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Objective: To determine if firearm ownership is positively related to elevated child lead levels at a state-level, even when accounting for other sources of lead., Study Design: For this cross-sectional ecological study, we investigated whether household firearm ownership rates (a proxy for firearm-related lead exposure) was associated with the prevalence of elevated child blood lead levels in 44 US States between 2012 and 2018. To account for potential confounding, we adjusted for other known lead exposures, poverty rate, population density, race, and calendar year. To address missing data, we used multiple imputation by chained equations., Results: Prevalence of elevated child blood lead positively correlated with household firearm ownership and established predictors of lead exposure. In fully adjusted negative binomial regression models, child blood lead was positively associated with household firearm ownership and older housing; each IQR (14%) increase in household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (prevalence ratio: 1.41, 95% CI: 1.11-1.79)., Conclusion: These data provide state-level evidence that firearms may be an important source of child lead exposure. More research is needed to substantiate this relationship and identify modifiable pathways of exposure at the individual level., Competing Interests: Declaration of Competing Interest JMB has been compensated for serving as an expert witness for plaintiffs involved in PFAS-contaminated drinking water and has NIH funding: R21 ES034187. MR has grants from the CDC and NIH related to firearm injury, and has unpaid roles as Senior Strategic Advisor to AFFIRM at the Aspen Institute and as a Board Member for the NonViolence Institute. The other authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This work was supported by the National Collaborative for Gun Violence Research (no grant number)., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This work was supported by the National Collaborative for Gun Violence Research (no grant number)., (Copyright © 2022 Elsevier Inc. All rights reserved.)

One way to reduce firearm suicide is to keep household guns away from a person at risk for suicide. To learn who owned (and presumably controlled access to) the guns used in suicide and which broad gun type they were, we examined National Violent Death Reporting System (NVDRS) data from 2015 to 2017 for five US states that supplied information on gun owner in over 80% of firearm suicides (AK, IA, NH, UT, WI). For adult males, 88% used their own gun; for women, 52% used their own gun and 32% used their partner's gun; for youth ages 18-20, 42% used their own gun, 43% used a family member's, and 8% used a friend's; for children, 19% used their own gun (usually a long gun) and 79% used a family member's gun. Almost 3/4 of firearm suicides involved a handgun, ranging from 62% for youth to 92% for women. In times of suicide risk, interventions for a youth should address not only the parents' guns, but those of other family members and the youth's own rifle or shotgun. For a woman, interventions need to address her own and her partner's guns. For a man, locking guns alone will confer little protection if he controls the keys or combination. Storing firearms-or a critical component-away from home or having someone else control the locks may be safer. Five NVDRS states provided useful data on who owned the gun used in firearm suicides. More NVDRS states should follow suit., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Inc.)

In 1999, the Centers for Disease Control and Prevention proclaimed the reduction in motor vehicle fatalities to be one of the great public health achievements of the 20th century. That motor vehicle success story has had enormous intellectual impact on the injury prevention field, providing many guiding lessons. Can we learn any lessons from what has happened to motor vehicle safety in the 21st century? A key lesson may come from the fact that the great injury achievement of reducing the motor vehicle death rate did not stop in 2000-it continued. We believe that is largely due to the 20th century creation of the conditions that promote continuous declines in injury. By contrast, in the firearms area, these conditions do not exist, and rates of death have not fallen, but have increased. As the idea of continuous quality improvement has become a staple in medicine, we should similarly have a focus on how to continuously reduce injuries. An important lesson from the 21st century motor vehicle success story for the injury prevention field is that we should put more strategic emphasis on creating the conditions that will lead to continuous reductions in injuries. But first we need a much better understanding of what those conditions are., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: none

