Cassandra K. Crifasi

Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates

OBJECTIVE In 2013, more than 40,000 individuals died from suicide in the United States. Restricting access to lethal means has the potential to prevent suicide, as suicidal thoughts are often transient. Permit-to-purchase (PTP) laws for handguns could potentially reduce suicides by making it more difficult for persons at risk of suicide to purchase a handgun. METHODS We used a quasi-experimental research design with annual, state-level suicide data to evaluate changes to PTP laws in Connecticut and Missouri. Data were analyzed for 1981-2012. We used synthetic control modeling as the primary method to estimate policy effects. This methodology provided better prediction of pre-PTP-law-change trends in the two states with PTP law changes than econometric models and is thus likely to provide more accurate estimates of policy effects. RESULTS The synthetic control model estimated a 15.4% reduction in firearm suicide rates associated with Connecticuts PTP law. Missouris PTP law repeal was associated with a 16.1% increase in firearm suicide rates. Evidence that PTP laws were associated with non-firearm suicide rates was mixed in Connecticut and negative in Missouri. CONCLUSION The findings are consistent with prior research linking firearm availability to increased risk of suicide and lower suicide risks associated with PTP handgun laws.

Storage Practices of US Gun Owners in 2016

Objectives To examine gun storage practices and factors influencing those practices among gun owners. Methods We conducted a nationally representative online survey of US gun owners (n = 1444) in 2016 to assess gun storage practices and attitudes, factors influencing storage practices, and groups that might effectively communicate regarding safe storage. We generated descriptive statistics by using cross-tabulations and used logistic regression to estimate characteristics that influenced safe storage practices. Results Forty-six percent of gun owners reported safely storing all of their guns. Factors associated with higher odds of reporting safe storage were having a child in the home (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI] = 1.03, 2.03), only owning handguns (AOR = 1.84; 95% CI = 1.24, 2.73), and reporting that storage decisions were influenced by a gun safety course (AOR = 2.05; 95% CI = 1.54, 2.74) or discussions with family members (AOR = 1.39; 95% CI = 1.05, 1.86). Gun owners ranked law enforcement, hunting or outdoors groups, active-duty military, and the National Rifle Association as most effective in communicating safe storage practices. Conclusions Public health campaigns to promote safe gun storage should consider partnering with groups that garner respect among gun owners for their experience with safe use of guns.

Effects of state-level policy changes on homicide and nonfatal shootings of law enforcement officers

Objective To evaluate the impact of state-level policy changes on assaults on law enforcement officers (LEOs) in the USA. Methods Pooled time series and cross-sections with negative binomial regression were used to estimate the impact of state-level changes of right-to-carry (RTC), three-strikes and permit-to-purchase (PTP) handgun laws on fatal and non-fatal assaults of LEOs. LEO assaults were stratified by weapon type (all methods, handgun and non-handgun) and whether or not the assault was fatal. Data were collected from the Federal Bureau of Investigations Law Enforcement Officers Killed and Assaulted database and analysed for the period 1984–2013 for fatal assaults and 1998–2013 for non-fatal assaults. Results RTC laws showed no association with fatal (p>0.4) or non-fatal (p>0.15) assaults on LEOs. Three-strikes laws were associated with a 33% increase in the risk of fatal assaults on LEOs. Connecticuts PTP law was not associated with fatal (p>0.16) or non-fatal (p>0.13) assaults. Missouris repeal of its PTP legislation was marginally associated with a twofold increased risk of non-fatal handgun assaults (p=0.089). Conclusions This research indicates that three-strikes laws increase the risk of fatal assaults. RTC laws are not associated with increased risk of assault. Missouris PTP repeal may increase the risk of non-fatal handgun assaults.

Erratum to: Effects of the repeal of Missouri's handgun purchaser licensing law on homicides

