Deer Hunting Season and Firearm Violence in US Rural Counties.

Importance: Firearm violence is a major public health problem in the US. However, relatively little research has focused particular attention on firearm violence in rural areas, and few studies have used research designs that draw on exogenous variation in the prevalence of firearms to estimate the association between firearm presence and shootings. Objective: To investigate the association between the start of deer hunting season and shootings in rural counties in the US. Design, Setting, and Participants: In this cohort study, data from all rural US counties in states with available data on the timing of deer hunting season were matched with data on shootings from the Gun Violence Archive from January 1, 2014, to December 31, 2021. Exposure: Shootings in the first 3 weeks of deer hunting season were compared with the week prior to the start of deer hunting season. Main Outcomes and Measures: The main outcome was daily total shootings. The association between the start of deer hunting season and shootings was estimated using Poisson regression models to analyze change within counties while controlling for relevant calendar year, month of year, and seasonal effects. Results: The sample included 854 rural counties with a mean (SD) population of 16 416 (18 329) per county and 5.4 (13.3) annual shootings per 100 000 people. The county fixed-effects specification analyzing the association between deer hunting season and shootings showed that relative to the week prior to deer hunting season, the incidence rate ratio for total shootings was 1.49 (95% CI, 1.13-1.95) for the first week of deer hunting season and 1.41 (95% CI, 1.02-1.94) for the second week of deer hunting season. Estimates remained consistent when excluding hunting accidents and were most pronounced in states with more hunting licenses per capita. Conclusions and Relevance: In this cohort study of the association between the start of deer hunting season and firearm violence, results showed that the start of deer hunting season was associated with a substantial increase in shootings. The findings highlight the role of firearm prevalence in gun violence and suggest the need for focused policies designed to reduce firearm violence in areas with substantial hunting activity during the first weeks of deer hunting season.

Healthcare Professionals and Extreme Risk Protection Orders: A Concise Review.

BACKGROUND: Extreme risk protection orders (ERPOs) are one policy mechanism to address the critical public health problem of gun violence. The inclusion of healthcare professionals with ERPOs is a promising approach to expanding ERPO utilization, yet early evidence has not been examined. OBJECTIVE: The purpose of this study was to synthesize the current research on healthcare professionals and ERPOs. DATA SOURCES: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Academic Search Complete, and Web of Science were searched. STUDY SELECTION: Studies examined healthcare professionals' role and function within the context of ERPOs. DATA EXTRACTION: Relevant studies were reviewed and included through consensus of the authors. Data extracted included authors, objective, design, states, healthcare professional type, mental health professional type, healthcare professional roles/involvement and key outcomes. DATA SYNTHESIS: There is unfamiliarity with ERPOs among healthcare professionals. Healthcare professionals lack ERPO knowledge and are unclear about ethical and legal ERPO liability. CONCLUSION: The available evidence suggests that healthcare professionals have an important role in ERPOs, but critical gaps in ERPO knowledge, training/resources, and liability will limit use and effectiveness of healthcare professionals, including nurses, in the role of ERPO petitioner.

US Surgeon General Vivek Murthy: Firearm Violence Is a Public Health Crisis.

This Medical News article is an interview with US Surgeon General Vivek Murthy, MD, MBA, and JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about a new advisory that declares gun violence a public health crisis.

Mapping Milwaukee's Blueprint for Peace: Evaluating the Geospatial Reach of a Cure Violence Implementation, 414LIFE.

BACKGROUND: Cure Violence interruption programs are evidence-based interventions aimed at reducing the transmission of gun violence and its related injuries. Assessing the implementation of these programs can include the metric of "reach." This study evaluated one such program - 414LIFE - in Milwaukee, Wisconsin. The evaluation reconceptualized "reach" as a metric for reaching the individuals and neighborhoods at greatest risk for gun violence. METHODS: 414LIFE's reach was analyzed descriptively and geospatially through its program evaluation dataset from May 2019 through September 2020 using a cross-sectional design. Program referral criteria includes patients who sustained a gunshot wound, are less than 36 years old, and a resident of, or injured in, the city of Milwaukee. A choropleth map visualized location of participants' residence, which justified a global Moran's I, and then a local Moran's I calculation to identify statistically significant clustering of referrals. RESULTS: In the first 1.5 years of the program's partnership with the local level I trauma center and affiliated academic medical institution, 398 patients were referred. Three hundred referrals (75.4%) met program criteria; 53.8% were Black men. Statistically significant clusters were identified and mapped. Half of the top 10 neighborhoods with referrals were the city's identified priority neighborhoods. CONCLUSIONS: 414LIFE successfully reaches its intended population and geographic locations. Geospatial reach should be considered routinely in program evaluations of Cure Violence programs to track growth and reach over time.

