Toward a clearer understanding of what works to reduce gun violence: the role of falsification strategies.

Strong epidemiologic evidence from ecologic and individual-level studies in the United States supports the claim that access to firearms substantially increases the risk of dying by suicide, homicide, and firearm accidents. Less certain is how well particular interventions work to prevent these deaths and other firearm-related harms. Given the limits of existing data to study firearm violence, and the infeasibility of conducting randomized trials of firearm access, it is important to do the best we can with the data we already have. We argue that falsification strategies are a critical - yet underutilized - component of any such analytic approach. The falsification strategies we focus on are versions of "negative controls" analyses in which we expect an analysis should yield a null causal effect, and thus where not obtaining a null effect estimate raises questions about the assumptions underlying causal interpretation of a study's findings. We illustrate the saliency of this issue today with examples drawn from studies published within the last five years in leading peer-reviewed journals. Collecting rich, high-quality data always takes time, urgent as the need may be. On the other hand, doing better with the data we already have can start right now.

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.

An Introduction to the Semantics and Statistics Behind the Firearm Policy Debates.

It is impossible to fully understand why the United States has consistently failed to protect its citizens from firearm violence until one understands some of the key discrepancies that exist at the center of the firearm policy debate. Differences in language, data categorization, and research related to firearms and their impacts in the United States contribute to confusion and debate between firearm policy advocates and opponents, ultimately stalling progress toward some common goals. As frontline health professionals, emergency nurses must be aware of these nuances in order to be informed advocates for the safety of their patients and their communities. Emergency nurses can use the information from this article to help inform screening and education related to firearm safety and injury prevention. They can also use this information to inform nursing research as well as local and national advocacy efforts related to firearm injuries and deaths.

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.

Parental Perceptions of Their Children's Access to Household Firearms.

OBJECTIVES: To provide a nationally representative estimate of the proportion of gun owners who report a child has independent access to one of their guns, and to describe characteristics of these gun owners relative to other gun-owning parents. STUDY DESIGN: We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of US adults in households with firearms (n = 4030, response 65%). The sample comprised gun-owning respondents living in homes with children (n = 689) who were asked questions about their firearms, including how they were stored, and about who other than themselves had access to their guns: "If you were not there, who in your household could get one of your guns (and load it if it is not loaded already) if they needed to?" RESULTS: Twelve percent of US gun owners in homes with children report that a child has independent access to one of their guns (about one-fifth of those having children under age 12 years only). Gun owners who reported child access were more likely than those who reported no child access to store guns unlocked and loaded, but still one-fifth of those reporting access stored all guns locked and unloaded. CONCLUSIONS: We find that more than 10% of gun owners with children report that a child can independently access one of their guns, including parents who store all guns locked and unloaded suggesting that guidance to parents should focus on access in addition to firearm storage.

Firearm licensure, lead levels and suicides in Massachusetts.

Nationally, between 2011 and 2019, suicide was the second leading cause of injury death, and about half of all suicides were firearm related. An overlooked factor connecting firearms and suicide is lead exposure. Lead bullets and primers are used throughout the US and pose danger to adults and children. Most (not all) studies link lead to mental illness, while others link lead with suicide. Research has linked lead and firearm violence, but rarely examined the relationship among firearms, lead exposure, and suicide. We collected data for cities/towns in Massachusetts between 2011 and 2019 regarding the number of firearm licenses, suicides, prevalence of blood lead levels, and covariates. We hypothesized that; 1) towns with higher levels of licensure will have higher levels of firearm suicides but licensure will have little relationship with non-firearm suicide; 2) towns with higher levels of licensures would have higher rates of lead exposure; 3) higher lead levels would be associated with higher rates of suicide by all methods. Individuals living in towns with higher rates of licensure were significantly more likely to die in firearm suicides and all suicide types. They were not more or less likely to die from non-firearm suicides. Lead was a predictor of all suicide types. Our study appears to be the first to show the established firearm suicide relationships holds within municipalities in a single state. We provide evidence concerning the link between lead exposure and suicide, particularly from firearms, and provide a glimpse into the relationship between firearm prevalence and elevated blood lead levels.

Exploring whether mental health crisis text conversations that include discussion of firearms differ from those without firearms.

