Firearm-related Deaths Research Articles

The effect of drugs and guns on life expectancy in the United States, 2000–2020

ObjectivesThis study estimated the effect of changing trends in drug- and firearm-related mortality on life expectancy in the U.S. over the last two decades. Study designRetrospective cross-sectional study. MethodsWe used national vital registration data from CDC WONDER, stratified by sex, to estimate the mortality rate due to accidental and intentional poisoning (ICD Codes X40-X49, X60-X69, Y10-Y19 and X85), and firearm deaths (ICD codes W32-W34, X72-X74, X93-X95, Y22-Y24) for the period 2000–2020. We applied standard life table methods to all cause mortality rates with and without these mortality causes to estimate the life expectancy at each age over this period. ResultsIn 2020, mortality due to drugs and firearms combined reduced male life expectancy by1.67 years compared to 0.67 years in 2000, and without the effect of these two causes of death, male life expectancy in 2019 would have been 78.02 years. For women, drugs and firearm-related mortality reduced life expectancy by 0.20 years in 2000 and 0.63 years in 2020, and female life expectancy would have been 82.25 years in 2019 without the retarding effect of these two preventable causes. ConclusionsDrug- and firearm-related deaths have increased so rapidly, especially among younger populations, that life expectancy at birth is significantly reduced by these causes of death. Without urgent action to tackle these preventable causes of death, US life expectancy will continue to stagnate and may even decline, even without the effect of COVID-19.

Relationship Between Firearm-Related Deaths and Food Insecurity in Hampton Roads

Relationship Between Firearm-Related Deaths and Food Insecurity in Hampton Roads

A Student Call for Gun Violence Education in Medical Schools

This Viewpoint discusses the lack of gun violence education in medical school curricula despite the high prevalence of firearm-related deaths and injuries in the US.

The State of Firearm Policy Research in the United States.

Firearm-related deaths lead to the most person-years of life lost in the US. There were 48,830 deaths from homicides and suicides in 2021 alone. Firearm access remains at an all-time high in most states - indicated by record manufacturing, sales, employment in firearm industry, taxes collected from sales, and the number of federal background check applications in 2020 and 2021. Yet, firearm injury is a politically contentious topic to the point of stalling progress on an important public health topic. This politicization led to nearly three decades of federal disinvestment in firearm research; reduced surveillance of firearm-related crime, injury, and death; and degraded data quality. This left generations of researchers with limited epidemiologic tools to conduct firearm policy research, jeopardizing the amount and quality of research conducted. Despite these limitations, research has persisted and promising approaches to reduce firearm morbidity and mortality have been identified. Yet the field has struggled to keep pace with methodological advancements and conceptualizations of racial and ethnic disparities as products of systemic racism. In this commentary, we highlight some existing evidence-informed policies, explicate some limitations in the field, and identify opportunities to address the limitations of prior work to strengthen future capacity for evidence-informed prevention.

A multi-state evaluation of extreme risk protection orders: a research protocol

BackgroundExtreme Risk Protection Orders (ERPOs) are civil court orders that prohibit firearm purchase and possession when someone is behaving dangerously and is at risk of harming themselves and/or others. As of June 2024, ERPOs are available in 21 states and the District of Columbia to prevent firearm violence. This paper describes the design and protocol of a six-state study of ERPO use.MethodsThe six states included are California, Colorado, Connecticut, Florida, Maryland, and Washington. During the 3-year project period (2020–2023), ERPO case files were obtained through public records requests or through agreements with agencies with access to these data in each state. A team of over four dozen research assistants from seven institutions coded 6628 ERPO cases, abstracting 80 variables per case under domains related to respondent characteristics, events and behaviors leading to ERPO petitions, petitioner types, and court outcomes. Research assistants received didactic training through an online learning management system that included virtual training modules, quizzes, practice coding exercises, and two virtual synchronous sessions. A protocol for gaining strong interrater reliability was used. Research assistants also learned strategies for reducing the risk of experiencing secondary trauma through the coding process, identifying its occurrence, and obtaining help.DiscussionAddressing firearm violence in the U.S. is a priority. Understanding ERPO use in these six states can inform implementation planning and ERPO uptake, including promising opportunities to enhance safety and prevent firearm-related injuries and deaths. By publishing this protocol, we offer detailed insight into the methods underlying the papers published from these data, and the process of managing data abstraction from ERPO case files across the multi-state and multi-institution teams involved. Such information may also inform future analyses of this data, and future replication efforts.RegistrationThis protocol is registered on Open Science Framework (https://osf.io/kv4fc/).