Interpersonal firearm violence is a major public health problem in the United States. The objective of this study was to determine the effects of gun victimization on the likelihood of post emotional and physical symptoms as reported by victims. We focused on non-fatal violent crimes reported to the National Crime Victimization Surveys for 2009-2019 and ran a set of binary logistic regressions. For outcome measures, we used two dichotomous variables, whether the victim reported feeling at least one of the seven emotional symptoms included in the survey (i.e., anxious, angry, sad/depressed, vulnerable, violated, distrustful, unsafe) and whether they reported having at least one of the seven physical symptoms (i.e., headaches, sleep eating/drinking disorders, upset stomach, fatigue, high blood pressure, muscle tension). Our key independent variable was the type of weapons used by the offender: guns, other weapons, and no weapon. We controlled for demographics of the victim, as well as other aspects of the crime (e.g., age, race, sex of victim, multiple offenders, type of violent crime). Victims of crimes in which the offender used a gun were most likely to report both emotional and physical symptoms, followed by victims of crimes in which the offender used other weapons, and lastly by victims of unarmed offenders. Our findings suggest that the presence of a firearm during a violent crime results in an increased likelihood of subsequent emotional and physical repercussions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Some shooting ranges have adopted policies to prevent suicides at their facilities. Little data have been available to guide them. Aim: We aimed to describe the incidence and characteristics of suicides at public shooting ranges. Method: We conducted text searches of 63,710 firearm suicides in the 16 states participating in the National Violent Death Reporting System from 2004 to 2015 to identify those occurring at public shooting ranges. Results: A total of 118 (or 0.18%) occurred at a shooting range, or 0.12 per million population. If that rate held for the nation as a whole, there would have been roughly 35 shooting range suicides per year during the study period. In total, 88% of decedents arrived alone. When gun ownership was noted, 86% of guns were rented from the range. In some cases, people drove to the range and took their lives in the parking lot with their own gun. Limitations: Our search strategy may have missed cases, and the data may not be nationally representative. Conclusion: Suicides at shooting ranges are rare. Policies that some ranges have adopted - such as allowing rentals only if the person is not alone - are responsive to the actual characteristics of these deaths and could potentially prevent most.

The firearms data infrastructure in the United States is severely limited in scope and fragmented in nature. Improved data systems are needed in order to address gun violence and promote productive conversation about gun policy. In the absence of federal leadership in firearms data systems improvement, motivated states may take proactive steps to stitch gaps in data systems. We propose that states evaluate the gaps in their systems, expand data collection, and improve data presentation and availability.

Approximately 1000 people are killed by police acting in the line of duty each year. Historically, research on these deaths, known as legal intervention homicides (LIH), has been limited by data that is either contextually rich but narrow in scope and not readily available to the public (e.g., police department reports from a single city), or detail-poor but geographically broad, large, and readily available (and maintained by federal agencies) (e.g., vital statistics and supplemental homicide reports). Over the past 5 years, however, researchers have turned to the National Violent Death Reporting System (NVDRS), which captures nearly all lethal police shootings in participating states while providing detailed incident and victim information. The current study extends prior work on police-involved lethal shootings in three important ways. First, we use latent class analysis to construct a data-driven, exhaustive, mutually exclusive typology of these events, using NVDRS data 2014-2015. Second, rather than fitting some, but not all cases into predefined sub-types, every case is assigned membership to a particular emergent class. Third, we use a validated case identification process in NVDRS to identify incidents of lethal police-involved shootings. Seven classes emerge. Classes differ across important incident and victim characteristics such as the event that brought the victim and law enforcement together, the highest level of force used by the victim against law enforcement, and the kind of weapon, if any, used by the victim during the incident. Demographic variables do not distribute uniformly across classes (e.g., the latent class in which the victim appeared to pose minimal threat to law enforcement was the only class in which the plurality of victims was a non-white race). Our approach to generating these typologies illustrates how data-driven techniques can complement subjective classification schemes and lay the groundwork for analogous analyses using police encounter data that include fatal and non-fatal outcomes.