BACKGROUND: Firearm violence represents a public health crisis in the United States. Yet, there is limited knowledge about how firearms are discussed in the context of mental health emergencies representing a major gap in the current research literature. This study addresses this gap by examining whether the content of mental health crisis text conversations that mention firearms differ from those that do not mention firearms in a large, unique dataset from a national crisis text line. METHODS: We examined data from over 3.2 million conversations between texters to Crisis Text Line and volunteer crisis counselors between September 2018 and July 2022. We used a study developed text classification machine learning algorithm that builds on natural language processing to identify and label whether crisis conversations mentioned firearms. We compared the frequency of psychosocial factors between conversations that mention firearms with those that did not. RESULTS: Results from a generalized linear mixed-effects model demonstrated that. conversations mentioning firearms more frequently were associated with suicide, racism, physical, sexual, emotional, and unspecified abuse, grief, concerns about a third party, substance use, bullying, gender and sexual identity, relationships, depression, and loneliness. Further, conversations mentioning firearms were less likely to be related to self-harm and eating/body image. CONCLUSIONS: These results offer an initial glimpse of how firearms are mentioned in the context of acute mental health emergencies, which has been completely absent in prior literature. Our results are preliminary and help sharpen our understanding of contextual factors surrounding mental health emergencies where a firearm is mentioned.

Trends and Sources of Crime Guns in California: 2010-2021.

Firearm-related interpersonal violence is a leading cause of death and injury in cities across the United States, and understanding the movement of firearms from on-the-books sales to criminal end-user is critical to the formulation of gun violence prevention policy. In this study, we assemble a unique dataset that combines records for over 380,000 crime guns recovered by law enforcement in California (2010-2021), and more than 126,000 guns reported stolen, linked to in-state legal handgun transactions (1996-2021), to describe local and statewide crime gun trends and investigate several potentially important sources of guns to criminals, including privately manufactured firearms (PMFs), theft, and "dirty" dealers. We document a dramatic increase over the decade in firearms recovered shortly after purchase (7% were recovered within a year in 2010, up to 33% in 2021). This corresponds with a substantial rise in handgun purchasing over the decade, suggesting some fraction of newly and legally acquired firearms are likely diverted from the legal market for criminal use. We document the rapid growth of PMFs over the past 2-3 years and find theft plays some, though possibly diminishing, role as a crime gun source. Finally, we find evidence that some retailers contribute disproportionately to the supply of crime guns, though there appear to be fewer problematic dealers now than there were a decade ago. Overall, our study points to temporal shifts in the dynamics of criminal firearms commerce as well as significant city variation in the channels by which criminals acquire crime guns.

Qualitative Evidence on the Implementation of Cure Violence in Trinidad and Tobago.

Violence is a significant social problem in many cities throughout the world. In seeking to prevent or control violence, communities have put in place a variety of interventions. Many of these rely on the formal criminal justice process to arrest, prosecute, and imprison offenders. However, formal social control is well known to be an incomplete solution to violence. As a result, some communities have experimented with community-based solutions. One such approach is Cure Violence, an initiative that treats violence as a public health issue. Based on methods used to prevent the spread of infectious disease, Cure Violence seeks to stop the spread of violence within communities. This study presents qualitative results on the implementation of Cure Violence in Trinidad and Tobago, a two-island nation in the southeastern Caribbean near Venezuela. We conducted 36 in-depth semi-structured interviews and two focus groups with a variety of stakeholders, including program staff, residents, family members of victims, and police. Our findings suggest that the implementation of Cure Violence in Trinidad and Tobago led to educational and employment support for community members and a reduction in violence, particularly retaliation killings in the target communities. Our results are useful for understanding the factors that shape the implementation of community-based violence reduction initiatives like Cure Violence.

Psychiatric disorders among employment requiring firearms.

Individuals who carry guns as a requirement of employment frequently experience hazards that can be stress inducing, violent, traumatizing, or cause personal injury. This study used data from the Collaborative Psychiatric Epidemiological Surveys (CPES; n = 20,013), to examine mental health diagnoses of individuals that ever worked at a job requiring a firearm. Consistent with existing literature, the findings indicated that those who worked in professions requiring a firearm showed similar risk of mental health diagnoses as law enforcement officers which includes symptoms of trauma, mood disorders, and alcohol use. Further, race/ethnic differences emerged in patterns of mental health diagnoses, suggesting sociocultural differences influence diagnoses. These findings indicate the necessity for further investigation of the understudied area of mental health of those within employment positions that require firearms.

