Firearm-related Deaths Research Articles

91. RESIDENTS EDUCATION ON FIREARMS SAFETY COUNSELING: CURRENT STATUS, PERCEIVED BARRIERS, AND SUGGESTED RESOURCES

Background Firearm (FA) related deaths & injuries are national public health crises. FA is the leading cause of death among black children & teens. FA safety counseling has positive impact on increasing gun safety at home. It is crucial for Residents in training (RES) to learn skills of counseling with regards to this topic. Methods Cross sectional survey at Brookdale Hospital, NY including RES from all specialties. Questionnaire based on literature review was sent using “SurveyMonkey”. Comparison of responses among subgroups of RES was done using Chi-squared or Fisher's exact test. Results Of 244 RES, 134 (55%) responded to survey [51% males, 34% from pediatrics (PED) (Table 1-A)]. Nearly all RES agree that gun violence is a problem in their community (96%). Unavailability of FA safety training in residency programs was reported in 66% (less in PED vs. non-PED, Table 2). Overall, only few RES felt confident to counsel about FA (14%). Majority of respondents (67%) were interested in receiving additional education (more in PED vs. non-PED). Methods of FA training in the RES’ programs as well as topics covered are shown in Table 1-B (PED reported more CME/grand rounds and less case-based scenarios / or standardize patient, table 2). RES were similarly interested in receiving education in FA safety counseling, independent of the PGY level (Table 3). There was no difference in perceived barriers, except that PGY1 were more likely to “worry about upsetting families if asked about FA” (Table 3). Also, PGY1 were less likely to choose “workshops” & “grand rounds” as resources to increase FA education. US graduates (USG) & non-USG had same perception on barriers to FA safety counseling and resources to increase FA safety education. Similarly, there was no difference on responses to these questions between RES raised in North America vs. those that did not. In contrast, RES who are non USG, or those raised without FA at home were more likely to agree with gun violence being a problem in the community & interested in receiving FA safety education (Table 4-A,B). Conclusion Regardless of subspecialty, majority of RES reported no FA safety education received during their training. PED RES were more likely to indicate interest in training, which they thought it is their program's responsibility. Only few RES felt comfortable & confident counseling on FA safety.

Annals for Educators - 1 September 2020.

Annals for Educators - 1 September 2020.

Purchaser Licensing, Point-of-Sale Background Check Laws, and Firearm Homicide and Suicide in 4 US States, 1985-2017.

Objectives. To estimate and compare the effects of state background check policies on firearm-related mortality in 4 US states.Methods. Annual data from 1985 to 2017 were used to examine Maryland and Pennsylvania, which implemented point-of-sale comprehensive background check (CBC) laws for handgun purchasers; Connecticut, which adopted a handgun purchaser licensing law; and Missouri, which repealed a similar law. Using synthetic control methods, we estimated the effects of these laws on homicide and suicide rates stratified by firearm involvement.Results. There was no consistent relationship between CBC laws and mortality rates. There were estimated decreases in firearm homicide (27.8%) and firearm suicide (23.2%-40.5%) rates associated with Connecticut's law. There were estimated increases in firearm homicide (47.3%), nonfirearm homicide (18.1%), and firearm suicide (23.5%) rates associated with Missouri's repeal.Conclusions. Purchaser licensing laws coupled with CBC requirements were consistently associated with lower firearm homicide and suicide rates, but CBC laws alone were not.Public Health Implications. Our results contribute to a body of research showing that CBC laws are not associated with reductions in firearm-related deaths unless they are coupled with handgun purchaser licensing laws.