Outcomes and implications of pediatric spinal gun shot wounds: A cross-sectional analysis using 2017-2021 TQIP data

BackgroundPediatric morbidity and mortality due to gun violence has steadily risen in recent years, becoming the leading cause of death among children and teens as of 2022 per the Center for Disease Control (CDC). For patients under the age of 17 in the United States, gunshot wounds (GSWs) are the underlying cause of traumatic spinal cord injury (tSCI) in 8.3% of patients. Although prior studies have examined the broader trends of firearm-related deaths in children, investigation specifically focusing on gunshot wounds to the spine has not addressed the pediatric population. MethodsThe TQIP database from 2017 to 2021 was queried for patients under the age of 18 with gunshot traumas, and ICD-10 diagnosis codes were used to identify associated spinal injuries. The incidence across time and risk factors for adverse hospital outcomes were analyzed using multivariate logistic regression. Factors of interest included demographic characteristics, insurance provider, and comorbidities. ResultsA total of 3,155 gunshot injuries to the spine (GSIS) in the pediatric population were reported to TQIP between 2017 and 2021. Average patient age was 16 ± 2.8 years old and the majority of patients (n=1819, 57.6%) were uninsured. Assault was the intent of firearm discharge in 2,582 (81.8%) patients and unintentional injury occurred in 322 (10.2%) cases. Mortality occurred in 11.7% of GSIS, twice that of the 5.8% seen in all pediatric GSW. Those with psychiatric disorders were more likely to result in extended LOS (OR, 2.538; 95% CI, 1.638-3.932; P < 0.001) and in-hospital complications (OR, 1.841; 95% CI, 1.139-2.891; P = 0.012) when analyzed with multivariate binomial logistic regression. ConclusionIn this large-scale retrospective study using TQIP data, we identified trends in spine injuries sustained from gun trauma in the pediatric population. Consideration of demographics, hospital course, and outcomes as examined in this study can provide valuable insights to clinicians, public health organizations, and policy makers.

Integrating firearm storage and safety devices into health care.

Millions of US children and adolescents live in homes with loaded firearms, with only half of these homes securing their guns. Firearm-related deaths among youth have doubled over the past decade, making firearms the leading cause of death for children and adolescents in the United States. The recent advisory by the US Surgeon General, identifying firearm violence as a public health crisis, underscores the urgent need for responsible firearm ownership, including safe firearm storage. However, the healthcare community currently lacks durable medical equipment (DME) codes for firearm storage devices, limiting the ability of healthcare providers to support responsible gun ownership. We propose the establishment of DME codes for firearm storage and safety devices, which would facilitate insurance coverage of these vital prevention measures. Durable medical equipment codes would empower physicians and other healthcare providers to integrate anticipatory guidance and lethal means counseling of firearm safety into routine care and support hospital- and community-based efforts to prevent firearm-related injuries and deaths among children and adolescents.

Examining firearm-related deaths in Mexico, 2015–2022

BackgroundGlobally, Mexico is one of six countries with the highest level of firearm mortality. While previous studies have examined firearm mortality in Mexico before 2015, increases in violence since then highlight the need for an updated analysis. In this study, we examined changes in firearm-related deaths in Mexico from 2015 to 2022 and described these deaths by key demographic groups, incident location, and state of occurrence. Data came from Mexico’s Instituto Nacional de Estadistica y Geografia (INEGI), a federal agency that collects and reports national population data. We used descriptive statistics to analyze rates, proportions, and percentage changes in firearm mortality, and we displayed temporal trends using time plots and special trends using maps.ResultsFirearm deaths increased in Mexico from 2015 to 2018 but slightly decreased from 2018 to 2022. Homicides presented the highest increase and the highest proportion of firearm-related deaths from 2015 to 2022. Victims were primarily males but rates among women increased at a higher proportion (99.5% vs 53.5%). One third of victims were 20–29y but rates among children and adolescents (10–9y) increased at a higher proportion. Most firearm-related deaths occurred in streets or public spaces but the percentage of incidents occurring in households have increased. State-level rates and percentage changes varied significantly. States with higher rates of firearm mortality coincide with those involving conflict among organized criminal organizations.ConclusionFirearm mortality in Mexico is a major public health burden. The epidemiology of firearm-related deaths in Mexico varies by intent, demographics, location, and states. To mitigate this challenge, multiple solutions are required.

