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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(CBC) laws for handgun purchasers; Connecticut, which adopted a handgun purchaser licensing law; and Missouri, which repealed a similar law.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.

To date, there have been no peer-reviewed studies in the United States estimating the impact of gun-free zone policies in alcohol-serving establishments on rates of firearm violence in and around such establishments. In this study, we utilized a cross-sectional design to estimate the impact of Texas’s 51% alcohol law, which prohibits the carrying of firearms in establishments that generate over half of their revenue from alcohol sales. The analysis focused on the difference in shooting incidents in and around establishments with and without firearm carrying prohibitions in 2021 and 2022. After adjusting for establishment type (bar/restaurant), alcohol sales volume, census tract level demographic factors, and the number of nearby restaurants and bars, results indicated that gun-prohibiting bars experienced significantly fewer shootings compared to those that allowed guns. Specifically, establishments that were gun-prohibited had 37% fewer shootings within 50 m than those that were gun-allowing, with a 95% confidence interval ranging from 60% fewer to 0.2% fewer. This association was more prominent in bars than in restaurants. The protective association with gun-prohibited status diminished with increased distance from the establishments; results were not significant at 100 m. Our study findings align with research suggesting that gun-free zones can reduce firearm violence. However, future studies using quasi-experimental designs that can better support causal inference are needed to support such a conclusion, as are studies exploring the efficacy of such policies in various settings and over longer periods.

Intimate partner violence is a major public health problem in the US. Both firearms and alcohol have been documented to contribute to the risk and severity of this violence. Yet there has been little research examining the nexus of the two risk factors. This study sought to determine whether alcohol-related problems, as indicated by a history of conviction for offenses such as driving under the influence (DUI), were associated with risk for future intimate partner violence among authorized purchasers of handguns in California. Using a longitudinal cohort design, we found that purchasers with prior DUI convictions (and no other criminal history) had close to three times the risk of subsequent arrest for an intimate partner violence offense than did those with no criminal history at the time of the index firearm purchase. The regulation of firearm ownership among people with alcohol use problems may represent an important opportunity to reduce intimate partner violence and the escalation of firearm-related harm.

Firearm violence remains a persistent public health threat. Comparing the impact of targeted high-risk versus population-based approaches to prevention may point to efficient and efficacious interventions. We used agent-based modeling to conduct a hypothetical experiment contrasting the impact of high-risk (disqualification) and population-based (price increase) approaches on firearm homicide in New York City (NYC). We simulated 800,000 agents reflecting a 15% sample of the adult population of NYC. Three groups were considered and disqualified from all firearm ownership for five years, grouped based on prevalence: low prevalence (psychiatric hospitalization, alcohol-related misdemeanor and felony convictions, 0.23%); moderate prevalence (drug misdemeanor convictions, domestic violence restraining orders, 1.03%); and high prevalence (all other felony/misdemeanor convictions, 2.30%). Population-level firearm ownership was impacted by increasing the price of firearms, assuming 1% price elasticity. In this hypothetical scenario, to reduce firearm homicide by 5% in NYC, 25% of the moderate prevalence group, or 12% of the high prevalence group needed to be effectively disqualified; even when all of the low prevalence group was disqualified, homicide did not decrease by 5%. An 18% increase in price similarly reduced firearm homicide by 5.37% (95% CI 4.43-6.31%). Firearm homicide declined monotonically as the proportion of disqualified individuals increased and/or price increased. A combined intervention that both increased price and effectively disqualified \"high-risk\" groups achieved approximately double the reduction in homicide as any one intervention alone. Increasing illegal firearm ownership by 20%, a hypothetical response to price increases, did not meaningfully change results. A key takeaway of our study is that adopting high-risk versus population-based approaches should not be an \"either-or\" question. When individual risk is variable and diffuse in the population, \"high-risk approaches\" to firearm violence need to focus on relatively prevalent groups and be highly efficacious in disarming people at elevated risk to achieve meaningful reductions in firearm homicide, though countering issues of social justice and stigma should be carefully considered. Similar reductions can be achieved with population-based approaches, such as price increases, albeit with fewer such countering issues.

BACKGROUND:In 2016, firearms killed 38,658 people in the United States. Federal law requires licensed gun dealers, but not private parties, to conduct background checks on prospective firearm purchasers with the goal of preventing prohibited persons from obtaining firearms. Our objective was to estimate the effect of the repeal of comprehensive background check laws – requiring a background check for all handgun sales, not just sales by licensed dealers – on firearm homicide and suicide rates in Indiana and Tennessee. METHODS:We compared age-adjusted firearm homicide and suicide rates, measured annually from 1981-2008 and 1994-2008 in Indiana and Tennessee, respectively, to rates in control groups constructed using the synthetic control method. RESULTS:The average rates of firearm homicide and suicide in Indiana and Tennessee following repeal were within the range of what could be expected given natural variation (differences = 0.7 firearm homicides and 0.5 firearm suicides per 100,000 residents in Indiana and 0.4 firearm homicides and 0.3 firearm suicides per 100,000 residents in Tennessee). Sensitivity analyses resulted in similar findings. CONCLUSION:We found no evidence of an association between the repeal of comprehensive background check policies and firearm homicide and suicide rates in Indiana and Tennessee. In order to understand whether comprehensive background check policies reduce firearm deaths in the United States generally, more evidence on the impact of such policies from other states is needed.

