduced support among non-gun owners. Support declined for three permissive policies: allowing legal gun carriers to bring guns onto college campuses or K-12 schools and stand your ground laws. Public support for gun-related policies decreased from 2019 to 2021, driven by decreased support among Republicans and non-gun owners.

Reimagining public safety: Public opinion on police reform and gun violence prevention by race and gun ownership in the United States.

Inequitable experiences of community gun violence and victimization by police use of force led to nationwide calls to "reimagine public safety" in 2020. In January 2021, we examined public support among U.S. adults for 7 policy approaches to reforming policing and investing in community gun violence prevention. Using a nationally representative sample (N = 2778), with oversampling for Black Americans, Hispanic Americans, and gun owners, we assessed support overall and by racial, ethnic, and gun owner subgroups. Overall, we found majority support for funding and implementing police and mental health co-responder models (66% and 76%, respectively), diversion from incarceration for people with symptoms of mental illness (72%), stronger laws to assure police accountability (72%), and funding for community-based and hospital-based gun violence prevention programs (69% and 60%, respectively). Support for redirecting funding from the police to social services was more variable (44% overall; White: 35%, Black: 60%, Hispanic: 43%). For all survey items, support was strongest among Black Americans. Gun owners overall reported lower support for public safety reforms and investments than respondents who did not own guns, but this distinction was found to be driven by White gun owners. The views of Black gun owners were indistinguishable from Black non-owners and were similar to White non-owners on most issues. These findings suggest that broad public support exists for innovative violence reduction strategies and public safety reforms.

The 5 A's of firearm safety counseling: Validating a clinical counseling methodology for firearms in a simulation-based randomized controlled trial.

The 5 A's of Firearm Safety Counseling is a novel framework by which clinicians can approach firearm injury prevention counseling. To evaluate this methodology as a tool for clinicians, a single-center, simulation-based randomized controlled trial was performed with clinical trainees in psychiatry, medicine, and pediatrics in an urban quaternary care center. Participants received didactic education on firearm injury epidemiology and evidence-based policies and training on a specific counseling framework, the 5 A's of Firearm Safety Counseling which they then implemented in a simulation setting with standardized patients. Of the 29 participants who were randomized, 28 completed the trial. Most participants were psychiatry trainees (residents or subspecialty fellows). While over 60% of participants were uncomfortable or extremely uncomfortable counseling on firearm injury prior to the interventions, only 4% reported being uncomfortable after receiving education and participating in simulated encounters. There was no significant difference between the quality and content of the counseling provided before and after the didactic-only session. There was a significant difference between the quality and content of the counseling provided before and after the specific training on the 5 A's for Firearm Safety Counseling strategy. The 5 A's for Firearm Safety Counseling is a promising educational tool to improve quality, content, and comfort delivering patient-centered counseling on firearm injury prevention in a simulation-based setting. These findings suggest that further validation in a clinical setting is warranted given there is an urgent need for feasible and effective firearm injury prevention strategies among clinicians.

Officer-Involved Shootings and Concealed Carry Weapons Permitting Laws: Analysis of Gun Violence Archive Data, 2014-2020.

About 1,000 civilians are killed every year by a law enforcement officer in the USA, more than 90% by firearms. Most civilians who are shot are armed with a firearms. Higher rates of officer-involved shootings (OIS) are positively associated with state-level firearm ownership. Laws relaxing restrictions on civilians carrying concealed firearms (CCW) have been associated with increased violent crime. This study examines associations between CCW laws and OIS. We accessed counts of fatal and nonfatal OIS from the Gun Violence Archive (GVA) from 2014-2020 and calculated rates using population estimates. We conducted legal research to identify passage years of CCW laws. We used an augmented synthetic control models with fixed effects to estimate the effect of Permitless CCW law adoption on OIS over fourteen biannual semesters. We calculated an inverse variance weighted average of the overall effect. On average, Permitless CCW adopting states saw a 12.9% increase in the OIS victimization rate or an additional 4 OIS victimizations per year, compared to what would have happened had law adoption not occurred. Lax laws regulating civilian carrying of concealed firearms were associated with higher incidence of OIS. The increase in concealed gun carrying frequency associated with these laws may influence the perceived threat of danger faced by law enforcement. This could contribute to higher rates of OIS.

Public opinion on laws regulating public gun carrying.

This study sought to examine public support for gun carrying-related policies from 2019 to 2021, a period encompassing the COVID-19 pandemic and increasing calls for racial and social justice. We conducted the National Survey of Gun Policy in January 2019 and 2021. The surveys were fielded using the NORC AmeriSpeak panel. Respondents indicated support for six policies regulating civilian gun carrying. Analyses, conducted in 2021, incorporated survey weights for nationally representative estimates. There were significant declines in support from 2019 to 2021 for two policies that would expand where civilians can lawfully carry guns: allowing concealed carry when on K-12 school grounds (23% in 2021 vs 31% in 2019) and college/university campuses (27% vs 36%). Support was also significantly lower for requiring concealed carry applicants to pass a test demonstrating safe and lawful use (74% in 2021 vs 81% in 2019). For the two new policies in the 2021 survey, more than half of respondents overall supported prohibiting open carry at demonstrations/rallies (54%) and prohibiting the carry of guns into government buildings (69%). There was lower support among gun owners (39% and 57%, respectively). Since 2019, there has been a decline in support for expanding locations for civilian gun carrying. Support remains high among U.S. adults, including the two-thirds of gun owners, for requiring concealed carry applicants to demonstrate competence in safe and lawful gun use. Our findings in support of a more regulated approach to concealed carry are in direct contrast to state-level shifts eliminating concealed gun carrying regulations.

Using synthetic control methodology to estimate effects of a Cure Violence intervention in Baltimore, Maryland.