In the United States, firearm homicides disproportionately occur in urban areas. We examine whether the same is true for fatal police shootings. We use data on fatal police shootings from Washington Post's "Fatal Force Database" (2015-2017). Using Census population estimates, we examine rates of fatal police shootings, stratified by race/ethnicity (White, Black, Hispanic), across urban and rural areas using five different classification schemes. Two classification schemes-from the National Center for Health Statistics and the US Department of Agriculture-use counties as the basic unit. Three classification schemes-from the National Center for Education Statistics, the US Census Bureau, and the website "FiveThirtyEight" use zip codes. There were just under 1000 fatal police shootings per year from 2015 to 2017, a rate of 0.31 per 100,000 population. Black victimization rates were more than twice those for Whites, with Hispanic victimization rates in between. Across all classification schemes there was little difference in rates of fatal police shootings between urban and rural areas, with suburbs having somewhat lower rates. Among Whites, rates of fatal police shooting victimization were higher in rural areas compared to urban areas, while among Blacks the rates were higher in more urban areas. Our results suggest that efforts to reduce police shootings of civilians should include rural and suburban as well as urban areas., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: This article aims to examine whether state firearm laws impact homicide rates differently in suburban and rural areas compared to large cities in the United States., Methods: We analyzed serial, cross-sectional data for the 26-year period 1991-2016 using a panel design. We examined the relationship between 6 specific state firearm laws and homicide rates in large cities (those with greater than 100,000 people in 1990) and in all geographic areas outside of these cities. Using a city-level fixed effects negative binomial regression, we modeled the number of homicides as a function of state firearm laws, while controlling for time fixed effects and time-varying state- and city-level sociodemographic factors., Findings: Two policies-universal background checks and "may issue" laws that required a heightened showing of suitability for concealed carry-were associated with lower firearm homicide rates in large cities but were not associated with firearm homicide rates in suburban and rural areas. In contrast, laws that prohibited gun possession by people convicted of a violent misdemeanor were associated with lower firearm homicide rates in suburban and rural areas, but were not associated with firearm homicide rates in large cities. Permit requirements were associated with lower firearm homicide rates in both large cities and suburban and rural areas., Conclusions: This article provides the first evidence that state firearm laws may have a differential impact on firearm homicide rates in suburban and rural areas compared to urban areas in the United States., (© 2019 National Rural Health Association.)

Objectives. To evaluate the effect of large-capacity magazine (LCM) bans on the frequency and lethality of high-fatality mass shootings in the United States. Methods. We analyzed state panel data of high-fatality mass shootings from 1990 to 2017. We first assessed the relationship between LCM bans overall, and then federal and state bans separately, on (1) the occurrence of high-fatality mass shootings (logit regression) and (2) the deaths resulting from such incidents (negative binomial analysis). We controlled for 10 independent variables, used state fixed effects with a continuous variable for year, and accounted for clustering. Results. Between 1990 and 2017, there were 69 high-fatality mass shootings. Attacks involving LCMs resulted in a 62% higher mean average death toll. The incidence of high-fatality mass shootings in non-LCM ban states was more than double the rate in LCM ban states; the annual number of deaths was more than 3 times higher. In multivariate analyses, states without an LCM ban experienced significantly more high-fatality mass shootings and a higher death rate from such incidents. Conclusions. LCM bans appear to reduce both the incidence of, and number of people killed in, high-fatality mass shootings.

This study aimed to investigate the potential differential effects of state-level firearm laws on black and white populations. Using a panel design, authors examined the relationship between state firearm laws and homicide victimization rates among white people and black people in 39 states during the period between 1991 and 2016. Authors modeled homicide rates using linear regression with year and state fixed effects and controlled for a range of time-varying, state-level factors. Results showed that universal background check laws and permit requirement laws were associated with lower homicide rates among both white and black populations, and "shall issue" laws were associated with higher homicide rates among both white and black populations. Laws that prohibit firearm possession among people convicted of a violent misdemeanor or require relinquishment of firearms by people with a domestic violence restraining order were associated with lower black homicide rates, but not with white homicide rates. Author identification of heterogeneity in the associations between state firearm laws and homicide rates among different racial groups has implications for reducing racial health disparities., (© 2019 National Association of Social Workers.)

In Utah, a state with a high rate of gun ownership, the shared concerns of diverse stakeholders generated bipartisan support for a state-funded study that tracked patterns of firearm suicide. The study linked sensitive public health and public safety data and identified opportunities for firearm suicide prevention. Findings reported to the state legislature included the proportion of suicide decedents who could have passed a background check for legal firearm possession at their time of death, had a permit to carry a concealed firearm, or had been seen in the hospital for a previous suicide attempt or self-harm. Within six months of the report's release, the legislature, health care and religious groups, and state agencies had launched diverse, major initiatives to reduce firearm suicide that were informed by the report's findings. We present the Utah experience as a case study in bringing diverse stakeholders-particularly gun owners-together to find common ground on firearm suicide prevention and in using linked data to support and guide their efforts.