Conceptualization of Firearm-Related Terms Among Rural Adolescents: Definitions Matter.

Rural adolescents are at risk for firearm-related injury and death. In response, professional organizations have called for communication between adolescents, parents, and providers about firearms. A shared understanding of firearms between providers and families can facilitate effectiveness of health interventions. However, few studies engage adolescents in identifying their perception of common firearm terminology. The current study aimed to understand how adolescents in rural communities defined firearm-related terms including firearm, carrying, and handling, and differences in terms based on prior firearm training. Data were from a mixed methods community-based participatory study of 93 adolescents from rural Washington state. Thematic qualitative coding identified themes for firearm (gun, weapon, projectile, and tool), carrying (on you/your person, transportation, and holding), and handling (actively using, safe use, and holding) and differences between those with prior firearms training. Findings provide insight into perceptions of firearm-related terms for adolescents, an often-neglected voice, and inform rural policy and prevention efforts.

Firearm ownership and suicide: Has the time come to discuss uniformity of health and social assessments in aid of regulation? Reflection from a retrospective study on a forensic case series.

Firearm-related deaths are an issue of ongoing public interest, from a health and economic perspective. Worldwide, firearm prevalence in suicides varies widely, depending on multiple factors including the availability of weapons in each country. Although several studies have shown that national laws about gun ownership, reducing legal access to guns, decrease the risk of suicide by firearm, the current situation clashes with widely differing legislations. Retrospective study on a forensic case series. Autopsy reports assessed at the Section of Legal Medicine of Milan (Italy) from January 2014 to December 2023 were retrospectively documented. Only firearm suicides were considered. For each case, a close analysis of the criminal offence reports has been performed to obtain information about the gender and age of the victim, as well as the legal possession of firearms, psychiatric disorders, alcohol, and illicit drug abuse. Among all the 1,164 suicides assessed at the Section of Legal Medicine of Milan over a 10-year-period, 101 cases (8.7%) were firearm-related. The male to female ratio was therefore about 13:1. No seasonal trends were observed. Most of the individuals owned the firearm license. Of the entire dataset, 35.6% suffered from psychiatric disorders, 4% of alcohol abuse and 2% of drug addiction. Among the owners of a firearm license, 42.3% had psychiatric disorders. Knowledge about firearm suicide and its relation to firearm legal possession is limited and current preventive laws should be reconsidered. Present administrative and clinical examinations required to obtain a firearm license in Italy and in some European territories are dealt with. The evaluation of the firearm-related risk of abuse is an essential but complex procedure, which requires not only clinic-anamnestic data but also in-deep psychiatric information. There is a need to develop and reinvigorate a debate that currently presents very heterogeneous solutions, but which would probably benefit from a common vision of the prevention strategies that can be implemented and enacted for the benefit of the entire community.

Gunshot injuries in Central Europe – Epidemiology and outcome in Germany, Switzerland and Austria – an analysis based on the TraumaRegister DGU®

