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What we've become : living and dying in a country of arms
When a naked, mentally ill white man with an AR-15 killed four young adults of color at a Waffle House, Nashville-based physician and gun policy scholar Dr. Jonathan M. Metzl once again advocated for commonsense gun reform. But as he peeled back evidence surrounding the racially charged mass shooting, a shocking question emerged: Did the public health approach he had championed for years have it all wrong? Long at the forefront of a movement advocating for gun reform as a matter of public health, Metzl has been on constant media call in the aftermath of fatal shootings. But the 2018 Nashville killings led him on a path toward recognizing the limitations of biomedical frameworks for fully diagnosing or treating the impassioned complexities of American gun politics.
Book
Gun violence exposure and population health inequality: a conceptual framework
This essay establishes a conceptual framework to understand how direct, secondar and community exposures to gun violence converge to influence population health. Our framework asserts that persistent gun violence in structurally disadvantaged communities enacts broad consequences for mental, physical and behavioural health, operating as a key driver of racial and socioeconomic health disparities. We discuss the applications of this framework for research and improved data collection with a focus on establishing timely and accurate measures of gun violence alongside individual and community health measures. We then address the policy implications of the framework, emphasising the need for long-term, institutional investment in gun violence prevention and intervention, survivor service provision and evidence-based policies at all levels of government.
Journal Article
A systematic review of the causes and prevention strategies in reducing gun violence in the United States
Approximately 100 lives are lost each day as a result of gun violence in the United States (US) with civilian mass shootings increasing annually. The gun violence rate in the US is almost 20 times higher than other comparable developed countries and has the most gun ownership per capita of any nation in the world. Understanding the causes and risk factors are paramount in understanding gun violence and reducing its incidence.
A literature search of all published articles relating to gun violence and mass shootings in the US was conducted using the Medline and PMC databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used in conducting this study. Rayyan statistical software was utilized for analysis. Statistical significant was defined as p < .05.
Of the initial 2304 eligible manuscripts identified, 22 fulfilled our selection criteria. A variety of common causal and contributory factors were identified including but not limited to mental illness, suicidal ideation, intimate partner violence, socioeconomic status, community distress, family life, childhood trauma, current or previous substance abuse, and firearm access.
Gun violence is pervasive and multi-factorial. Interventions aimed at reducing gun violence should be targeted towards the most common risk factors cited in the literature such as access, violent behavioral tendencies due to past exposure or substance abuse, and mental illness including suicidal ideation.
Journal Article
Public Support for Gun Violence Prevention Policies Among Gun Owners and Non–Gun Owners in 2017
Objectives. To compare public support for 24 different gun policies between gun owners and non–gun owners in 2017. Methods. We fielded a national public opinion survey in January 2017 using an online panel to measure US adults’ support for 24 gun policies. We compared support among gun owners and non–gun owners. Results. For 23 of the 24 policies examined, most respondents supported restricting or regulating gun ownership. Only 8 of 24 policies had greater than a 10-point support gap between gun owners and non–gun owners. Conclusions. Policies with high public support and minimal support gaps by gun ownership status included universal background checks, greater accountability for licensed gun dealers unable to account for their inventory, higher safety training standards for concealed carry permit holders, improved reporting of records related to mental illness for background checks, gun prohibitions for persons subject to temporary domestic violence restraining orders, and gun violence restraining orders. Public Health Implications. Although there are important areas where Americans disagree on guns, large majorities of both gun owners and non–gun owners strongly support measures to strengthen US gun laws.
Journal Article
Effect of Remediating Blighted Vacant Land on Shootings: A Citywide Cluster Randomized Trial
Objectives. To determine if remediating blighted vacant urban land reduced firearm shooting incidents resulting in injury or death. Methods. We conducted a cluster randomized controlled trial in which we assigned 541 randomly selected vacant lots in Philadelphia, Pennsylvania, to 110 geographically contiguous clusters and randomly assigned these clusters to a greening intervention, a less-intensive mowing and trash cleanup intervention, or a no-intervention control condition. The random assignment to the trial occurred in April and June 2013 and lasted until March 2015. In a difference-in-differences analysis, we assessed whether the 2 treatment conditions relative to the control condition reduced firearm shootings around vacant lots. Results. During the trial, both the greening intervention, −6.8% (95% confidence interval [CI] = −10.6%, −2.7%), and the mowing and trash cleanup intervention, −9.2% (95% CI = −13.2%, −4.8%), significantly reduced shootings. There was no evidence that the interventions displaced shootings into adjacent areas. Conclusions. Remediating vacant land with inexpensive, scalable methods, including greening or minimal mowing and trash cleanup, significantly reduced shootings that result in serious injury or death. Public Health Implications. Cities should experiment with place-based interventions to develop effective firearm violence–reduction strategies. Trial Registration. This trial was registered with the International Standard Randomized Controlled Trial Number (study ID ISRCTN92582209; http://www.isrctn.com/ISRCTN92582209 ).
