The relationship between alcohol consumption and the desire to own a firearm: an empirical study on citizens of São Paulo city, Brazil.

OBJECTIVE: The main objective of this study was to investigate the association between alcohol consumption (use and bingeing) and the desire to own a firearm for protection. STUDY DESIGN: We used data from three random cross-sectional victimisation surveys conducted in São Paulo city, Brazil, in 2003, 2008 and 2013 with people aged ≥16 years. METHODS: We performed tests for equality of proportions. Our analysis was performed separately for each victimisation survey to check the robustness of the results. We also used probit models, estimated by the maximum likelihood method, to analyse the relationship between desire to own a firearm and alcohol consumption, controlling for many other variables. RESULTS: In 2013, although only 1.5% of the population surveyed reported living in a household with a firearm, 15.7% report that they would possess a firearm if they could, and 13.0% believed they would be safer/more protected from violence if they had a firearm. The desire to own a firearm is higher among people who consume alcoholic beverages than among those who do not and is higher as alcohol binge frequency increases. CONCLUSION: In São Paulo city, alcohol consumption and binge drinking are positively associated with the desire to own a firearm.

Intimate partner violence perpetration, standard and gendered STI/HIV risk behaviour, and STI/HIV diagnosis among a clinic-based sample of men.

BACKGROUND: The estimated one in three women worldwide victimized by intimate partner violence (IPV) consistently demonstrate elevated STI/HIV prevalence, with their abusive male partners' risky sexual behaviours and subsequent infection increasingly implicated. To date, little empirical data exist to characterise the nature of men's sexual risk as it relates to both their violence perpetration, and STI/HIV infection. METHODS: Data from a cross-sectional survey of men ages 18-35 recruited from three community-based health clinics in an urban metropolitan area of the northeastern US (n = 1585) were analysed to estimate the prevalence of IPV perpetration and associations of such violent behaviour with both standard (eg, anal sex, injection drug use) and gendered (eg, coercive condom practices, sexual infidelity, transactional sex with a female partner) forms of sexual-risk behaviour, and self-reported STI/HIV diagnosis. RESULTS: Approximately one-third of participants (32.7%) reported perpetrating physical or sexual violence against a female intimate partner in their lifetime; one in eight (12.4%) participants self-reported a history of STI/HIV diagnosis. Men's IPV perpetration was associated with both standard and gendered STI/HIV risk behaviours, and to STI/HIV diagnosis (OR 4.85, 95% CI 3.54 to 6.66). The association of men's IPV perpetration with STI/HIV diagnosis was partially attenuated (adjusted odds ratio (AOR) 2.55, 95% CI 1.77 to 3.67) in the multivariate model, and a subset of gendered sexual-risk behaviours were found to be independently associated with STI/HIV diagnosis-for example, coercive condom practices (AOR 1.67, 95% CI 1.04 to 2.69), sexual infidelity (AOR 2.46, 95% CI 1.65 to 3.68), and transactional sex with a female partner (AOR 2.03, 95% CI 1.36 to 3.04). CONCLUSIONS: Men's perpetration of physical and sexual violence against intimate partners is common among this population. Abusive men are at increased risk for STI/HIV, with gendered forms of sexual-risk behaviour partially responsible for this association. Thus, such men likely pose an elevated infection risk to their female partners. Findings indicate the need for interwoven sexual health promotion and violence prevention efforts targeted to men; critical to such efforts may be reduction in gendered sexual-risk behaviours and modification of norms of masculinity that likely promote both sexual risk and violence.

Recent psychopathology, suicidal thoughts and suicide attempts in households with and without firearms: findings from the National Comorbidity Study Replication.