Background: Firearm injuries are a major cause of mortality in the USA. Few recent studies have simultaneously examined the impact of multiple state gun laws to determine their independent association with homicide and suicide rates., Objective: To examine the relationship between state firearm laws and overall homicide and suicide rates at the state level across all 50 states over a 26-year period., Design: Using a panel design, we analyzed the relationship between 10 state firearm laws and total, age-adjusted homicide and suicide rates from 1991 to 2016 in a difference-in-differences, fixed effects, multivariable regression model. There were 1222 observations for homicide analyses and 1300 observations for suicide analyses., Participants: Populations of all US states., Main Measures: The outcome measures were the annual age-adjusted rates of homicide and suicide in each state during the period 1991-2016. We controlled for a wide range of state-level factors., Key Results: Universal background checks were associated with a 14.9% (95% CI, 5.2-23.6%) reduction in overall homicide rates, violent misdemeanor laws were associated with a 18.1% (95% CI, 8.1-27.1%) reduction in homicide, and "shall issue" laws were associated with a 9.0% (95% CI, 1.1-17.4%) increase in homicide. These laws were significantly associated only with firearm-related homicide rates, not non-firearm-related homicide rates. None of the other laws examined were consistently related to overall homicide or suicide rates., Conclusions: We found a relationship between the enactment of two types of state firearm laws and reductions in homicide over time. However, further research is necessary to determine whether these associations are causal ones.

Objectives: To describe firearm storage practices among US adults and examine the relationship between having received formal firearms training and firearm storage., Methods: In 2015 we asked a nationally representative online sample of 2072 gun owners how they stored household firearms, their reasons for owning guns, the number and types owned, had they carried a loaded handgun in the prior month and whether they had formal firearms training (and if so, whether training covered suicide prevention, accident prevention, firearm theft prevention, safe handling and safe storage). Unadjusted associations between gun owner characteristics and storage practices were estimated using Pearson's χ 2 tests; adjusted associations used multivariate logistic regressions. Final survey weights that combined presample and study-specific poststratification weights account for oversampling of firearm owners and survey non-response., Results: 29.7% (95% CI 27.4% to 32.1%) stored ≥1 firearm loaded and unlocked. Of the 61.4% (95% CI 58.9% to 63.9%) of gun owners with firearms training, 32.3% (95% CI 29.4% to 35.3%) stored ≥1 firearm loaded and unlocked, compared with 25.8% (95% CI 22.3% to 29.7%) of those without training. Storage did not differ by training component, age, sex or race. However, firearms were more likely stored loaded and unlocked when respondents owned for protection, owned >1 firearm, owned handguns or carried a loaded gun. After adjusting for firearm-related characteristics, firearms training was not associated with storing firearms loaded and unlocked (adjusted OR=1.11, 95% Cl 0.80 to 1.53)., Conclusion: Firearms training, as currently provided, is unlikely to reduce unsafe firearm storage., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Firearm safety instructors and public health professionals are natural allies in the quest to prevent firearm injuries. We audited basic firearm classes to provide information that can help familiarise public health professionals and others with the content covered., Methods: With the advice of expert instructors, we created an audit form. Volunteers audited 20 basic firearm classes in seven north-eastern states., Results: All trainers covered a wide variety of safety issues. Some specific basics were covered in 90+% of the classes, including how to safely load/unload a gun, keeping your finger off the trigger until ready to shoot, and being aware of your target and what is behind it. In 50%-75% of the classes, the trainer covered topics such as operating a safety, clearing jams and cartridge malfunctions, and recommended storing guns unloaded and locked when not in use. Few instructors covered firearm suicide prevention (10%) or domestic violence (10%). Most encouraged gun ownership, gun carrying, gun use in self-defence and membership in a gun rights group., Discussion: From a public health standpoint, we would like to see more instructors covering topics such as firearm suicide and alternatives to gun use in self-defence, and to recommend safer storage of firearms., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Gun violence has increased in Mexico since the mid-2000s, but little is known about patterns of gun ownership. We examine the size and composition of the privately held urban firearm stock in Mexico, motivations for ownership, and attitudes about gun laws. To this end, a household telephone survey of 1361 adults living in nine Mexican cities was conducted in the summer of 2017. We find that few urban Mexican households contain guns. Most of those who report ownership possess one gun, having purchased it recently for self-defense. Few urban Mexican citizens plan to purchase a gun in the future. Respondents are more likely to believe that crime in Mexico would increase if guns were allowed in more places (ie, workplaces and motor vehicles). Evidence suggests urban Mexico has relative low rates of firearm ownership. Few city dwellers plan on obtaining a firearm in the near future., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The USA has very high rates of homicide by police compared to other high-income countries, with approximately 1000 civilians killed annually. The overwhelming majority of these police homicides are fatal shootings. Over the past 5 years, several comprehensive, real-time, data repositories, drawn largely from news reporting, have kept track of incidents in which civilians die during an encounter with the police and have become widely available. Data from these repositories, which are more complete than data available from federal data systems, have been used to explore fatal police shootings of civilians, often with a focus on racial disparities in police shootings of unarmed civilians, and have consistently found that police are more likely to shoot unarmed African American men than unarmed White men. Although numerous studies have examined how rates of police killings of civilians are related to several ecologic determinants of these events, no peer-reviewed study to date has examined the extent to which variation in police involved firearm homicides is explained by firearm prevalence while adjusting for violent crime rates (the most well-established ecologic factor associated with fatal police shootings). The current cross-sectional state-level analysis uses data on the number of civilians shot and killed by police in the line of duty, aggregated over 2015-2017. Data come from the Washington Post's "Fatal Force Database", which assembles the information from news reports and other sources. Data provided include information on whether the victim was armed, and, if so, with what weapon. Explanatory ecologic variables in our models include the violent crime rate, the percentage of the state population that is non-White, poverty rate, and urbanization, along with a validated proxy for firearm prevalence. We find that rates of police shooting deaths are significantly and positively correlated with levels of household gun ownership, even after accounting for the other explanatory variables. The association is stronger for the shooting of armed (with a gun) rather than unarmed victims.