BackgroundFirearms are of special interest in trauma research due to high lethality and criminal value. Strong correlation between guns per capita and fire-arm related deaths has been shown. Most of existing literature regarding gun-shot fatalities are from the U.S. and data for Central Europe is lacking. Thus, the aim of this study was to assess the legal frameworks regarding gun-ownership in Germany (DE), Austria (A) and Switzerland (CH), and to retrospectively analyze data from the TraumaRegister DGU® regarding the epidemiology, injury severity, intention and outcome of gunshot-related deaths in these countries. MethodsAll patients from TR-DGU who sustained a gunshot injury in the time period from 1st January 2009 to 31st December 2019 were considered for analysis. Only cases admitted to level 1 or 2 trauma center in Germany, Switzerland, or Austria were included. Predicted mortality was calculated using the RISC-II. Further, the legal framework for firearm posession were explored. ResultsThe legal frameworks do not differ significantly between the countries. However, only ex-military men from Switzerland are allowed to keep their automatic (military) weapon at home. We assessed 1312 gunshot fatalities (DE 1,099, A 111, CH 102) of which most were due to suspected suicide (A 72.1 %, CH 64.7 %, and DE 56.6 %, p = 0.003). Act of suspected violent crime or accidental gunshots were rare in all three countries. Amongst all gunshot fatalities, Austria showed the highest mean age (57.6 years), followed by DE (53.4 years) and CH (49.4 years; p < 0.01). Gunshot fatalities amongst all assessed countries due to suspected suicide showed a peak at the age of 60 years and above, whereas suspected violent crime delicts with gunshots were mainly seen in younger age groups. The highest mortality was found in suspected suicide cases, showing a mortality of 82.1 % (predicted 65.2 %) in Switzerland, 75.3 % (predicted 65.8 %) in Austria and 63.7 % (predicted 56.2 %) in Germany. ConclusionGunshot wounds are still rare in central Europe, but gunshot-related suicide rates are high. Gun ownership laws may have an impact on gunshot wounds due to suspected suicide. Injury patterns differ compared to countries where a high incidence of gun ownership is seen.

Emergency Medical Services Encounters for Firearm Injuries - 858 Counties, United States, January 2019-September 2023.

Firearm-related deaths and injuries have increased in recent years. Comprehensive and timely information on firearm injuries and the communities and geographic locations most affected by firearm violence is crucial for guiding prevention activities. However, traditional surveillance systems for firearm injury, which are mostly based on hospital encounters and mortality-related data, often lack information on the location where the shooting occurred. This study examined annual and monthly rates of emergency medical services (EMS) encounters for firearm injury per 100,000 total EMS encounters during January 2019-September 2023 in 858 counties in 27 states, by patient characteristics and characteristics of the counties where the injuries occurred. Overall, annual rates of firearm injury EMS encounters per 100,000 total EMS encounters ranged from 222.7 in 2019 to 294.9 in 2020; rates remained above prepandemic levels through 2023. Rates were consistently higher among males than females. Rates stratified by race and ethnicity were highest among non-Hispanic Black or African American persons; rates stratified by age group were highest among persons aged 15-24 years. The greatest percentage increases in annual rates occurred in urban counties and in counties with higher prevalence of severe housing problems, higher income inequality ratios, and higher rates of unemployment. States and communities can use the timely and location-specific data in EMS records to develop and implement comprehensive firearm injury prevention strategies to address the economic, social, and physical conditions that contribute to the risk for violence, including improvements to physical environments, secure firearm storage, and strengthened social and economic supports.

Implementation of Extreme Risk Protection Orders in Colorado from 2020 to 2022: Firearm relinquishment and return and petitioner characteristics

IntroductionFirearm injury remains a public health problem, with nearly 50,000 firearm-related deaths in the US in 2021. Extreme risk protection orders (ERPOs) are civil restraining orders that intend to reduce firearm deaths by temporarily removing firearms from individuals who are threatening violence to themselves or others. We described ERPO use by petitioner type and implementation including firearm removal. MethodsAll ERPO petitions filed in Colorado (1/1/2020–12/31/2022) were analyzed using an established abstraction tool and team-based approach. Case data abstracted from petitions and court documents were analyzed descriptively. ResultsOver three years, there were 353 ERPO petitions filed in Colorado. Only 39 % percent of granted petitions had documentation of firearms being relinquished. The average number firearms relinquished was 1.8 with a range of 1 to 31 firearms. One third (37.7 %) of petitions mentioned a mental health issue, 10 % had a renewal request, and half (54.6 %) of petitions were filed by law enforcement (LE). LE petitions filed were more likely to be granted temporary ERPOs (94.3 % vs 35.0 %, p < 0.0001) and full year ERPOs (79.7 % vs 39.3 %, p < 0.0001) compared to non-LE petitions. ConclusionResults from these analyses shed light on data gaps surrounding ERPO use and implementation. Differences in LE vs others’ ERPO outcomes suggest a need for additional research and training. ERPOs’ efficacy hinges on removing access to firearms among those at risk, and a lack of documentation limits the ability to evaluate these policies. This suggests a need to standardize reporting to ensure ERPO utilization and impact can be evaluated.Mini abstract: This descriptive study assessed use, implementation and data gaps surrounding Extreme Risk Protection Orders in Colorado.Abbreviations: Extreme risk protection orders (ERPOs) are civil restraining orders that intend to reduce firearm deaths by temporarily removing firearms from individuals who are threatening violence to themselves or others.