OBJECTIVE: To assess the relationship between firearm ownership and possible psychiatric confounders of the firearm-suicide relationship. METHODS: Multivariate logistic regression was used to estimate the association between living in a home with firearms and 12-month occurrence of major Diagnostic and statistical manual of mental disorders (DSM)-IV disorders and suicidal behaviour among respondents to the National Comorbidity Survey Replication, a household survey of 9282 adults aged 18+. Analyses controlled for sociodemographic characteristics including age, sex, race/ethnicity, educational attainment and poverty. RESULTS: Approximately one in three Americans reported living in a home with firearms. People living in a home with firearms were no more or less likely than people in homes without firearms to have recent (past year) anxiety disorders (OR = 1.0, 95% CI 0.8 to 1.2), mood disorders (OR = 0.9, 95% CI 0.7 to 1.1) or substance dependence and/or abuse (OR = 0.9, 95% CI 0.6 to 1.3). Past year suicidal ideation (OR = 0.8, 95% CI 0.5 to 1.3) and suicide planning (OR = 0.5, 95% CI 0.2 to 1.4) were also not associated with living in households with firearms. Having made a suicide attempt over the previous year was the only outcome more common among participants reporting that they currently lived in a home without [corrected] firearms. CONCLUSIONS: The previously reported association between household firearm ownership and heightened risk of suicide is not explained by a higher risk of psychopathology among gun-owning families. As there are Americans with suicidal ideation and/or significant and recent psychiatric disorders currently living in homes with firearms, future work should focus on understanding the impediments to effectively communicating the suicide risk associated with household firearms.

Effectiveness of a law to reduce alcohol-impaired driving in Japan.

OBJECTIVE: To estimate the effect of a new road traffic law against alcohol-impaired driving in Japan. METHODS: Japan passed a new road traffic law in June 2002 intended to reduce alcohol-impaired driving by decreasing the permissible blood alcohol level and by increasing penalties. Using data collected from police reports, the number of traffic fatalities and injuries were analyzed by time series. RESULTS: Simple comparisons of the average of all severe traffic injuries, traffic fatalities, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven showed reductions after enactment of the new road traffic law in June 2002. The rate of alcohol-related traffic fatalities per billion kilometers driven decreased by 38% in the post-law period. In segmented regression analyses with adjustment for baseline trends, seasonality, and autocorrelation, all traffic injuries, severe traffic injuries, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven declined significantly from baseline after the new traffic law. CONCLUSION: Large, immediate public health benefits resulted from the new road traffic law in Japan.

The US gun stock: results from the 2004 national firearms survey.

OBJECTIVES: To examine the size and composition of the privately held firearm stock in the US; and to describe demographic patterns of firearm ownership and motivations for ownership. DESIGN, SETTING AND PARTICIPANTS: A nationally representative household telephone survey of 2770 adults aged>or=18 years living in the US, conducted in the spring of 2004. MAIN OUTCOME MEASURE: Responses to questions regarding firearm ownership, the number and types of guns owned, and motivations for ownership. RESULTS: 38% of households and 26% of individuals reported owning at least one firearm. This corresponds to 42 million US households with firearms, and 57 million adult gun owners. 64% of gun owners or 16% of American adults reported owning at least one handgun. Long guns represent 60% of the privately held gun stock. Almost half (48%) of all individual gun owners reported owning>or=4 firearms. Men more often reported firearm ownership, with 45% stating that they personally owned at least one firearm, compared with 11% for women. CONCLUSIONS: The US population continues to contain at least one firearm for every adult, and ownership is becoming increasingly concentrated. Long guns are the most prevalent type of gun in the US but handgun ownership is widespread. Ownership demographic patterns support findings of previous studies.

The association between changes in household firearm ownership and rates of suicide in the United States, 1981-2002.