OBJECTIVE: To estimate the long-term impact of Safe Streets Baltimore, which is based on the Cure Violence outreach and violence interruption model, on firearm violence. METHODS: We used synthetic control methods to estimate programme effects on homicides and incidents of non-fatal penetrating firearm injury (non-fatal shootings) in neighbourhoods that had Safe Streets' sites and model-generated counterfactuals. Synthetic control analyses were conducted for each firearm violence outcome in each of the seven areas where Safe Streets was implemented. The study also investigated variation in programme impact over time by generating effect estimates of varying durations for the longest-running programme sites. RESULTS: Synthetic control models reduced prediction error relative to regression analyses. Estimates of Safe Streets' effects on firearm violence varied across intervention sites: some positive, some negative and no effect. Beneficial programme effects on firearm violence reported in prior research were found to have attenuated over time. CONCLUSIONS: For highly targeted interventions, synthetic control methods may provide more valid estimates of programme impact than panel regression with data from all city neighbourhoods. This research offers new understanding about the effectiveness of the Cure Violence intervention over extended periods of time in seven neighbourhoods. Combined with existing Cure Violence evaluation literature, it also raises questions about contextual and implementation factors that might influence programme outcomes.

Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals.

PURPOSE: Firearm injury is a leading cause of morbidity and mortality in the United States. However, many medical professionals currently receive minimal or no education on firearm injury or its prevention. The authors sought to convene a diverse group of national experts in firearm injury epidemiology, injury prevention, and medical education to develop consensus on priorities to inform the creation of learning objectives and curricula for firearm injury education for medical professionals. METHOD: In 2019, the authors convened an advisory group that was geographically, demographically, and professionally diverse, composed of 33 clinicians, researchers, and educators from across the United States. They used the nominal group technique to achieve consensus on priorities for health professions education on firearm injury. The process involved an initial idea-generating phase, followed by a round-robin sharing of ideas and further idea generation, facilitated discussion and clarification, and the ranking of ideas to generate a prioritized list. RESULTS: This report provides the first national consensus guidelines on firearm injury education for medical professionals. These priorities include a set of crosscutting, basic, and advanced learning objectives applicable to all contexts of firearm injury and all medical disciplines, specialties, and levels of training. They focus on 7 contextual categories that had previously been identified in the literature: 1 category of general priorities applicable to all contexts and 6 categories of specific contexts, including intimate partner violence, mass violence, officer-involved shootings, peer (nonpartner) violence, suicide, and unintentional injury. CONCLUSIONS: Robust, data- and consensus-driven priorities for health professions education on firearm injury create a pathway to clinician competence and self-efficacy. With an improved foundation for curriculum development and educational program-building, clinicians will be better informed to engage in a host of firearm injury prevention initiatives both at the bedside and in their communities.

Gun purchasing behaviours during the initial phase of the COVID-19 pandemic, March to mid-July 2020.

We sought to characterize gun and ammunition purchasing during the initial phase of the COVID-19 pandemic using a nationally representative sample of U.S. adults. We fielded a survey using NORC's Amerispeak Panel between 7 and 22 July 2020 (survey completion rate = 91.1%, N = 1337). We used survey-weighted data to calculate the proportion of adults who purchased a gun during this time period and types of guns and amount of ammunition purchased. Between March and mid-July 2020, 6% of adults purchased a gun and 9% bought ammunition. Of those purchasing a gun, 34% were first-time purchasers. Among those purchasing ammunition, 19% reported purchasing more than usual in response to the COVID-19 pandemic while 27% purchased less than usual. An estimated 6,451,163 adults bought guns for the first time between March and mid-July 2020. Increases in gun purchasing, particularly among first-time gun owners, could pose significant short- and long-term implications for public health.

The role of domestic violence in fatal mass shootings in the United States, 2014-2019.

BACKGROUND: Fatal mass shootings, defined as four or more people killed by gunfire, excluding the perpetrator, account for a small percentage of firearm homicide fatalities. Research has not extensively focused on the role of domestic violence (DV) in mass shootings in the United States. This study explores the role of DV in mass shootings in the United States. METHODS: Using 2014-2019 mass shooting data from the Gun Violence Archive, we indexed our data by year and mass shooting and collected the number of deaths and injuries. We reviewed news articles for each mass shooting to determine if it was 1) DV-related (i.e., at least one victim of a mass shooting was a dating partner or family member of the perpetrator); 2) history of DV (i.e., the perpetrator had a history of DV but the mass shooting was not directed toward partners or family members); or 3) non-DV-related (i.e., the victims were not partners or family members, nor was there mention of the perpetrator having a history of DV). We conducted descriptive analyses to summarize the percent of mass shootings that were DV-related, history of DV, or non-DV-related, and analyzed how many perpetrators died during the incidents. We conducted one-way ANOVA to examine whether there were differences in the average number of injuries or fatalities or the case fatality rates (CFR) between the three categories. One outlier and 17 cases with unknown perpetrators were excluded from our main analysis. RESULTS: We found that 59.1% of mass shootings between 2014 and 2019 were DV-related and in 68.2% of mass shootings, the perpetrator either killed at least one partner or family member or had a history of DV. We found significant differences in the average number of injuries and fatalities between DV and history of DV shootings and a higher average case fatality rate associated with DV-related mass shootings (83.7%) than non-DV-related (63.1%) or history of DV mass shootings (53.8%). Fifty-five perpetrators died during the shootings; 39 (70.9%) died by firearm suicide, 15 (27.3%) were killed by police, and 1 (1.8%) died from an intentional overdose. CONCLUSIONS: Most mass shootings are related to DV. DV-related shootings had higher CFR than those unrelated to DV. Given these findings, restricting access to guns by perpetrators of DV may affect the occurrence of mass shootings and associated casualties.