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

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. To estimate the incidence of youth parental death due to drugs, firearms, and all other causes. 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. Parental death due to drug poisoning or firearms. 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. 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%). 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.

Characteristics of firearm injury by injury intent: The need for tailored interventions.

While the United States has high quality data on firearm-related deaths, less information is available on those who arrive at trauma centers alive, especially those discharged from the emergency department. This study sought to describe characteristics of patients arriving to trauma centers alive following a firearm injury, postulating that significant differences in firearm injury intent might provide insights into injury prevention strategies. This was a multicenter prospective cohort study of patients treated for firearm-related injuries at 128 US trauma centers from March 2021 to February 2022. Data collected included patient-level sociodemographic, injury and clinical characteristics, community characteristics, and context of injury. The outcome of interest was the association between these factors and the intent of firearm injury. Measures of urbanicity, community distress, and strength of state firearm laws were used to characterize patient communities. A total of 15,232 patients presented with firearm-related injuries across 128 centers in 41 states. Overall, 9.5% of patients died, and deaths were more common among law enforcement and self-inflicted firearm injuries (80.9% and 50.5%, respectively). These patients were also more likely to have a history of mental illness. Self-inflicted firearm injuries were more common in older White men from rural and less distressed communities, whereas firearm assaults were more common in younger Black men from urban and more distressed communities. Unintentional injuries were more common among younger patients and in states with lower firearm safety grades, whereas law enforcement-related injuries occurred most often in unemployed patients with a history of mental illness. Injury, clinical, sociodemographic, and community characteristics among patients injured by a firearm significantly differed between intents. With the goal of reducing firearm-related deaths, strategies and interventions need to be tailored to include community improvement and services that address specific patient risk factors for firearm injury intent. Prognostic and Epidemiological; Level III.

Smart city planning focused on the US cities in need of policing innovations and public health safety technologies and strategies

The issue of firearm-related injuries, deaths and crime in the United States is of particular relevance. Every year, about 32,000 lives are lost as a result of firearm-related incidents, including self-inflicted injuries. Other 74,000 people suffer non-fatal gunshot wounds. Addressing this multi-faceted problem is possible through a comprehensive and integrated approach that encompasses public health initiatives, law enforcement efforts, and security measures. In the context of solving this problem, the concepts of “community-oriented policing”, “problem-oriented policing”, “broken windows theory”, “smart city social sustainability initiative” (multi-system improvement and meeting the needs of marginalised residents), “feedback methodology”, etc. are thoroughly considered. The author proposes the strategic deployment of mini-police stations in areas with a high crime rate as proper centres of police visibility and a deterrent to criminals. To realise this task, it is necessary to integrate the latest approaches to Smart Urban Development with innovative urban planning technologies that would increase the influence of law enforcement agencies in the process of protecting public health and safety in cities. In particular, the article proposes the following for implementation: identifying crime hotspots by means of advanced geographic information systems, applying machine learning algorithms to predict future crime trends, using advanced real-time surveillance technologies and firearms detection systems, applying geospatial analysis to optimise patrol routes, dynamically adjusting patrol routes depending on real-time data analytics, deploying mobile command centres. As a result, law enforcement agencies can effectively communicate to potential criminals that their actions will not go unnoticed. They may achieve significant success in improving the overall quality of life of residents in such areas. Also, they will create safer communities, and reduce the number of incidents involving the use of firearms.

Transition to Permitless Open Carry and Association with Firearm-Related Suicide.

