BACKGROUND:Youth aged 15-24 experience high rates of firearm homicide and suicide, yet there is limited research on the impact of promising preventative policies, such as firearm purchaser licensing (FPL) laws, among this age group. The purpose of this study was to evaluate the effect of adopting or repealing an FPL law on homicide and suicide among those aged 15-24, by age subgroup (ie, 15-17, 18-20, 21-24). METHODS:Mortality data from 1990 to 2019 were obtained from the National Center for Health Statistics. We used augmented synthetic controls to estimate the effect of FPL law adoption in Connecticut and Maryland and repeal in Missouri and Michigan on youth homicide and suicide rates. Analyses were stratified by age subgroup and firearm involvement. RESULTS:FPL adoption was associated with decreases in firearm homicide and suicide among those aged 15-24 overall and among most age subgroups in Connecticut. FPL repeal was consistently associated with increases in firearm suicide among each age subgroup, with less consistent results for firearm homicide. DISCUSSION AND CONCLUSIONS:FPL law changes had meaningful impacts on firearm homicide and suicide among youth aged 15-24, with consistent protective effects observed following adoption in Connecticut and consistent harmful effects following repeal in Missouri. Mixed results in Maryland and Michigan highlight the importance of policy features and sociopolitical context in shaping the effectiveness of these laws. These findings reinforce the effectiveness of FPL laws as a strategy to reduce firearm-related mortality among youth.

OBJECTIVE:To understand how the implementation and enforcement of universal background check (UBC) laws may influence the use of background checks during private party firearm transfers in the USA. METHODS:This is a mixed-method, descriptive study. Data included the content of relevant state statutes and sentencing information from the 19 states with UBC laws in 2019, prosecutions and convictions for private party firearm transfer violations from 5 states and New York City, firearm transfer education and promotion efforts, and key informant interviews. RESULTS:Information on conducting safe and legal private-party firearm transfers was widely available, but persuasive language encouraging background checks was rare. The median maximum prison time for violating UBC laws was 12 months and the median of the maximum fines was US$5000. However, the chances of being prosecuted in our sample states were extremely low. Finally, public support for UBC policies is high, but among some firearm owners, the perceived utility of such laws is very low. CONCLUSIONS:Available data suggest that enforcement of UBC requirements for private party transfers is rare. Additionally, advocacy efforts to encourage private gun sellers to make sales contingent on buyers passing background checks are few. People may choose to avoid the additional burden of undergoing a background check when they feel neither social nor legal pressure to comply. The results of this research can be used to identify potential avenues for enhancing enforcement of and compliance with private party firearm background check laws.

Endemic levels of community firearm violence in United States cities disproportionately burden certain sociodemographic groups. Nonfatal injuries are an understudied aspect of firearm violence. Police data in a large and heterogenous place like New York City (NYC) provide the unique opportunity to use a single data source to measure fatal and nonfatal community firearm violence. The study analyzed epidemiologic trends in fatal and nonfatal community firearm violence using the publicly available New York Police Department (NYPD) Shooting Incident Dataset from 2019 to 2023. The analyses tabulated shooting victims by sociodemographic variables (age group, race and ethnicity, and sex) and case fatality rates, mapped shootings by census tract, and described social determinants of health (SDOH)—poverty, educational attainment, unemployment—in the census tracts where shootings occurred. From 2019 to 2023, the annual average number of shooting victims in NYC was 1,578. Shootings doubled from 2019 to 2020 though trended downward from 2021 to 2022 to 2023. Four out of five shootings were nonfatal. Males, people ages 18-24, and non-Hispanic Black people in NYC experienced the greatest proportion of shootings. Shootings coincided with census tracts also experiencing above median percentages of adverse SDOH (i.e., highest levels of unemployment, poverty, and low educational attainment). Nonfatal injuries are an important component of community firearm violence to monitor. The findings identify inequities in community firearm violence by sex, age group, and race and ethnicity in NYC. One contributor to racial inequities in violence is the impact of place-based SDOH in certain NYC neighborhoods. This study leverages NYPD data to estimate the full magnitude of violence by tracking nonfatal in addition to fatal injuries. The study emphasizes the need for researchers to go beyond individual demography and better understand the place-based social determinants of firearm violence.