Journal Article
Gun violence during COVID-19 pandemic: Paradoxical trends in New York City, Chicago, Los Angeles and Baltimore
According to the NYPD, as of April 4 there has been 172 shooting incidents which represent an 11.7% increase compared to 2019 and an 18.6% increase compared to 2018 [4]. According to a report from the US Department of Labor, there has been a surge in number of unemployment claims during the pandemic [8]. Another explanation is that as people with low socioeconomic status become unemployed and experience tremendous financial stress, they may resort to robbery for income, which is reflected in the increased robbery rates in NY (22.4%) and Chicago (10%) compared to 2019.
Journal Article
Concealed firearm carrying laws and defensive firearm use in public locations of US metropolitan areas, 1986–2004
ObjectivesThere has been extensive debate in the USA as to how laws regulating the carrying of concealed firearms affect crime and public safety. This study examines whether US state laws making it easier for civilians to obtain permits to carry concealed handguns in public increase defensive gun uses against violent threats and attacks in public.MethodsWe used National Crime Victimization Survey data from 39 metropolitan statistical areas (MSAs) in the USA over a 19-year period (1986–2004) to examine whether laws making it easier for civilians to obtain concealed carry permits are linked to higher levels of defensive gun use against violence in public spaces of metropolitan areas. Bivariate χ2 tests and multivariate logistic regression models (controlling for actor and situational characteristics) were used with 7196 public incidents to examine whether the likelihood of the victim using a gun against an attacker(s) varied based on the type of concealed carry law in the MSA at the time of the incident.ResultsThe prevalence of self-defensive gun use in this sample was not clearly related to the passage of permissive gun carrying laws. Although defensive gun use was more common in MSAs with permissive gun carrying laws, this difference was not consistently related in magnitude or statistical significance to the passage of those laws or the length of time they had been in effect.ConclusionsPermissive concealed carry permit laws do not produce evident increases in self-defensive gun uses against crime in public locations.
Journal Article
Evaluating advance peace in Fresno, California: An interrupted times series analysis of a community-based gun violence intervention
Gun violence is a critical public health issue, contributing to the disproportionate burden of health inequities among racially and economically marginalized populations. Advance Peace, a community-driven gun reduction program that integrates street outreach workers to interrupt conflicts with trauma-informed programming to provide mentorship and support for young people at the center of urban gun violence, may be a strategy to reduce gun violence and build healthy communities. We assessed whether the implementation of Advance Peace in Fresno, California was associated with a reduction in gun-related violence, including homicides and assaults. We hypothesized that post-implementation of Advance Peace, there would be a reduction in both gun-related homicides and assaults.
Leveraging crime statistics from the Fresno Police Department on gun-related homicides and assaults between January 2014 and June 2023, we evaluated the impact of Advance Peace programming, implemented beginning in July 2021, on gun violence in Fresno. Descriptive analysis assessed average gun violence rates over time. We used interrupted time series models to assess the rates of gun violence associated with the implementation of Advance Peace in Fresno.
In Fresno, there was evidence of a reduction in crime rates following the introduction of Advance Peace intervention. Two years post-intervention, there was a 46% decrease in the rate of all gun-related crimes, including both homicides and assaults (rate ratio: 0.54, 95% CI: 0.36-0.81). The intervention was also associated with a reduction in the rate of gun-related homicides (RR = 0.45, 95% CI: 0.21-0.95) and the rate of gun-related assaults (RR = 0.58, 95% CI: 0.38-0.89).
Findings from this study demonstrate that Advance Peace may be an effective strategy to reduce gun violence.
Journal Article
Protocol for a nationwide case-control study of firearm violence prevention tactics and policies in K-12 schools
Most U.S. K-12 schools have adopted safety tactics and policies like arming teachers and installing metal detectors, to address intentional school gun violence. However, there is minimal research on their effectiveness. Furthermore, sociodemographic factors may influence their implementation. Controlled studies are necessary to investigate their impact on gun violence and related disciplinary outcomes.
The paper outlines the protocol for a case-control study examining gun violence prevention policies in U.S. K-12 schools. The study aims to investigate if there is an association between the total number and type of specific safety tactics and policies and the occurrence of intentional shootings in K-12 public schools, student disciplinary outcomes, and if urbanicity, economic, and racial factors modify these associations.
We will create a nationally representative dataset for this study and ascertain a full census of case schools (schools that experienced intentional gunfire on the campus during school hours since 2015) through national school shooting databases. Matched control schools will be randomly selected from U.S. Department of Education's national database of all public schools. We will analyze 27 school safety strategies organized into seven key exposure groupings.
Supported by the National Institutes for Child Health and Development (R01HD108027-01) and having received Institutional Review Board approval, our study is currently in the data collection phase. Our analytical plan will determine the association between the number and type of school safety tactics and policies with the occurrence of intentional shootings and suspensions and expulsions in a national sample of approximately 650 K-12 public schools. Additional analyses will investigate the effect modification of specific covariates.
As the first national, controlled study, its results will provide novel and needed data on the effectiveness of school safety tactics and policies in preventing intentional shootings at K-12 public schools.
Journal Article