The Disturbing Findings of Pediatric Firearm Injuries From the National Trauma Data Bank: 2010-2016

BackgroundTrauma is the leading cause of pediatric and adolescent morbidity and mortality. Firearm-related injuries and deaths contribute substantially to the overall disease burden. This study described the intent, location, demographics, and outcomes of a nationally representative pediatric population with firearm injuries. We hypothesized that younger patients would have a higher percentage of unintentional and self-inflicted injuries with associated higher mortality rates. Materials and methodsThe National Trauma Data Bank, maintained by the American College of Surgeons, from 2010 to 2016 was utilized. All pediatric patients (0-19 y) with firearm injuries who had complete data were analyzed for mechanism, location, demographics, and outcomes. Basic descriptive statistics were used to compare subgroups. Multivariable logistic regression analysis was applied to investigate risk factors for firearm injury–caused mortality. ResultsIn the study period, 46,039 pediatric patients sustained firearm injuries (median age = 17 y). Males, Blacks, ages 15-19, and the Southern region were the most common injured demographics. However, subgroup analysis showed the demographics differ for self-inflicted and unintentional firearm injuries, which had significantly higher White patients (66.6% and 47.9%, respectively; P < 0.001). Nearly 76% of injuries were related to assaults, 14% were unintentional, 5% were self-inflicted, and 5% were undetermined. The overall mortality was nearly 12%. The youngest population had higher proportion of unintentional injuries and highest mortality rate when compared with other classifications of intent (P < 0.001). ConclusionsPediatric firearm injuries have high mortality, especially in the youngest populations. Age-tailored prevention strategies, such as strict child access prevention laws and enforced gun storage violations, may help in reducing firearm injuries and improving health outcomes.

Changes in firearm mortality following the implementation of state laws regulating firearm access and use

Although 39,000 individuals die annually from gunshots in the US, research examining the effects of laws designed to reduce these deaths has sometimes produced inconclusive or contradictory findings. We evaluated the effects on total firearm-related deaths of three classes of gun laws: child access prevention (CAP), right-to-carry (RTC), and stand your ground (SYG) laws. The analyses exploit changes in these state-level policies from 1970 to 2016, using Bayesian methods and a modeling approach that addresses several methodological limitations of prior gun policy evaluations. CAP laws showed the strongest evidence of an association with firearm-related death rate, with a probability of 0.97 that the death rate declined at 6 y after implementation. In contrast, the probability of being associated with an increase in firearm-related deaths was 0.87 for RTC laws and 0.77 for SYG laws. The joint effects of these laws indicate that the restrictive gun policy regime (having a CAP law without an RTC or SYG law) has a 0.98 probability of being associated with a reduction in firearm-related deaths relative to the permissive policy regime. This estimated effect corresponds to an 11% reduction in firearm-related deaths relative to the permissive legal regime. Our findings suggest that a small but meaningful decrease in firearm-related deaths may be associated with the implementation of more restrictive gun policies.

Partnering With Patients to Reduce Firearm-Related Death and Injury.

In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathic physicians have a unique opportunity to affect this public health concern through patient education. Several evidenced-based recommendations can be incorporated at the bedside to reduce firearm injuries and deaths, including gun education, safe storage, and proper disposal.

A National Research Strategy to Reduce Firearm-Related Injury and Death: Recommendations from the Health Policy Research Subcommittee of the Society of General Internal Medicine (SGIM).

Injury due to firearms is a serious health issue in the USA, leading to nearly 40,000 deaths annually and many more non-fatal injuries. Despite the significant impact on morbidity and mortality, relatively little research funding is dedicated to understanding the impact of firearm-related injury and to developing strategies to mitigate harm. In part, research has been stymied by decades-old language in federal legislation that was interpreted as prohibiting federal funding for firearm injury-related research. This paper, prepared by members of the Society of General Internal Medicine (SGIM), calls for support for research that seeks to understand the nature of firearm-related injury and resources to develop effective approaches to prevent it. We outline recommendations to develop evidence to inform policymakers and the medical and public health communities. These recommendations include (1) development of a shared national research agenda to address firearm-related injury and death; (2) allocation of federal funds specifically for research related to firearm injury; (3) support for the career development of researchers studying firearm-related injury; and (4) facilitating access to comprehensive data sources needed for developing evidence.

Physician Involvement in Promoting Gun Safety.