Research SummaryWe utilized the synthetic difference-in-difference method to estimate the impact of adopting a permitless Concealed Carry Weapons (CCW) law on rates of assaults, robberies, and homicides committed with a firearm and by other means, as well as weapons arrests, from 1981 to 2019. We stratified permitless CCW laws by whether they previously prohibited violent misdemeanants from obtaining a CCW permit or previously required live firearm training to obtain a permit prior to law adoption. Findings robust to sensitivity analyses suggest that states that lost a training requirement to obtain a CCW permit had 21 additional gun assaults per 100,000 population (SE = 5.2) (32% increase).Policy ImplicationsIn the wake of the Supreme Court's decision in New York State Rifle & Pistol Association, Inc. v. Bruen, states should implement CCW permitting law provisions that may reduce the risk of firearm violence. Requiring live firearm training prior to carry a concealed weapon may attenuate negative health impacts of deregulation associated with permitless CCW laws.

Objectives. To describe all-outcome injurious shootings by police and compare characteristics of fatal versus nonfatal injurious shootings nationally. Methods. From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by US police, identified from Gun Violence Archive. We estimated injury frequency, case fatality rates, and relative odds of death by incident and victim characteristics. Results. A total of 1769 people were injured annually in shootings by police, 55% fatally. When a shooting injury occurred, odds of fatality were 46% higher following dispatched responses than police-initiated responses. Injuries associated with physically threatening or threat-making behaviors, behavioral health needs, and well-being checks were most frequently fatal. Relative to White victims, Black victims were overrepresented but had 35% lower odds of fatal injury when shot. Conclusions. This first multiyear, nationwide analysis of injurious shootings by US police suggests that injury disparities are underestimated by fatal shootings alone. Nonpolicing responses to social needs may prevent future injuries. Public Health Implications. We call for enhanced reporting systems, comprehensive evaluation of emerging reforms, and targeted investment in social services for equitable injury prevention. (Am J Public Health. 2024;114(4):387-397. https://doi.org/10.2105/AJPH.2023.307560).

From 2015 to 2020, shootings by police injured or killed 1769 people annually in the United States, disproportionately harming members of minoritized groups. Prior studies of the structural determinants of these inequities have largely examined state-level aggregations and fatal outcomes. This study aimed to: 1) describe state and county variation in fatal and nonfatal injurious shootings by police, and 2) analyze the relationship between state and county context and differences in county rates of injurious shootings by police. Injury data were developed from manual review of incidents listed in the Gun Violence Archive, then aggregated by county-year. Covariate selection was informed by theories of police use of force and the Social Basis of Disparities in Health conceptual framework. Fixed effects negative binomial regression models were estimated, nesting years within counties and states. Analyses controlled for county population, local reporting presence, and multiple measures of social conflict and community violence. From 2015 to 2020, 56% of counties experienced injurious shootings by police. Higher county rates of victimization were associated with greater state spending on police relative to health, county income inequality, prevalence of unmet substance use disorder needs, higher county firearm availability, and permitless concealed carry statutes. Firearm purchaser licensing polices were associated with lower incidence of injurious shootings by police. To prevent patterns of injurious shootings by police, policymakers should consider addressing undermanaged substance use disorder through crisis fund allocation and use, adopting stronger firearm licensing systems, and evaluating local strategies to combat inequities and strengthen non-policing responses to social needs.

Motivated by disparities in gun violence, sharp increases in gun ownership, and a changing gun policy landscape, we conducted a nationally representative survey of U.S. adults (n=2,778) in 2021 to compare safety-related views of white, Black, and Hispanic gun owners and non-owners. Black gun owners were most aware of homicide disparities and least expecting of personal safety improvements from gun ownership or more permissive gun carrying. Non-owner views differed. Health equity and policy opportunities are discussed.

Inequitable experiences of community gun violence and victimization by police use of force led to nationwide calls to "reimagine public safety" in 2020. In January 2021, we examined public support among U.S. adults for 7 policy approaches to reforming policing and investing in community gun violence prevention. Using a nationally representative sample (N = 2778), with oversampling for Black Americans, Hispanic Americans, and gun owners, we assessed support overall and by racial, ethnic, and gun owner subgroups. Overall, we found majority support for funding and implementing police and mental health co-responder models (66% and 76%, respectively), diversion from incarceration for people with symptoms of mental illness (72%), stronger laws to assure police accountability (72%), and funding for community-based and hospital-based gun violence prevention programs (69% and 60%, respectively). Support for redirecting funding from the police to social services was more variable (44% overall; White: 35%, Black: 60%, Hispanic: 43%). For all survey items, support was strongest among Black Americans. Gun owners overall reported lower support for public safety reforms and investments than re-spondents who did not own guns, but this distinction was found to be driven by White gun owners. The views of Black gun owners were indistinguishable from Black non-owners and were similar to White non-owners on most issues. These findings suggest that broad public support exists for innovative violence reduction strategies and public safety reforms.