The goal of this study is to provide, for the United States, estimates for gun-owning and non-owning households in terms of firearm and non-firearm suicides and suicide attempts. To make these ballpark estimates I combine a half-dozen known "facts" about suicide (e.g., households with firearms are at approximately 3× the risk of suicide as households without firearms). Among the six major conclusions are that about 90% of firearm suicides occur among members of gun-owning households, that 75% of suicides among gun-owning families are firearm suicides, but only 20% of suicide attempts among these families are with firearms. This study not only provides estimates of suicides and suicide attempts by gun-owning and non-owning households, but the reasonableness of the estimates provides support for the reasonableness of the half-dozen known "facts" about firearms and suicide., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To quantify the proportion of current US gun owners who are new to owning firearms and compare new versus long-standing gun owners with respect to their firearms and firearm-related behaviors., Methods: We performed a cross-sectional analysis of a nationally representative probability-based online survey conducted in 2015 in the United States. We defined new gun owners as current firearm owners who acquired all of their firearms within the past 5 years, but who lived in a home without a gun at some time over the past 5 years. We defined long-standing firearm owners as all other current gun owners., Results: New gun owners represented 10% of all current US adult gun owners. In addition to being younger than long-standing gun owners, new gun owners were more likely to be liberal, own fewer guns, own handguns, own guns only for protection, and store guns in a safe manner., Conclusions: Gun ownership is dynamic, with approximately 1 million Americans becoming new gun owners each year. Public Health Implications. Clinical guidelines should be updated to explicitly endorse re-evaluating household firearm status at regular intervals.

Objective: One way that guns get into the wrong hands is via gun sales without a background check. While the large majority of Americans support laws requiring universal background checks, no prior study has assessed whether Americans think it is acceptable behaviour to sell a gun to a stranger without a background check, whether or not there is a law against it., Methods: We sponsored a nationally representative survey of over 3900 American adults, oversampling gun owners, using an online panel provided by the survey firm Growth for Knowledge., Results: Over 72% of American adults agree or strongly agree with the statement that 'whether it is legal or not, it is NOT acceptable to sell a gun to a stranger without a background check' and 11% disagree or strongly disagree. Subgroups less likely to agree are young adults, men, conservatives, those with less than a high school education and gun owners., Conclusion: Reducing the number of guns sold without a background check could help reduce the flow of guns to felons. Changes in normative attitudes and behaviours, as well as changes in law, could help accomplish this goal. Most Americans, including gun owners, believe selling a gun to a stranger without a background check is not acceptable behaviour., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