Firearm-related deaths are on the rise in the United States, especially among our youth. Tragically, proper firearm storage and safety could have prevented a great number of these deaths. Professional and public health organizations have thus encouraged physicians to provide direct patient counseling on firearm safety. Yet, even with these recommendations, the majority of physicians are still not talking to their patients about this issue. There may be many reasons for this, including concerns about liability, feeling unprepared, patient discomfort, and lack of time during office visits. Despite these concerns, we argue that physicians have an ethical obligation to discuss firearm safety with their patients. Making these discussions a part of routine clinical care would go a long way in the bipartisan effort to protect public safety and improve public health.

States tap pharmacists to combat human trafficking.

Florida’s 2019 legislative session closed with an unexpected but welcome mandate for pharmacists to receive training on how to identify and help patients who are victims of human trafficking. Kathy Baldwin, legal and regulatory affairs council chair for the Florida Society of Health-System Pharmacists (FSHP), said the organization was taken by surprise to learn of a new law requiring licensed health professionals to complete an hour of continuing education (CE) on human trafficking by January 2021. “Our lobbyists weren’t following it,” she said. “I didn’t even know that [trafficking] was a public health issue until recently.” Trafficking was one of the topics that members of ASHP’s councils discussed in September at a special Policy Week 2019 session on preventing workplace violence and firearm-related injury and death. Some council members said their workplace requires certain health professionals to undergo training to identify victims of human trafficking. Baldwin said that after the Florida pharmacy board notified FSHP about the new CE requirement, her team analyzed the legislation and concluded it was a positive development for the profession.

Beyond Band-Aids for Bullet Holes: Firearm Violence As a Public Health Priority.

To review the public health approach to preventing and treating firearm violence. Peer-reviewed, published scholarship and federal data systems. English-language, indexed research articles on the epidemiology, risk, prevention, and consequences of firearm violence. This narrative review includes findings related to the epidemiology and impact of firearm violence, focusing on short- and long-term outcomes. Evidence supporting interventions at the individual, agent, and environmental level to reduce firearm-related harm was examined. Firearm violence is a major public health challenge in the Unites States. The consequences of firearm violence reach beyond the nearly 40,000 firearm-related deaths and 90,000 firearm-related injuries each year. Firearm violence, including self-harm, assault, and unintentional injury, affects the health of individuals, families, communities, and health systems. Data sources remain inadequate, however, to fully capture these impacts. Treating firearm violence as a disease and taking a public health approach to prevention and treatment is key to reducing the harms of firearm violence. Using a public health framework not only recognizes the physical and mental consequences of firearm violence but also focuses our attention on underlying causes and on innovative, multi-level interventions to reduce the harms of firearm violence. The public health approach positions clinicians to change the conversation from political diatribe of pro-gun and anti-gun to systematically reducing injury and death. To achieve comparable success, we must design, test, and implement effective interventions at the environmental, policy, technological, and individual levels to prevent firearm violence. We must collect robust data on firearm violence and its consequences. And we must reckon with the conditions of inequality and disadvantage that feed violence through all means.

Firearm Storage Maps: A Pragmatic Approach to Reduce Firearm Suicide During Times of Risk.

Preventing firearm-related injury and death requires pragmatic, community-based solutions. The authors describe their initial experiences developing a statewide map of locations where firearms may ...

Building Consensus to Decrease Firearm Injuries and Death in the USA: Engaging Medical and Public Health Organizations to Find Common Ground

Firearm injury deaths are rising and as of 2017 exceed motor vehicle crash deaths in the USA. We as healthcare professionals treat many of the injured, including those cared for in the network of over 560 ACS-verified trauma centers. In order to address this public health crisis that affects us all, we need to develop a multifaceted public health strategy to decrease and prevent firearm injuries and deaths. While personal opinions about firearm ownership vary significantly across the USA, an inclusive, consensus-based, public health approach to reducing firearm deaths is possible. This article reviews recent literature on this approach, first building consensus among surgeons and then extending across the entire healthcare professional community. There is broad support for a public health approach which focuses on the understanding and addressing the underlying causes of violence while also making firearm ownership as safe as possible. This approach requires the expertise and committed support of healthcare and public health providers, along with their professional organizations, healthcare systems, and public health networks which they lead. To achieve the goals of eliminating preventable firearm-related death and disability also requires engaging firearm owners and members from vulnerable communities as key stakeholders in the public health solution. In order to achieve the goals of the public health approach, increased federal and philanthropic research funding is required to identify and evaluate the most effective injury prevention initiatives.