OBJECTIVE: To explore whether recent declines in household firearm prevalence in the United States were associated with changes in rates of suicide for men, women, and children. METHODS: This time series study compares changes in suicide rates to changes in household firearm prevalence, 1981-2002. Multivariate analyses adjust for age, unemployment, per capita alcohol consumption, and poverty. Regional fixed effects controlled for cross sectional, time invariant differences among the four census regions. Standard errors of parameter estimates are adjusted to account for serial autocorrelation of observations over time. RESULTS: Over the 22 year study period household firearm ownership rates declined across all four regions. In multivariate analyses, each 10% decline in household firearm ownership was associated with significant declines in rates of firearm suicide, 4.2% (95% CI 2.3% to 6.1%) and overall suicide, 2.5% (95% CI 1.4% to 3.6%). Changes in non-firearm suicide were not associated with changes in firearm ownership. The magnitude of the association between changes in household firearm ownership and changes in rates of firearm and overall suicide was greatest for children: for each 10% decline in the percentage of households with firearms and children, the rate of firearm suicide among children 0-19 years of age dropped 8.3% (95% CI 6.1% to 10.5%) and the rate of overall suicide dropped 4.1% (2.3% to 5.9%). CONCLUSION: Changes in household firearm ownership over time are associated with significant changes in rates of suicide for men, women, and children. These findings suggest that reducing availability to firearms in the home may save lives, especially among youth.

Violence in Jamaica: an analysis of homicides 1998-2002.

The aim of the study was to create a profile of Jamaican homicide victims and to describe the circumstances, motives, and the weapons used in homicide incidents. The authors read the police narratives for all Jamaican homicides 1998-2002 and coded them using a predetermined set of variables. Analyses were conducted to describe victim characteristics, motive, and weapon use. The majority of homicide victims were male (over 89%), and 15-44 years old (80%). The rate of homicide for males age 15-44 years was 121 per 100,000 compared with a rate of 12 per 100,000 for females in the same age group. The main motives for homicide were disputes (29%) and reprisals (30%). Gunshot wounds were the cause of death in 66% of all homicides. Guns were used primarily in reprisals, robbery, and drug/gang related homicides; in half of all dispute related homicides the perpetrator used a knife. Homicides in Jamaica are not primarily gang or robbery related. Rather, they are mainly caused by arguments or reprisals. Homicide has become a common feature of dispute resolution in Jamaica.

Unsupervised firearm handling by California adolescents.

OBJECTIVE: Relatively little is known about the behavior of adolescents around firearms. The present investigation was undertaken to estimate the proportion of community-residing adolescents who report that they have ever handled a gun without adult knowledge or supervision. METHODS: A random digit dial interview was conducted with 5801 California adolescents as part of the California Health Interview Survey. Respondents were asked whether they have ever held a gun and whether they have ever done so without adult knowledge or supervision. Study design and population weights were applied to these data. In addition, adolescents' reports about the most recent unsupervised handling incident were coded to ascertain what they were doing with the gun as well as with whom and where the incident occurred. RESULTS: One third (33%) of California adolescents report that they have handled a firearm; 5% report that they have done so without adult knowledge or supervision. Half (49%) of all unsupervised handling involved shooting and only 11% occurred in the respondent's home. Several demographic variables (being male, African American, living in a rural area) and risk behaviors (smoking, drinking, being the victim of a gun related threat), as well as having a gun in the home and parents not knowing the adolescent's whereabouts in the afternoon were each associated with unsupervised gun handling. CONCLUSIONS: Unsupervised gun handling is associated with other health risk behaviors. Unsupervised gun handling typically involves shooting the gun and usually occurs with friends, away from the home.

A quantification of preventable unintentional childhood injury mortality in the United States.