In a cross-sectional, panel study, we examined the relationship between state firearm laws and the extent of interstate transfer of guns, as measured by the percentage of crime guns recovered in a state and traced to an in-state source (as opposed to guns recovered in a state and traced to an out-of-state source). We used 2006-2016 data on state firearm laws obtained from a search of selected state statutes and 2006-2016 crime gun trace data from the Bureau of Alcohol, Tobacco, Firearms, and Explosives. We examined the relationship between state firearm laws and interstate transfer of guns using annual data from all 50 states during the period 2006-2016 and employing a two-way fixed effects model. The primary outcome variable was the percentage of crime guns recovered in a state that could be traced to an original point of purchase within that state as opposed to another state. The main exposure variables were eight specific state firearm laws pertaining to dealer licensing, sales restrictions, background checks, registration, prohibitors for firearm purchase, and straw purchase of guns. Four laws were independently associated with a significantly lower percentage of in-state guns: a waiting period for handgun purchase, permits required for firearm purchase, prohibition of firearm possession by people convicted of a violent misdemeanor, and a requirement for relinquishment of firearms when a person becomes disqualified from owning them. States with a higher number of gun laws had a lower percentage of traced guns to in-state dealers, with each increase of one in the total number of laws associated with a decrease of 1.6 percentage points in the proportion of recovered guns that were traced to an in-state as opposed to an out-of-state source. Based on an examination of the movement patterns of guns across states, the overall observed pattern of gun flow was out of states with weak gun laws and into states with strong gun laws. These findings indicate that certain state firearm laws are associated with a lower percentage of recovered crime guns being traced to an in-state source, suggesting reduced access to guns in states with those laws.

Introduction: No one has systematically collected the views of firearm researchers to determine if and where agreement exists on the scientific evidence about firearms and firearm violence., Methods: We send a short monthly on-line survey to firearm researchers. Each survey asks respondents their level of agreement with a statement about firearms, their rating of the quality of the scientific evidence on the specific issue, their familiarity with that literature and their area of expertise. Survey participants are first-authors of a firearms article published in a peer-reviewed journal since 2011. For the first 15 surveys, on average, surveys were sent to 322 researchers, and 109 researchers responded (34% response rate)., Results: Among respondents, approximately 46% were public health researchers and 32% were sociologists/criminologists. Agreement exists among firearm researchers that more guns and weaker gun laws cause serious public health problems, that the costs of gun availability are typically greater than the benefits and that stronger gun laws may improve public safety and health. 84% of researchers agreed, and only 8% disagreed with the statement 'in the United States, having a gun in the home increases the risk of suicide'. For only three statements did most respondents rate the quality of the scientific evidence as strong or very strong. Overall, there was a higher level of agreement among public health/medicine researchers than among researchers in the other disciplines., Discussion: Surveys of researchers can provide useful information about agreement on specific issues and about the quality of the scientific evidence., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Importance: Firearm homicide is a leading cause of injury death in the United States, and there is considerable debate over the effectiveness of firearm policies. An analysis of the effectiveness of firearm laws on firearm homicide is important to understand optimal policies to decrease firearm homicide in the United States., Objective: To evaluate the association between firearm laws and preventing firearm homicides in the United States., Evidence Review: We evaluated peer-reviewed articles from 1970 to 2016 focusing on the association between US firearm laws and firearm homicide. We searched PubMed, CINAHL, Lexis/Nexis, Sociological Abstracts, Academic Search Premier, the Index to Legal Periodicals and Books, and the references from the assembled articles. We divided laws into 5 categories: those that (1) curb gun trafficking, (2) strengthen background checks, (3) improve child safety, (4) ban military-style assault weapons, and (5) restrict firearms in public places and leniency in firearm carrying. The articles were assessed using the standardized Guide to Community Preventive Services data collection instrument and 5 additional quality metrics: (1) appropriate data source(s) and outcome measure(s) were used for the study, (2) the time frame studied was adequate, (3) appropriate statistical tests were used, (4) the analytic results were robust, and (5) the disaggregated results of control variables were consistent with the literature., Findings: In the aggregate, stronger gun policies were associated with decreased rates of firearm homicide, even after adjusting for demographic and sociologic factors. Laws that strengthen background checks and permit-to-purchase seemed to decrease firearm homicide rates. Specific laws directed at firearm trafficking, improving child safety, or the banning of military-style assault weapons were not associated with changes in firearm homicide rates. The evidence for laws restricting guns in public places and leniency in gun carrying was mixed., Conclusions and Relevance: The strength of firearm legislation in general, and laws related to strengthening background checks and permit-to-purchase in particular, is associated with decreased firearm homicide rates. High-quality research is important to further evaluate the effectiveness of these laws. Legislation is just 1 part of a multipronged approach that will be necessary to decrease firearm homicides in the United States.