Firearm-related death rates continue to rise in the US. As some states enact more permissive firearm laws, we sought to assess the relationship between a change to permitless open carry (PLOC) and subsequent firearm-related death rates, a currently understudied topic. Using state-level data from 2013 to 2021, we performed a linear panel analysis using a state fixed-effects model. We examined total firearm-related death, suicide, and homicide rates separately. If a significant association between OC law and death rate was found, we then performed a difference-in-difference (DID) analysis to assess for a causal relationship between changing to PLOC and increased death rate. For significant DID results, we performed confirmatory DID separating firearm and nonfirearm death rates. Nineteen states maintained a no OC or permit-required law, whereas 5 changed to permitless and 26 had a PLOC before 2013. The fixed-effects model indicated more permissive OC law that was associated with increased total firearm-related deaths and suicides. In DID, changing law to PLOC had a significant average treatment effect on the treated of 1.57 (95% CI 1.05 to 2.09) for total suicide rate but no significant average treatment effect for the total firearm-related death rate. Confirmatory DID results found a significant average treatment effect on the treated of 1.18 (95% CI 0.90 to 1.46) for firearm suicide rate. OC law is associated with total firearm-related death and suicide rates. Based on our DID results, changing to PLOC is indeed strongly associated with increased suicides by firearm.

Burden and Regional Disparities in the Firearm Mortality Profiles in Brazil: A Systematic Analysis of Findings From the Global Burden of Disease 2019

Introduction: Due to legislative changes and regional disparities, knowledge of firearm death profile in Brazil is limited, creating a complex situation that requires data to improve the strategies to reduce the burden of this health problem. Objective: To describe the burden of firearm injuries and regional disparities in Brazil, including the characterization of mortality profiles specifically in the year 2019. MethodThe researchers extracted secondary data from the Institute of Health Metrics and Evaluation, from Global Burden of Disease (GBD) Study, including information on new cases and deaths caused by firearms. They also examined metrics such as incidence, mortality, years of life lost due to disability, years of life living with disability, and years of life lost due to premature death. Descriptive statistics (number of deaths and proportion) were performed. ResultsThe findings reveal that nearly 50,000 firearm-related deaths occurred in Brazil in 2019, corresponding to a rate of 21.6 deaths per 100,000 inhabitants. These deaths collectively contributed to around 3 million years of life lost when adjusted for disability. Notably, there are significant regional disparities, with the Northeast region of Brazil bearing a higher burden of firearm injuries. The study further differentiates mortality profiles based on the type of firearm-related death. Young individuals and young adults experience a higher mortality rate due to homicides. On the other hand, individuals aged 70 and above are more prone to firearm-related suicides. Conclusionfirearm injuries in Brazil have distinct mortality profiles. Acknowledging these different profiles is crucial when devising effective public policies to address this issue.

Trends in Legal Firearm Transactions: A Possible Protective Role of Gun Law Strength.

The United States (US) holds the highest personal firearm ownership among industrialized nations, with implications for firearm-related deaths tied to increased per capita gun ownership and varying gun laws. This study examines the influence of gun law strength on legal firearm transactions, positing a correlation between stronger laws and reduced transactions. The analysis, focused on the stress-laden COVID-19 pandemic, evaluates handgun, long gun, and multiple gun transactions in 2020 and 2021 compared to 2018-2019. The Giffords Gun Law scorecard categorized states into the top 25 "strong" and bottom 25 "weak" gun law groups. Multivariate linear regressions assessed the association between strong gun law states and monthly National Instant Criminal Background Check System (NICS) data from 2018 to 2021. The study queried NICS for handgun, long gun, and multiple gun transactions, comparing median monthly transactions in 2018 and 2019 to 2020 and 2018-2020 to 2021. When evaluating gun law strength through multivariate linear regression models, stronger gun law states had fewer monthly NICS transactions for handguns, long guns, and multiple guns in 2020 and 2021 versus all comparison years (all P < .05). However, from 2018-2019 to 2020 and 2018-2020 to 2021, median monthly NICS transactions per 100,000 people for all gun types increased (all P < .05). Stricter gun laws correlated with decreased firearm transactions in stronger law states, yet handgun, long gun, and multiple gun transactions increased during the pandemic years of 2020 and 2021. Therefore, strengthening firearm legislation may be protective against the proliferation of firearms, which warrants further research.

Strategies for recruiting adolescents in rural areas in firearm injury research

BackgroundParticipant recruitment is a central aspect of human sciences research. Barriers to participant recruitment can be categorised into participant, recruiter and institutional factors. Firearm injury research poses unique barriers to...