OBJECTIVE: To calculate the preventable fraction of unintentional childhood injury deaths in the United States. DESIGN: Ecological study of cause specific unintentional childhood injury mortality rates across the 50 states (and the District of Columbia) of the United States (US) over the 10 year period 1989-98. METHODS: The internet accessible database from the National Center for Injury Prevention and Control was used in order to estimate unintentional childhood (0-14 years) injury mortality rates by external cause and time trends over the study period for each of the US states and for the four major geographical regions of the country. In the principal analysis, a calculation was made of the fraction and absolute number of unintentional childhood injury deaths that could have been prevented annually if the mortality rate in the region with the lowest rate also existed in the remaining three. In another scenario, the lowest external cause specific unintentional childhood injury mortality rates from the 50 US states and the District of Columbia were summed to provide the "ideal" lowest conceivable unintentional childhood injury mortality rate from all causes. Ecological correlations between unintentional childhood injury mortality rates from specified external causes, median income, and percent of the population with a college degree were made. MAIN OUTCOME MEASURES: Unintentional childhood injury mortality rates by cause. RESULTS: Unintentional childhood injury mortality rate declined by 3.5% per year in the country as a whole. If every region of the US had experienced the same injury rate as the Northeast, then one third of all unintentional childhood injuries would not have occurred. More optimistic scenarios indicate that up to two thirds of all unintentional childhood injury deaths could be prevented. Across states, unintentional childhood injury mortality is strongly inversely related to median income. CONCLUSIONS: About one third of all unintentional childhood injury deaths in the US are preventable with the means and resources available in the Northeastern states. Among the relevant characteristics in the Northeast region, in comparison with other US regions, are the higher education level of parents, the lower gun ownership, the higher population density that implies shorter distances traveled by cars, a better developed emergency medical system, and the existence of several injury prevention programs.

Association of rates of household handgun ownership, lifetime major depression, and serious suicidal thoughts with rates of suicide across US census regions.

OBJECTIVE: Cross sectional studies in the United States often find a significant positive association between levels of household firearm ownership and suicide rates. This study investigates whether the association can be explained by differences in levels of mental health. METHODS: The relationship between household handgun ownership and overall suicide rates across United States regions after accounting for two mental health variables-lifetime prevalence of major depression and serious suicidal thoughts-were examined. Analyses also add another control variable (urbanization, education, unemployment, or alcohol consumption). Data on mental health variables come from the National Comorbidity Study, conducted in the early 1990s. Data on household handgun ownership come from the General Social Surveys. RESULTS: Across the nine regions for the early 1990s (n = 9), household handgun ownership rates are positively correlated with the suicide rate (r = 0.59) and are not correlated with either the lifetime prevalence of major depression or suicidal thoughts. After controlling for major depression and suicidal thoughts (and any of the four additional control variables), handgun ownership rates remain significantly associated with the overall suicide rate. CONCLUSIONS: In United States regions with higher levels of household handgun ownership, there are higher suicide rates. This relationship cannot be explained by differences in the prevalence of two mental health indicators-lifetime rates of either major depression or suicidal thoughts.

Do criminals go to the hospital when they are shot?

OBJECTIVES: To determine whether criminals go to the hospital when they are shot. Such information is needed to check on the accuracy of using hospital emergency room data to estimate non-fatal gunshot wounds. SETTING: Five jails across the US. METHODS: A survey of inmates being booked into jail, administered by in-house health care staff. RESULTS: Over 90% of over 300 criminals who had been wounded sometime before their incarceration reported going to a hospital for treatment after being shot. These results are consistent with previous findings from one jail. CONCLUSIONS: Jail inmates who had previously been shot were likely to have been treated in a hospital. This limited finding is consistent with the proposition that hospital/emergency department data may miss only a small percentage of gunshot wounds to criminals.

Underestimates of unintentional firearm fatalities: comparing Supplementary Homicide Report data with the National Vital Statistics System.

OBJECTIVE: A growing body of evidence suggests that the nation's vital statistics system undercounts unintentional firearm deaths that are not self inflicted. This issue was examined by comparing how unintentional firearm injuries identified in police Supplementary Homicide Report (SHR) data were coded in the National Vital Statistics System. METHODS: National Vital Statistics System data are based on death certificates and divide firearm fatalities into six subcategories: homicide, suicide, accident, legal intervention, war operations, and undetermined. SHRs are completed by local police departments as part of the FBI's Uniform Crime Reports program. The SHR divides homicides into two categories: "murder and non-negligent manslaughter" (type A) and "negligent manslaughter" (type B). Type B shooting deaths are those that are inflicted by another person and that a police investigation determined were inflicted unintentionally, as in a child killing a playmate after mistaking a gun for a toy. In 1997, the SHR classified 168 shooting victims this way. Using probabilistic matching, 140 of these victims were linked to their death certificate records. RESULTS: Among the 140 linked cases, 75% were recorded on the death certificate as homicides and only 23% as accidents. CONCLUSION: Official data from the National Vital Statistics System almost certainly undercount firearm accidents when the victim is shot by another person.