Two case reports of fatal injuries sustained from tear gas guns loaded with pebbles as missiles.

These two case reports are of fatal injuries from less-lethal weapons (tear gas guns) using pebbles as an unconventional ammunition. Reported here are the fatal outcomes of two 19-year-old males, one with head trauma and the other with abdominal trauma. They were admitted to the ED and subjected to immediate exploratory operations, but they passed away. On autopsy, the first case demonstrated a right frontal bone fracture with subdural hemorrhage and a 3 × 2.5 cm pebble retained in the skull. The second case showed severe liver laceration in close vicinity to a cubical pebble (3.2 × 3 cm). The mechanical forces involved in skull fracture and autopsy are discussed. In the current cases, the relatively larger weight and size together with the surface configuration of the pebble projectile were the main influential factors that contributed to the severity of damage and fatality.These case reports are a working example of the effect of the mass of projectiles in increasing the power of penetration. The direct shooting to the head and the abdomen together with the misuse of these weapons are capable of inflicting fatal injuries.

Prevalence and characteristics associated with firearm ownership among low-income U.S. veterans.

This study examined the prevalence of firearm ownership among low-income U.S. military veterans and associated sociodemographic, trauma, and clinical characteristics. Data were analyzed from a nationally representative study of low-income U.S. veterans conducted in 2021 (n = 1,004). Hierarchical logistic regression analyses identified characteristics associated with firearm ownership and mental health correlates of firearm ownership. The results revealed 41.7% of low-income U.S. veterans (95% confidence interval [CI] = 38.7-44.8%) reported owning firearms in their household. Controlling for other factors, firearms owners were significantly more likely to be male and living in their own house. There were no significant associations between trauma exposure (history of assault, unwanted social contact, death of close friend/family, homelessness) or mental health characteristics (history of bipolar disorder, suicide attempt, drug use problems) with firearm ownership. In conclusion, two of five low-income U.S. veterans own a firearm; the prevalence of firearm ownership is higher among men and homeowners. Targeted research on these key segments of the U.S. veteran population and ways to mitigate their firearm misuse may be needed.

Upper extremity firearm injuries: epidemiology and factors predicting hospital admission.

INTRODUCTION: Civilian gun violence is a public health crisis in the USA that will be an economic burden reported to be as high as $17.7 billion with over half coming from US taxpayers dollars through Medicaid-related costs. The purpose of this study is to review the epidemiology of upper extremity firearm injuries in the USA and the associated injury burden. METHODS: The Inter-university Consortium for Political and Social Research's Firearm Injury Surveillance Study database, collected from the National Electronic Injury Surveillance System, was queried from 1993 to 2015. The following variables were reviewed: patient demographics, date of injury, diagnosis, injury location, firearm type (if provided), incident classification, and a descriptive narrative of the incident. We performed chi-square testing and complex descriptive statistics, and binomial logistic regression model to predict factors associated with hospital admission. RESULTS: From 1993 to 2015, an estimated 314,369 (95% CI: 291,528-337,750; 16,883 unweighted) nonfatal firearm upper extremity injuries with an average incidence rate of 4.76 per 100,000 persons (SD: 0.9; 03.77-7.49) occurred. The demographics most afflicted with nonfatal gunshot wound injuries were black adolescent and young adult males (ages 15-24 years). Young adults aged 25-34 were the second largest estimate of injuries by age group. Hands were the most commonly injured upper extremity, (55,014; 95% CI: 75,973-89,667) followed by the shoulder, forearm, and upper arm. Patients who underwent amputation (OR: 28.65; 95% CI: 24.85-33.03) or with fractures (OR: 26.20; 95% CI: 23.27-29.50) experienced an increased likelihood for hospitalization. Patients with a shoulder injury were 5.5× more likely to be hospitalized than those with a finger injury (OR:5.57; 95% CI:5.35-5.80). The incidence of upper extremity firearm injuries has remained steady over the last decade ranging between 4 and 5 injuries per 100,000 persons. Patients with proximal injuries or injuries involving the bone were more likely to require hospital admission. This study should bring new information to the forefront for policy makers regarding gun violence.