Nurses as Petitioners: A Legal Mapping of State Extreme Risk Protection Order Laws.

Gun violence is a leading public health concern in the US; subsequently, firearm-related violence prevention is a top priority for policymakers. Extreme risk protection order (ERPO) laws are a state-level attempt to reduce gun-related injuries and deaths. These court-issued orders prohibit people found to be dangerous to themselves or others from temporarily purchasing or possessing a firearm. Six states (Colorado, Connecticut, Hawaii, Maryland, Michigan, New York) and the District of Columbia have passed or amended their laws to include nurses as ERPO petitioners. The study's purpose was to conduct a review of state ERPO laws that included nurses as petitioners. Using a legal mapping approach, information on nurse ERPO petitioning was extracted from the seven jurisdictions. ERPO laws with nurse petitioners were passed between 1999 and 2023. Nurse petitioners included advanced practice registered nurse (n = 3), clinical nurse specialists (n = 3), nurse practitioner (n = 3), professional nurse (n = 2), and register nurse (n = 1). Psychiatric/mental health (n = 2) and school nurses (n = 2) were specified. Statutes differed in the handling of disclosed health information as part of the ERPO petition, as well as how health information would be handled by the court (e.g. sealed by the court, confidential by the court, returned to provider/disposed of post-hearing/order.) Three statutes exempted petitioners from civil and/or criminal liability, if petitions were submitted in good faith. Two of these states extended protection from liability to all petitioners, while one only referenced petitioners who were healthcare providers. The study findings have important policy, clinical, and research implications.

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.

A Review of Community-Based Gun Violence Prevention Programs and the Physician's Role.

Gun violence (GV) and safety is a contentious topic in the United States, despite increasing morbidity and mortality among children and adolescents. It is important for physicians to take a role in preventing future GV. This article aims to present several methods that physicians can use to prevent GV in their own communities, ranging from implementation of large-scale intervention programs to simple screenings and anticipatory guidance. As the problem of GV persists, it is important for physicians to use their role to identify individuals who are at high-risk and advocate for changes that will benefit their future health.

A comparative framework for understanding and addressing interpersonal gun violence.

Gun violence, often characterized as a singular issue, is not one cohesive problem. Instead, it takes many forms resulting from the complex interplay of multiple factors. Outcomes of gun violence also vary significantly. They may be (a) physically non-injurious (a gun is brandished), (b) injurious but non-lethal, or (c) lethal. To understand and address gun violence effectively, it is essential to consider various risk factors for both non-lethal and lethal gun violence victimization, using a comprehensive, comparative framework. We present a novel comparative framework for better understanding gun violence, and for developing policy responses to this violence. We disaggregate gun violence into its various forms and propose a conceptualization of risk factors in discrete categories, each with important implications for policy intervention. While we emphasize the value of this framework for understanding and combatting interpersonal gun violence in America, the research and policy approaches discussed here should be equally applicable to other international contexts with gun violence as a serious public health issue as well.

Firearm Policy in the Hospital Setting-Recognizing Health Care as a "Sensitive Place".