Suicide and firearm prevalence: are youth disproportionately affected?

The effect of firearm availability on suicide may differ among age groups. We used regression analysis to examine the relationship between suicide rates and household firearm ownership for four age groups in the nine census regions from 1979 to 1994, adjusting for regional divorce rates, education, unemployment, and urbanicity. Results showed that firearm ownership levels are correlated with suicide rates among 15- to 24-year-olds and 65- to 84-year-olds, but not among 25-to 64-year-olds. The findings suggest that if the relationship is causal, a 10% fall in regional firearm ownership levels would lead to a 3.0% decrease in suicide rates.

Firearm prevalence and social capital.

PURPOSE: Previous studies have shown a correlation between measures of social capital and morbidity, mortality, and violent crime. This article examines the association across U.S. states between social capital (as measured by mutual trust and civic engagement) and firearm availability. METHODS: The analysis uses OLS to determine degrees of association across U.S. states. Measures of mutual trust come from responses to questions on the U.S. General Social Survey that "you can't be too careful in dealing with people," and most people "would try to take advantage of you." Measures of formal civic engagement come from responses to Lifestyle Survey questions concerning times volunteered, club meetings attended, community projects worked on, and church services attended. Informal civic engagement measures come from responses to number of times bowled, played cards, entertained at home, and gave or attended dinner parties, and number of greeting cards sent. The Lifestyle Survey also asked whether respondent believed whether "most people are honest." The percentage of suicides from firearms, and the average percentage of suicides and homicides from firearms, are used as proxies for state firearm ownership rates. Control variables are the degree of urbanization, the rates of poverty, and the percentage of nonwhites in the state. RESULTS: Across the U.S. states, higher levels of firearm ownership are associated with significantly lower levels of mutual trust and civic engagement. CONCLUSION: While the analysis cannot show causation, states with heavily armed civilians are also states with low levels of social capital.

Lymphocytes, lymphokines, and silicosis.

Silicosis is characterized by mononuclear cell aggregation with mineral particles and fibrosis. Lymphocytes are abundant in these lesions. We exposed inbred strains of mice to a respirable aerosol of cristobalite silica (70 mg/m3, 5 h/d, 12 d) or shamair. Silicosis evolved over months after exposure. The silica-exposed mice showed the accumulation of lymphocytes in alveolar spaces (seen in bronchoalveolar lavage), in lung parenchymal lesions and nodules, and in enlarged bronchial-associated lymphoid tissues and thoracic lymph nodes. The lung lymphocytes were predominantly CD4+ T cells, but numerous CD8+ T cells, natural killer cells, and CD4- gammadelta-TCR+ T cells were present as well. Interferon-gamma (IFN-gamma) production was upregulated, suggesting a THelper-1-like response in silicosis. In silicotic lung tissue, mRNA transcripts for the macrophage-derived cytokines IL-12 and -18 were increased. IFN-gamma gene-deleted mice (C57Bl/6-Ifngtm1 Ts) exposed to silica developed less extensive silicosis and less lung collagen accumulation than wild-type mice. We hypothesize that there is a reiterative amplification cycle in which macrophages with silica may produce cytokines, such as IL-12 and -18, that attract and activate lymphocytes. These activated lymphocytes may then produce additional mediators that in turn attract and activate an expanded secondary population of macrophages. IFN-gamma would be a likely cause of macrophage activation in this cycle. More work is needed to understand the biological events that lead from the inhaled dust to the scarred lung, and to clarify the role of lymphocytes in this process.

Firearm availability and unintentional firearm deaths.