Women who experience housing instability are at high risk for violence and have disproportionately high rates of emergency department (ED) use. However, little has been done to characterize the violence they experience, or to understand how it may be related to ED use. We recruited homeless and unstably housed women from San Francisco shelters, free meal programs, and single room occupancy (SRO) hotels. We used generalized estimating equations to examine associations between violence and any ED use (i.e., an ED visit for any stated reason) every 6 months for 3 years. Among 300 participants, 44% were African-American, and the mean age was 48 years. The prevalence of violence experienced in the prior 6 months included psychological violence (87%), physical violence without a weapon (48%), physical violence with a weapon (18%), and sexual violence (18%). While most participants (85%) who experienced physical violence with a weapon or sexual violence in the prior 6 months had not visited an ED, these were the only two violence types significantly associated with ED use when all violence types were included in the same model (ORphysical/weapon = 1.83, 95% CI 1.02–3.28; ORsexual = 2.15, 95% CI 1.30–3.53). Only violence perpetrated by someone who was not a primary intimate partner was significantly associated with ED use when violence was categorized by perpetrator. The need to reduce violence in this population is urgent. In the context of health care delivery, policies to facilitate trauma-informed ED care and strategies that increase access to non-ED care, such as street-based medicine, could have substantial impact on the health of women who experience homelessness and housing instability.

ObjectiveTo 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.MethodsThis 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.ResultsInformation 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.ConclusionsAvailable 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.

Thousands of buildings in Cleveland, Ohio were demolished or rehabilitated since the Great Recession in the 2000s. Recent evidence suggests removing vacant and decaying buildings reduces violent and firearm-involved crime. This study examines the dose-response relationship between demolitions, rehabilitations, and crime. We use Bayesian spatiotemporal models to estimate the association of interest for five types of crime outcomes: violent crimes, violent crimes involving a firearm, drug crimes, and crimes often associated with building vacancy. We estimate associations in quarterly time periods from 2012 through 2017 in 569 hexagons approximately the size of a neighborhood (2000 feet, approximately 610 m, in diameter), stratified by vacancy level. Across vacancy levels, the majority of our models do not identify statistically significant associations between demolition and rehabilitation dose and crime incidence. However, in some cases, we identify positive associations between demolition and crime. These associations generally appeared at higher levels of demolition (2 or 3 or more demolitions) in areas characterized by medium to high levels of vacancy. We also find that the presence of a property rehabilitation is associated with an increase in drug crimes in areas with medium levels of vacancy.

Background Violence is a leading cause of death and disparity in the United States. Individuals’ physical and social environments can prevent or foster violence, but these complex milieus are challenging to model. In this study, we used machine learning to identify features of the local environment that are most predictive of violence in two Midwestern cities struggling with disinvestment and crime. Methods This was a serial cross-sectional study of census tracts in Cleveland, Ohio and Detroit, Michigan, 2011–2019. We took a machine learning approach—extreme gradient boosting—that enabled us to model 55 neighborhood features simultaneously and without making assumptions about their relationships or functional form. These features included building quality and type, public goods and services, residential stability, socioeconomic features, historical features, and demographic features. Primary outcomes were police-reported counts per square mile of violent crime and violent crime involving a firearm in Cleveland. Secondary outcomes were homicide and firearm homicide in Cleveland and Detroit. Variable importance was assessed with Shapley values. Results The primary models performed well, with a correlation between observed and predicted counts of 0.89 for violent crime and 0.65 for firearm-involved violent crime. For both outcomes, the variables with the highest importance tended to be in the domains of building quality and type or socioeconomic features. Several variables had high importance for both outcomes, including multifamily homes per square mile, road network density, commercial buildings per square mile, and percentage of the population that was white. Conclusions These findings underscore the fundamental importance of place in preventing and generating violence. Future studies should explore modifiable, highly important variables as potential points of intervention.

Background Following the Supreme Court’s decision in New York State Rifle & Pistol Association, Inc. v. Bruen, which ruled a New York concealed-carry permitting requirement unconstitutional, laws restricting the public carrying of firearms in “sensitive places,” like college campuses, have received increasing attention. However, there is little evidence for whether permissive campus carry policies increase firearm violence or, via deterrence, reduce general crime on campus. We estimated the effect of implementing state laws allowing the carry of firearms on public college and university campuses on rates of violent crime and burglary. Methods Arkansas, Georgia, and Texas, containing 106 public institutions, implemented permissive campus carry laws in 2017, 2017, and 2016, respectively. Control institutions were all those in states that did not allow the carry of firearms on college campuses for the entire study period (2006–2019) (n = 324 institutions, 21 states). The rates of major violence and burglary per 1,000 enrolled students was obtained from the Office of Postsecondary Education Campus Safety and Security Statistics website. We use two-way fixed effects difference-in-differences models to estimate state-specific effects and a modified difference-in-differences approach that accounts for variation in treatment timing to generate an overall estimate. Results Differences in rates of major violence and burglary were not statistically distinguishable from zero in our main models and sensitivity analyses. The overall estimated difference in the rate of major violence following policy implementation was − 0.01 (− 0.113, 0.093). For burglary, we estimated a difference of − 0.02 (− 0.147, 0.106). Violence rates trended upward in treated states in the last exposure period, but differences were not consistently distinguished from the null. Conclusions This study does not find significant changes in crime rates following state implementation of permissive campus carrying laws. Decision-makers might therefore consider other factors such as the opinions of students, faculty, and staff regarding campus carry policies and feelings of safety, potential impacts on instructional quality and student engagement, and potential impacts on accidental or self-directed harm.