Importance: Gun violence and injuries pose a substantial threat to children and youth in the United States. Existing evidence points to the need for interventions and policies for keeping guns out of the hands of children and youth., Objectives: (1) To examine the association between state gun law environment and youth gun carrying in the United States, and (2) to determine whether adult gun ownership mediates this association., Design, Setting, and Participants: This was a repeated cross-sectional observational study design with 3 years of data on youth gun carrying from US states. The Youth Risk Behavior Survey comprises data of representative samples of students in grades 9 to 12 from biennial years of 2007, 2009, and 2011. We hypothesized that states with more restrictive gun laws have lower rates of youth gun carrying, and this association is mediated by adult gun ownership., Exposures: State gun law environment as measured by state gun law score., Main Outcomes and Measures: Youth gun carrying was defined as having carried a gun on at least 1 day during the 30 days before the survey., Results: In the fully adjusted model, a 10-point increase in the state gun law score, which represented a more restrictive gun law environment, was associated with a 9% decrease in the odds of youth gun carrying (adjusted odds ratio [AOR], 0.91 [95% CI, 0.86-0.96]). Adult gun ownership mediated the association between state gun law score and youth gun carrying (AOR, 0.94 [ 95% CI, 0.86-1.01], with 29% attenuation of the regression coefficient from -0.09 to -0.07 based on bootstrap resampling)., Conclusions and Relevance: More restrictive overall gun control policies are associated with a reduced likelihood of youth gun carrying. These findings are relevant to gun policy debates about the critical importance of strengthening overall gun law environment to prevent youth gun carrying.

Objectives: In the United States, state firearm ownership has been correlated with homicide rates. More than 90% of homicides of law enforcement officers (LEOs) are committed with firearms. We examined the relationship between state firearm ownership rates and LEO occupational homicide rates., Methods: We obtained the number LEOs killed from 1996 to 2010 from a Federal Bureau of Investigation (FBI) database. We calculated homicide rates per state as the number of officers killed per number of LEOs per state, obtained from another FBI database. We obtained the mean household firearm ownership for each state from the Behavioral Risk Factor Surveillance System., Results: Using Poisson regression and controlling for factors known to affect homicide rates, we associated firearm ownership with the homicide rates for LEOs (incidence rate ratio = 1.044; P = .005); our results were supported by cross-sectional and longitudinal sensitivity analyses. LEO homicide rates were 3 times higher in states with high firearm ownership compared with states with low firearm ownership., Conclusions: High public gun ownership is a risk for occupational mortality for LEOs in the United States. States could consider methods for reducing firearm ownership as a way to reduce occupational deaths of LEOs.

Objectives: To describe the epidemiology of self-defense gun use (SDGU) and the relative effectiveness of SDGU in preventing injury and property loss., Methods: Data come from the National Crime Victimization Survey for 2007-2011, focusing on personal contact crimes. For property loss, we examined incidents where the intent was to steal property. Multivariate analyses controlled for age, gender of offender and victim, if offender had a gun, urbanicity, and thirteen types of self-protective action., Results: Of over 14,000 incidents in which the victim was present, 127 (0.9%) involved a SDGU. SDGU was more common among males, in rural areas, away from home, against male offenders and against offenders with a gun. After any protective action, 4.2% of victims were injured; after SDGU, 4.1% of victims were injured. In property crimes, 55.9% of victims who took protective action lost property, 38.5 of SDGU victims lost property, and 34.9% of victims who used a weapon other than a gun lost property., Conclusions: Compared to other protective actions, the National Crime Victimization Surveys provide little evidence that SDGU is uniquely beneficial in reducing the likelihood of injury or property loss., (Copyright © 2015 Elsevier Inc. All rights reserved.)

In almost all states in the United States, to carry a concealed handgun legally requires a permit from the police. Many states have changed from may-issue laws (where the local police chief has discretion about to whom to issue a license) to shall-issue laws (where the police chief must issue a permit if the applicant passes a computerized federal background check). Studies conflict on the effect on crime. None considered the situation in may-issue states when police used discretion and refused to issue a permit. We provide suggestive evidence from a December 2013 survey of police chiefs in Massachusetts' 351 cities and towns. Of the 121 responding police chiefs, a large majority favored retaining police discretion. Chiefs issued few discretionary denials - median 2 per year, citing providing false information, a history of assault (often domestic violence), a history of drug or alcohol abuse, or of mental-health issues as the most common reasons for denial.