ASHP councils discuss firearms, workplace violence.

ASHP members met September 12, 2019, to offer guidance on policy development, with a special focus on the pharmacy profession’s role in preventing workplace violence and firearm-related injury and death. “It’s a hard topic, and we realize that,” ASHP Chief Operating Officer Kasey K. Thompson told the members of ASHP’s 5 policy-recommending councils and the Council of Affiliate Relations during Policy Week 2019. He emphasized that ASHP has no specific policy outcome in mind and looks to the council members for their expertise and advice. “Our goal today is to listen to you,” he said. ASHP President Kathleen S. Pawlicki said federal data indicate that 18,000 healthcare and social service workers are assaulted in the workplace annually, and these incidents account for 70–74% of all workplace assaults. “Unfortunately, violence against healthcare workers is not unusual,” Pawlicki told the council members. Several attendees shared stories of violent events at their workplace, including some that involved pharmacy staff.

Firearms Screening in the Pediatric Inpatient Setting.

Firearm-related deaths remain a top cause of mortality in American children and adolescents. In a 2012 policy statement, the American Academy of Pediatrics urged pediatricians to incorporate questions about the availability of firearms into their patient history taking. We aim to evaluate the frequency of screening for home firearms in an academic tertiary-care hospital inpatient setting. This retrospective chart review examined patients with the following pediatric diagnoses admitted to a tertiary-care pediatric hospital from 2006 to 2015: asthma, bronchiolitis, cellulitis, jaundice, single liveborn infant, bacterial and viral pneumonia, and all mood disorders. Data analysts then searched the patient charts that met these inclusion criteria for documentation of firearm screening as indicated by use of the terms "firearm," "pistol," "gun," "handgun," "bullet," "ammunition," or "rifle" in the admissions history and physical. Evidence of screening for firearms in the home was found in 1196 of the 40 658 charts included in the study (2.94%). The most frequently screened diagnosis and admitting service were mood disorders and child psychiatry, respectively (1159 of 3107; 37.3%). Only 19.8% of identified gun-owning families received specific anticipatory guidance. Firearm screening and gun safety education occurred infrequently in the inpatient setting. Inpatient encounters may provide an opportunity for increased screening and education because the hospital environment also includes additional resources, exposure to a greater number of providers, and the presence of more family members or caregivers. Further studies are warranted to explore barriers to inpatient screening and possible mechanisms for improvement.

International comparison of civilian violent deaths: a public health approach to reduce gun-related deaths in US youth

ObjectivesThe political controversy surrounding firearm fatalities in US youths (aged 15–24 years) continues. This study examines whether a public health approach could reduce gun-related deaths in the US. MethodsBased on the latest World Health Organization (WHO) data, current (2015) numbers and rates per million of US civilian violent deaths (CVDs) (including transport deaths, suicides and homicides) for both the general population and youths (aged 15–24 years) are examined. US CVD results are considered in a wider context by comparing the results with those of seven other major Western countries (MWCs). To demonstrate the effectiveness of a public health policy, transport deaths between 1979 and 2015 are analysed, which corresponds to a time period when government interventions based on technical improvements and behaviour change were implemented to improve road safety. The statistical significance of the comparison between road fatalities and suicide rates between 1979 and 2015 is determined by the chi-squared test. ResultsIn 2015, the total number of US CVDs was 101,456, consisting of 44,193 suicides and 17,588 homicides (of which 30,891 were likely to be gun-related deaths). Youth deaths totalled 17,432; 5491 suicides and 4732 homicides, including approximately 5112 gun-related deaths. US CVDs are substantially higher than the other MWCs for both the general population and youths. In 1979, US transport deaths were 57,577, which decreased to 39,675 in 2015. Every country's public health approach to reduce road deaths, when compared with suicides, was highly statistically significant. ConclusionsGovernment interventions have reduced transport deaths; thus, new policies may also reduce gun-related violence. The evidence points towards a public health approach, such as that used to reduce road deaths, which could help reduce US firearm-related deaths to levels comparable with other MWCs.

Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study.

BackgroundGun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author’s knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings.Methods and findingsThis study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health—social mobility, social capital, income inequality, racial and economic segregation, and social spending—with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1–standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73–0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73–0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66–0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67–0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%–27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity.ConclusionsThis study finds that the rich–poor gap, level of citizens’ trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.

Firearm-Related Deaths in Multnomah County, Oregon, 2010-2016: Linking Medical Examiner Data to State Vital Records Data.

Violence due to firearms is a substantial public health problem. Death data from medical examiner and vital records were linked to evaluate the use of medical examiner data to augment routine surveillance and determine any differences in sex, age, manner of death, or race and ethnicity between the 2 data systems. Medical examiner data were searched for keywords of interest, and vital records data were obtained and linked for deaths occurring in Multnomah County, Oregon, from January 1, 2010, through December 31, 2016. Both data sets were compared for the number and proportion of firearm-related deaths by sex, age, manner of death, and race/ethnicity. Sensitivity and positive predictive values were calculated for variables that had discordant results. A total of 568 firearm-related deaths were identified in the medical examiner data. After matching with manual review, the 2 data systems had 100% case agreement. A reverse match showed that most cases not found in medical examiner data were due to transfer of case jurisdiction. The 2 systems matched nearly perfectly in sex, age, and manner of death but differed in characterization of race and ethnicity. Sensitivity was 62% for Hispanic ethnicity but 93% for white and black race. Using medical examiner data was a useful way to augment routine surveillance of firearm-related deaths in our jurisdiction in close to real time. However, caution is needed when analyzing data by subgroups because of discordant classifications of race between the data systems.

#ThisIsOurLane: Incorporating Gun Violence Prevention into Clinical Care

This article reviews the medical community’s evolving perspective on its role in gun violence prevention efforts, particularly evaluating the evidence for and potential impact of patient education and firearm safety counseling. Growing numbers of physicians and professional medical societies recognize gun violence as a public health crisis and are increasingly supporting a more active role for the profession to address it. In spite of this urging, relatively few physicians routinely address firearm safety with their patients, in part driven by a lack of standardized education about how to incorporate gun violence prevention into clinical care. Clinicians have a unique opportunity to prevent firearm-related injuries and death by performing firearm safety screening and violence prevention counseling at the bedside. With growing evidence for the effectiveness of such counseling and increasing number of widely available resources, clinicians across medical disciplines are well positioned to address this unmet need.

When Is It Appropriate for Health Professionals to Discuss Firearms with Their Patients

Although the rise in firearms-related deaths is a clear public health epidemic, many health professionals feel uncomfortable discussing firearms with

Fear of Crime, Racial Bias, and Gun Ownership.

Firearm-related violence is a significant threat to public health and safety in America. However, research highlights a critical disparity in firearm-related deaths by race. Researchers often cite racial bias as a contributing factor for the racial disparity in firearm-related deaths. To provide a foundation for potential social work interventions, the present article discusses the results of an assessment of whether explicit racial biases toward four racial and ethnic groups (white, black, Asian, Hispanic/Latino), fear of crime, and the quantity and quality of interactions with neighbors of a different race are predictors of gun ownership. Findings suggest that explicit racial bias toward black, Asian, and Hispanic/Latino individuals is a significant predictor of gun ownership. Fear of crime and more frequent interactions with neighbors of a different race are also significant predictors of gun ownership. Taken as a whole, findings suggest that gun owners are more likely to be more vigilant toward people of color because of stereotypical assumptions that racial and ethnic minorities are more likely to be involved with crime. Social work practice and policy implications include developing interventions aimed at reducing implicit bias and identifying policies that are associated with lower levels of implicit bias among gun owners.