BACKGROUND: Between 1979 and 1997, almost 30,000 Americans died from unintentional firearm injuries, half of whom were under 25 years of age and 4,600 of whom were less than 15 years old. PURPOSE: To explore the association between state firearm levels and rates of unintentional firearm deaths by age group, accounting for several potential confounders. METHODS: The study used a proxy for firearm availability and pooled cross-sectional time-series data on unintentional firearm deaths for the 50 United States from 1979 to 1997. Negative binomial models were used to estimate the association between firearm availability and unintentional firearm deaths. RESULTS: A statistically significant and robust association exists between gun availability and unintentional firearm deaths for the US as a whole and within each age group. Multivariate analysis found that, compared to states with the lowest gun levels, states with the highest gun levels had, on average, 9 times the rate of unintentional firearm deaths. These results hold among men and women, for Whites and African Americans. CONCLUSION: Of the almost 30,000 people who died in unintentional firearm deaths over the 19-year study period, a disproportionately high number died in states where guns are more prevalent. The results suggest that the increased risk of unintentional violent death among all age groups is not entirely explained by a state's level of poverty, urbanization, or regional location.

Nitrogen dioxide induces death in lung epithelial cells in a density-dependent manner.

Nitrogen dioxide (*NO2) is commonly known as an indoor and outdoor air pollutant. Inhalation of *NO2 is associated with epithelial cell injury, inflammation, and the aggravation of asthma. *NO2 can also be formed during inflammation, by the metabolism of nitric oxide. We describe a gas-phase exposure system for in vitro exposure of lung epithelial cells to *NO2. Immunofluorescence revealed 3-nitrotyrosine immunoreactivity of rat alveolar type II epithelial cells exposed to 5 parts per million of *NO2 for 4 h. Comparative analysis of log-phase and confluent cultures demonstrated that cell death occurred extensively in log-phase cells, whereas minimal death was observed in confluent cultures. Peroxynitrite (ONOO-) or the ONOO- generator 3-morpholinosydnonimine (SIN-1) caused similar amounts of death. Further, exposure of wounded cell cultures to *NO(2) or SIN-1 revealed that death was restricted to cells repopulating a wounded area. Cycloheximide or actinomycin D, inhibitors or protein and messenger RNA synthesis, respectively, significantly reduced terminal transferase reactivity, suggesting that a new protein(s) may be required for cell death. These results suggest that during restitution after pulmonary injury, epithelium may be sensitive to cell death by reactive nitrogen species.

The public health approach to motor vehicles, tobacco, and alcohol, with applications to firearms policy.

The public health approach that has been used to reduce problems caused by motor vehicles, tobacco and alcohol is applied to firearms policy. Manufacturers try to focus prevention efforts on the user rather than the product, and promote education and law enforcement policies directed toward the consumer. Public health efforts emphasize the systematic collection of data, scientific inquiry, and a multi-faceted policy approach that includes modifying the product and the environment. The endeavor to reduce gun violence is part of the general and continuing public health struggle to reduce harms caused by consumer products.

National attitudes concerning gun carrying in the United States.

OBJECTIVES: To determine public attitudes in the United States concerning gun carrying. SETTING: In the past 15 years, many state legislatures have passed laws making it easier for United States citizens to carry concealed firearms, not only on the street but into various locations, including churches and government buildings. METHODS: National random digit dial telephone surveys conducted in 1996 and 1999 asked questions concerning the public's feelings of safety as more people in their community carry firearms, and whether, in the language of the question, respondents believe "regular" citizens should be allowed to carry guns into public or government buildings. RESULTS: Americans feel less safe rather than more safe as more people in their community begin to carry guns. By margins of at least nine to one, Americans do not believe that "regular" citizens should be allowed to bring their guns into restaurants, college campuses, sports stadiums, bars, hospitals, or government buildings. CONCLUSIONS: The public believes that increased gun carrying by others reduces rather than increases their safety. Overwhelmingly, the public believes that in many venues gun carrying should be prohibited.