Introduction: Although some view the ownership of firearms as a deterrent to crime, the relationship between population-level firearm ownership rates and violent criminal perpetration is unclear. The purpose of this study is to test the association between state-level firearm ownership and violent crime., Methods: State-level rates of household firearm ownership and annual rates of criminal acts from 2001, 2002, and 2004 were analyzed in 2014. Firearm ownership rates were taken from a national survey and crime data were taken from the Federal Bureau of Investigation Uniform Crime Reports. Rates of criminal behavior were estimated as a function of household gun ownership using negative binomial regression models, controlling for several demographic factors., Results: Higher levels of firearm ownership were associated with higher levels of firearm assault and firearm robbery. There was also a significant association between firearm ownership and firearm homicide, as well as overall homicide., Conclusions: The findings do not support the hypothesis that higher population firearm ownership rates reduce firearm-associated criminal perpetration. On the contrary, evidence shows that states with higher levels of firearm ownership have an increased risk for violent crimes perpetrated with a firearm. Public health stakeholders should consider the outcomes associated with private firearm ownership., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

On an average day in the USA more than 100 Americans die by suicide-half use firearms. Suicide rates overall and by firearms are higher, on average, in states where household firearm ownership is more common. In general this means in states where a greater proportion of the population lives in rural areas. The current ecological study focuses on the relation between measures of household firearm prevalence and suicide mortality in urban areas (metropolitan statistical areas and divisions) using survey-based measures of firearm ownership. Suicide rates (1999-2010) for metropolitan statistical areas that are comprised of large US cities come from death certificate records; rates of household firearm ownership come from the 2002 and 2004 Behavioural Risk Factor Surveillance System. Higher rates of firearm ownership are strongly associated with higher rates of overall suicide and firearm suicide, but not with non-firearm suicide. Stratification by gender, age and race did not materially affect the association between firearms and suicide. This study provides evidence consistent with previous case-control work and extends evidence from previous state- and region-level ecological studies that firearms in the home impose suicide risk above and beyond baseline., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Importance: Over 30,000 people die annually in the United States from injuries caused by firearms. Although most firearm laws are enacted by states, whether the laws are associated with rates of firearm deaths is uncertain., Objective: To evaluate whether more firearm laws in a state are associated with fewer firearm fatalities., Design: Using an ecological and cross-sectional method, we retrospectively analyzed all firearm-related deaths reported to the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System from 2007 through 2010. We used state-level firearm legislation across 5 categories of laws to create a "legislative strength score," and measured the association of the score with state mortality rates using a clustered Poisson regression. States were divided into quartiles based on their score., Setting: Fifty US states., Participants: Populations of all US states., Main Outcome Measures: The outcome measures were state-level firearm-related fatalities per 100,000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence-related deaths, and household firearm ownership., Results: Over the 4-year study period, there were 121,084 firearm fatalities. The average state-based firearm fatality rates varied from a high of 17.9 (Louisiana) to a low of 2.9 (Hawaii) per 100,000 individuals per year. Annual firearm legislative strength scores ranged from 0 (Utah) to 24 (Massachusetts) of 28 possible points. States in the highest quartile of legislative strength (scores of ≥9) had a lower overall firearm fatality rate than those in the lowest quartile (scores of ≤2) (absolute rate difference, 6.64 deaths/100,000/y; age-adjusted incident rate ratio [IRR], 0.58; 95% CI, 0.37-0.92). Compared with the quartile of states with the fewest laws, the quartile with the most laws had a lower firearm suicide rate (absolute rate difference, 6.25 deaths/100,000/y; IRR, 0.63; 95% CI, 0.48-0.83) and a lower firearm homicide rate (absolute rate difference, 0.40 deaths/100,000/y; IRR, 0.60; 95% CI, 0.38-0.95)., Conclusions and Relevance: A higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association.

This paper investigates: (1) whether high school students overestimate gun carrying by their peers, and (2) whether those students who overestimate peer gun carrying are more likely to carry firearms. Data come from a randomly sampled survey conducted in 2008 of over 1,700 high school students in Boston, MA. Over 5% of students reported carrying a gun, 9% of boys and 2% of girls. Students substantially overestimated the percentage of their peers who carried guns; the likelihood that a respondent carried a gun was strongly associated with their perception of the level of peer gun carrying. Most respondents believed it was easier for other youth to obtain guns than it was for them. Social marketing campaigns designed to lower young people's perceptions about the prevalence of peer gun carrying may be a promising strategy for reducing actual gun carrying among youth., (Copyright © 2010 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)