Gun-related deaths and gun purchases were at record highs in 2020. In light of the COVID-19 pandemic, public protests against police violence, and a tense political environment, which may influence policy preferences, we aimed to understand the current state of support for gun policies in the U.S. We fielded a national public opinion survey in January 2019 and January 2021 using an online panel to measure support for 34 gun policies among U.S. adults. We compared support over time, by gun ownership status, and by political party affiliation. Most respondents supported 33 of the 34 gun regulations studied. Support for seven restrictive policies declined from 2019 to 2021, driven by reduced support among non-gun owners. Support declined for three permissive policies: allowing legal gun carriers to bring guns onto college campuses or K-12 schools and stand your ground laws. Public support for gun-related policies decreased from 2019 to 2021, driven by decreased support among Republicans and non-gun owners.

Gun-related deaths and gun purchases were at record highs in 2020. In light of the COVID-19 pandemic, public protests against police violence, and a tense political environment, which may influence policy preferences, we aimed to understand the current state of support for gun policies in the U.S. We fielded a national public opinion survey in January 2019 and January 2021 using an online panel to measure support for 34 gun policies among U.S. adults. We compared support over time, by gun ownership status, and by political party affiliation. Most respondents supported 33 of the 34 gun regulations studied. Support for seven restrictive policies declined from 2019 to 2021, driven by reduced support among non-gun owners. Support declined for three permissive policies: allowing legal gun carriers to bring guns onto college campuses or K-12 schools and stand your ground laws. Public support for gun-related policies decreased from 2019 to 2021, driven by decreased support among Republicans and non-gun owners.

This study sought to examine public support for gun carrying-related policies from 2019 to 2021, a period encompassing the COVID-19 pandemic and increasing calls for racial and social justice. We conducted the National Survey of Gun Policy in January 2019 and 2021. The surveys were fielded using the NORC AmeriSpeak panel. Respondents indicated support for six policies regulating civilian gun carrying. Analyses, conducted in 2021, incorporated survey weights for nationally representative estimates. There were significant declines in support from 2019 to 2021 for two policies that would expand where civilians can lawfully carry guns: allowing concealed carry when on K-12 school grounds (23% in 2021 vs 31% in 2019) and college/university campuses (27% vs 36%). Support was also significantly lower for requiring concealed carry applicants to pass a test demonstrating safe and lawful use (74% in 2021 vs 81% in 2019). For the two new policies in the 2021 survey, more than half of respondents overall supported prohibiting open carry at demonstrations/rallies (54%) and prohibiting the carry of guns into government buildings (69%). There was lower support among gun owners (39% and 57%, respectively). Since 2019, there has been a decline in support for expanding locations for civilian gun carrying. Support remains high among U.S. adults, including the two-thirds of gun owners, for requiring concealed carry applicants to demonstrate competence in safe and lawful gun use. Our findings in support of a more regulated approach to concealed carry are in direct contrast to state-level shifts eliminating concealed gun carrying regulations.

We conducted a review of studies on the effects of hospital-based violence intervention programs (HVIPs) on subsequent involvement in violence as a victim or perpetrator that included a nontreated control group. We identified seven randomized controlled trials (RCTs) and six observational studies. Most HVIPs evaluated relied principally on credible messengers to engage potential participants and intensive case management to provide social services. Evidence of linkage of HVIPs to community violence intervention programs was lacking. RCTs of the most robust HVIPs showed some evidence of protective effects, but overall evidence of reduced risks for violence was mixed. RCTs were underpowered, and all but one were vulnerable to selection bias. Stronger interventions and research methods are needed to advance our understanding of the potential for HVIPs to reduce risks for future violence.

We sought to examine support for gun polices by race and ethnicity, and among gun owning subgroups. We combined two waves of the National Survey of Gun Policy (January 2017 and 2019 [N = 3804]). We used chisquare tests to assess whether support for gun policies differed by race or ethnicity overall and among subgroups of gun owners. Most U.S. adults supported 17 of 21 gun-related policies. Among gun owners, Blacks supported six policies at higher levels than whites, including minimum age requirements for gun ownership and assault weapon and ammunition-related restrictions. Hispanic gun owners supported safe storage requirements at higher levels than white gun owners. While support differed by race and ethnicity for some policies, majorities of U.S. adults supported nearly all gun policies examine regardless of race. One notable exception, carrying a concealed gun on K-12 school grounds did not reach majority support among any subgroup. While tailored messaging may be appropriate in certain circumstances, it is important to highlight the similarities in support for evidence-based gun polices across racial and ethnic groups.