Importance: Hospitals are hot zones of the US gun injury epidemic. To shelter these facilities from the dangers of gun violence, state legislatures have enacted laws to reduce the carrying of firearms on hospital premises. However, these efforts currently face serious Second Amendment challenges in federal courts. The ongoing legal battles, which have wide-ranging implications for patient and clinician safety as well as public health generally, are setting the stage for a Supreme Court case that may decide the fate of firearm regulations in US hospitals. A permissible pathway for advancing sensible gun regulation in hospitals is urgently needed. Observations: Since the Supreme Court established a new constitutional test for firearm laws in New York State Rifle & Pistol Association v Bruen (2022), states now face unprecedentedly high barriers to enacting health-protecting legislation regarding firearms. Post-Bruen, the Supreme Court requires that laws be consistent with "this Nation's historical tradition of firearms regulation." This means that states hoping to enact laws barring public carry of firearms in hospitals must demonstrate that hospitals are a "sensitive place" as a historical matter (ie, analogous to a location where firearms were traditionally restricted). By reasoning from analogy, it is clear several historical comparators exist for regulating firearms in hospitals. Although the hospital (as understood today) did not exist in the 1700s, it is sufficiently analogous to asylums and schools, to name a few examples. These settings all share a common denominator with the modern-day hospital: serving vulnerable populations or individuals who may be at heightened risk of misusing firearms. Conclusions and Relevance: The Supreme Court's interpretation of the Second Amendment right to bear arms is threatening democratically enacted laws seeking to shelter hospitals from firearm violence. However, it is clear that hospitals and other health care settings are a sensitive place with compelling historical analogies. Policymakers' strategic deployment of the sensitive places designation, along with its rightful judicial recognition in the hospital setting, are critical to upholding laws that protect health care facilities, patients, and professionals from firearm violence-a conclusion consistent with the US Constitution, history, medical ethics, and common sense.

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

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

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

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

Youth Gun Violence.

Gun violence is a rapidly growing concern for youth. As rates of death by firearm rise, so does exposure to firearm violence and high levels of accompanying morbidity. Although gun violence cannot be attributed to any one cause, it is important pediatric health care providers understand the prevalence of this issue. Additionally, the long-term health effects are profound with many victims of, and witnesses to, gun violence experiencing new symptoms of general anxiety disorder. There are numerous initiatives taking place at the individual, local, and national levels to address this public health crisis. An overview of such interventions is also presented. With better screening and treatment of upstream and downstream symptoms of youth gun violence, pediatricians can decrease the morbidity and mortality that results from firearm use. [Pediatr Ann. 2024;53(6):e197-e199.].

Youth Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020.

Importance: Youth (those aged <18 years) parental death has been associated with negative health outcomes. Understanding the burden of parental death due to drug poisoning (herein, drugs) and firearms is essential for informing interventions. Objective: To estimate the incidence of youth parental death due to drugs, firearms, and all other causes. Design, Setting, and Participants: This cross-sectional observational study was conducted using vital registration, including all US decedents, and census data from January 1990 through December 2020. Data were analyzed from May 30, 2023, to March 28, 2024. Exposures: Parental death due to drug poisoning or firearms. Main Outcomes and Measures: A demographic matrix projection model was used to estimate the number and incidence of youth experiencing parental death, defined as the death of 1 or more parents, per 1000 population aged less than 18 years. Analyses evaluated parental deaths by drugs, firearms, and all other causes from 1999 through 2020 by race and ethnicity. Results: Between 1999 and 2020, there were 931 785 drug poisoning deaths and 736 779 firearm-related deaths with a mean (SD) age of 42.6 (16.3) years. Most deaths occurred among males (73.8%) and White decedents (70.8%) followed by Black (17.5%) and Hispanic (9.5%) decedents. An estimated 759 000 (95% CI, 722 000-800 000) youth experienced parental death due to drugs and an estimated 434 000 (95% CI, 409 000-460 000) youth experienced parental death due to firearms, accounting for 17% of all parental deaths. From 1999 to 2020, the estimated number of youth who experienced parental death increased 345% (95% CI, 334%-361%) due to drugs and 39% (95% CI, 37%-41%) due to firearms compared with 24% (95% CI, 23%-25%) due to all other causes. Black youth experienced a disproportionate burden of parental deaths, based primarily on firearm deaths among fathers. In 2020, drugs and firearms accounted for 23% of all parental deaths, double the proportion in 1999 (12%). Conclusions and Relevance: Results of this modeling study suggest that US youth are at high and increasing risk of experiencing parental death by drugs or firearms. Efforts to stem this problem should prioritize averting drug overdoses and firearm violence, especially among structurally marginalized groups.