Seeking the Peace: Anti-Gun Violence Cadres, Concepts, and Connections in Pittsburgh.

In 2015, Pittsburgh had the 21st highest murder rate in the USA at 18.6 murders per 100,000 population. By 2022, its murder rate had declined to 12.32 per 100,000, ranking it number 58 among American cities with greater than 100,000 residents. The article's principal concern is with identifying factors that may have contributed to mitigations of gun violence in metro-Pittsburgh, and especially with how local anti-violence mobilizations within and between key sectors may have contributed to these violence reductions. Activist cadres of youth, social service organizations, governmental decision-makers, foundation leaders, and faith leaders are examined, with attention to how their respective sectors may have been pushed beyond established scopes of concern to take up the fight against gun violence. Drawing upon original interview data from 30 local leaders and from published formal statements and policy issuances from relevant institutional sectors, the article investigates Pittsburgh gun violence and responses, emphasizing the importance of strategically positioned leaders who possessed commitments and capabilities to leverage Pittsburgh's ample institutional resources on behalf of anti-gun violence objectives.

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.

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.

Patterns of household gun ownership and firearm suicide among black men compared to white men.

Little is known about the patterns of household gun ownership among Black Americans, so little is known about the relationship between the patterns of Black household gun ownership and the patterns of Black firearm suicide. We analyze data from the 2001-2004 Behavioral Risk Factor Surveillance System, the first and last years for which a gun question was part of the core questions. We compare household gun ownership patterns for Black men compared to White men across geographic (region, urbanicity), demographic (age, education, married, children at home), and health-related characteristics (binge drinking, smoking), and find that the patterns are quite similar for all eight variables. However, when we compare these race-specific patterns to the race-specific firearm suicide patterns for 2001-2004, while the White firearm suicide patterns follow their gun ownership patterns, the Black patterns do not. While gun ownership increases with age, adult male Black firearm suicide rates are highest in the younger age group-an age group that also has a high proportion of suicides that are firearm suicides. Differences in unadjusted demographic patterns in firearm suicide between Black men and White men cannot be explained by differences in the self-reported patterns of household gun ownership.

Patterns of household gun ownership and firearm suicide among black men compared to white men.

Little is known about the patterns of household gun ownership among Black Americans, so little is known about the relationship between the patterns of Black household gun ownership and the patterns of Black firearm suicide. We analyze data from the 2001-2004 Behavioral Risk Factor Surveillance System, the first and last years for which a gun question was part of the core questions. We compare household gun ownership patterns for Black men compared to White men across geographic (region, urbanicity), demographic (age, education, married, children at home), and health-related characteristics (binge drinking, smoking), and find that the patterns are quite similar for all eight variables. However, when we compare these race-specific patterns to the race-specific firearm suicide patterns for 2001-2004, while the White firearm suicide patterns follow their gun ownership patterns, the Black patterns do not. While gun ownership increases with age, adult male Black firearm suicide rates are highest in the younger age group-an age group that also has a high proportion of suicides that are firearm suicides. Differences in unadjusted demographic patterns in firearm suicide between Black men and White men cannot be explained by differences in the self-reported patterns of household gun ownership.

Income support policies and firearm violence prevention: A scoping review.

Firearm violence is a major threat to global public health and safety. Several individual, family, peer, community, and societal risk and protective factors determine or modify the risk of firearm violence. Specifically, there is a strong relationship between poverty, income inequality, and firearm violence; as such, interventions that influence upstream determinants of health by providing income support may hold much promise in affecting multiple domains of risk that are on the causal pathway to firearm violence. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, we conducted a scoping review to examine the current state of evidence on the relationship between income support policies and risk of firearm violence. We searched 8 databases related to health and social sciences from inception through March 30, 2022, and placed no time, language, setting, or other publication restrictions on our search, as long as the study was quantitative or mixed-methods and addressed firearm violence specifically, rather than violence more broadly, as an outcome in relation to income support policies. We found 4 studies; of those, 3 were conducted in the United States and 1 in Brazil. All 4 found associations of policy-relevant magnitude between income support policies and reductions in risk of inter-personal firearm violence. We propose future opportunities to enhance the substantive scope and methodologic rigor of this field of research and inform policy and practice for greater impact.

The emerging infrastructure of US firearms injury data.

For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign "external cause of injury" codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.) Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments. We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police.