Federal law places no regulations on unlicensed, private firearm sellers. However, a majority of the firearms used in crime come from these unregulated markets. This study aims to characterize the demographics of gun owners who engage in private sales, determine how often these individuals engage in selling behaviors, and ascertain whether sellers' attitudes are associated with their reported behaviors in the private market. A nationally representative web-based survey of 1444 gun owners, fielded in Spring 2016, were asked about their participation in the private market. The 238 respondents who participated in the private market were asked about their behavior on their last sale and the extent to which they felt it was the responsibility of sellers to ensure purchasers were legally able to own a firearm. Less than half of private gun sellers agreed that it is the seller's responsibility to ensure purchasers are eligible to buy guns (46%). Among private sellers, only 44% checked purchasers for eligibility and 32% denied a sale due to concerns about whether the firearm would be used safely. Sellers who agreed it was their responsibility to ensure purchasers were eligible to buy a gun had 4.52 (95% CI:1.78 to 11.5) times greater odds of reporting checking for a permit or conduct a background check on their last sale. it. These findings suggest a need for strategies to increase gun sellers' perceptions of responsibility for ensuring only eligible purchasers purchase guns, potentially including communication campaigns or educational programs.

We sought to characterize gun and ammunition purchasing during the initial phase of the COVID-19 pandemic using a nationally representative sample of U.S. adults. We fielded a survey using NORC's Amerispeak Panel between 7 and 22 July 2020 (survey completion rate = 91.1%, N = 1337). We used survey-weighted data to calculate the proportion of adults who purchased a gun during this time period and types of guns and amount of ammunition purchased. Between March and mid-July 2020, 6% of adults purchased a gun and 9% bought ammunition. Of those purchasing a gun, 34% were first-time purchasers. Among those purchasing ammunition, 19% reported purchasing more than usual in response to the COVID-19 pandemic while 27% purchased less than usual. An estimated 6,451,163 adults bought guns for the first time between March and mid-July 2020. Increases in gun purchasing, particularly among first-time gun owners, could pose significant short- and long-term implications for public health.

Chapter 3 offers narratives about gun violence; these narratives draw from public health tenets and practice. Contributors sketch a road map to how people with differing philosophies can act together to prevent gun deaths: Michael B. Siegel describes public health principles that can shape thinking about gun policy. Drawing from his experiences in Baltimore, Daniel W. Webster illustrates how gun violence has influenced urban life, examining the implications of aggressive law enforcement. His work with police and community members and his involvement with a gun violence reduction consortium yield strategies for reducing harm. Zeroing in on the community environments in which gun violence occurs, Bernadette Callahan Hohl illustrates how a public health approach can improve safety. Using examples from community-driven projects, she offers evidence that strengthening neighborhoods pays off. The chapter concludes an action agenda.

Successful public health efforts are data-driven, focused on unhealthy or unsafe environments as well as risky behaviors, and often intentional about reforming systems that are unjust and harm public safety. While laws and their enforcement can be important to advance public health and safety, including reducing gun violence, minimizing harms of exposure to the criminal justice system is also important. Research demonstrates that appropriately targeted efforts that invest in and support individuals and neighborhoods at greatest risk for involvement in gun violence can be successful in saving lives and reaping impressive return on investment.

Firearms increase the risk of lethality in violent intimate relationships. Policies that restrict access to firearms by respondents to civil domestic violence protective orders (DVROs) are associated with reductions in intimate partner homicide, yet there is scant literature about how such prohibitions are implemented. We document how four localities are implementing gun possession prohibitions that result from civil and criminal restraining orders and domestic violence misdemeanor convictions; and assess the findings in the context of Kingdon’s agenda setting framework. We identified four jurisdictions where gun dispossession of prohibited domestic violence offenders was underway and collected data through in-depth interviews, site visits, and documents. We coded the data, identified explanatory themes, and compared the findings to Kingdon’s framework. The four jurisdictions have policies ranging from no state laws restricting domestic violence offenders’ access to guns to comprehensive state laws. We describe implementation initiatives to dispossess prohibited people of their guns in the four jurisdictions, two distinct implementation models through which gun dispossession occurs, and an expanded application of Kingdon’s model. In each jurisdiction, we identified one or more individuals who championed implementation. Policies that prohibit domestic violence offenders from possessing guns are promising, and possible in diverse settings and jurisdictions. Here we provide insight into implementation efforts in four jurisdictions, emphasize the role of individuals in prioritizing implementation, and highlight the potential to realize these restrictions across states with different laws. Focusing on implementation is a much-needed paradigm shift that complements the traditional focus on passing domestic violence prevention laws.