Erratum to: J Urban Health DOI 10.1007/s11524-014-9865-8 The authors would like to publish this erratum to correct estimates generated from regression analyses due to errors identified in the data for certain covariates used in those analyses. The authors apologize that they did not identify the errors prior to publication. The corrected data presented below are very similar to, but are more accurate than, the findings previously published. ABSTRACT 1. The fourth and fifth sentences should be deleted and replaced with, “Using death certificate data available through 2010, the repeal of Missouri’s PTP laws was associated with an increase in the annual firearm homicide rates of 1.18 per 100,000 (+25 %) representing 68 additional firearm homicides annually, but was unrelated to changes in non-firearm homicide rates. Using Uniform Crime Reports data from police available through 2012, the law’s repeal was associated with increased annual murder rates of 0.81 per 100,000 (+14 %) representing 49 additional murders per year.” 2. The last sentence should be deleted. (The corrected data from the prior sentence are integrated into the corrected sentences above.) RESULTS 1. Table 2 should be deleted and replaced with corrected Table 2 below. 2. The last sentence of the third paragraph should be deleted and replaced with, “After controlling for changes in rates of unemployment, poverty, burglary, incarceration, and law enforcement officers along with other state laws, the estimated increase in annual firearm homicide rates associated with the repeal of Missouri’s PTP handgun law was 1.18 per 100,000 population per year (p 3. The last sentence of the 4th paragraph should read, “Regression analyses indicated that Missouri’s repeal of its PTP handgun law was associated with no change in the age-adjusted non-firearm homicide rate (β = −0.07, p = .468, 95 % CI −0.27 to 0.12) and an increase in annual homicide rates for all methods of 1.08 (Table 2, p 4. The last sentence of the 5th paragraph should read, “A model which only controlled for state- and year fixed effects estimated a 1.34 increase in annual murder rates through the end of 2012 associated with the repeal of the PTP handgun law (β = 1.34, p = .001, 95 % CI 0.58 to 2.11); however, the estimated effect of the policy change was reduced to an increase of 0.81 murders per 100,000 per year after all covariates were included in the model (Table 2, β = 0.81, p = .004, 95 % CI 0.26 to 1.35), a 14 % increase relative to the counterfactual.” 5. The second sentence of the 6th paragraph should read, “New unsafe handgun bans adopted in California and Massachusetts were associated with an increase in firearm, non-firearm, and total homicide rates (β = 0.28, p = .014, 95 % CI 0.06 to 0.50; β = 0.19, p = .007, 95 % CI 0.05 to 0.32; β = 0.46, p = .008, 95 % CI 0.13 to 0.70).” 6. Supplemental Tables 1–4 should be replaced with the corrected Supplemental Tables below. DISCUSSION 1. The last sentence of the first paragraph should read, “Our estimates suggest that the repeal of the law was associated with an additional 68 firearm homicides per year in Missouri between 2008 and 2010 and 49 additional murders per year between 2008 and 2012 than the forecasted counterfactual.” Language: en

Association between Firearm Laws and Homicide in Urban Counties

Laws related to the sale, use, and carrying of firearms have been associated with differences in firearm homicide rates at the state level. Right-to-carry (RTC) and stand your ground (SYG) laws are associated with increases in firearm homicide; permit-to-purchase (PTP) laws and those prohibiting individuals convicted of violent misdemeanors (VM) have been associated with decreases in firearm homicide. Evidence for the effect of comprehensive background checks (CBC) not tied to PTP is inconclusive. Because firearm homicide tends to concentrate in urban areas, this study was designed to test the effects of firearm laws on homicide in large, urban U.S. counties. We conducted a longitudinal study using an interrupted time series design to evaluate the effect of firearm laws on homicide in large, urban U.S. counties from 1984 to 2015 (N = 136). We used mixed effects Poisson regression models with random intercepts for counties and year fixed effects to account for national trends. Models also included county and state characteristics associated with violence. Homicide was stratified by firearm versus all other methods to test for specificity of the laws’ effects. PTP laws were associated with a 14% reduction in firearm homicide in large, urban counties (IRR = 0.86, 95% CI 0.82–0.90). CBC-only, SYG, RTC, and VM laws were all associated with increases in firearm homicide. None of the laws were associated with differences in non-firearm homicide rates. These findings are consistent with prior research at the state level showing PTP laws are associated with decreased firearm homicide. Testing the effects of PTP laws specifically in large, urban counties strengthens available evidence by isolating the effects in the geographic locations in which firearm homicides concentrate.

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.

Assaults against U.S. law enforcement officers in the line-of-duty: situational context and predictors of lethality

BackgroundResearch on occupational safety of law enforcement officers (LEOs) has primarily focused on fatal assaults. Nonfatal assaults, however, have received little attention. The goal of this study was to describe the situational contexts in which LEOs are assaulted, and compare these contexts and risks between fatal and nonfatal assaults in the U.S. Analyzing both types of assaults provides a more complete understanding of occupational safety and opportunities for intervention.MethodsThis study includes a descriptive epidemiology of fatal and nonfatal assaults of LEOs in the U.S. and a pooled cross-sectional analysis of risk factors contributing to the odds of lethal assault. Data were collected from the Law Enforcement Officers Killed and Assaulted database. Descriptive statistics were used to characterize fatal and nonfatal assaults. Odds ratios were generated to understand the odds that an assault would result in a fatality.ResultsBetween 1998 and 2013, there were 791 fatal assaults and 2,022 nonfatal assaults of LEOs. Nearly 60% of primary wounds in fatal assaults were received to the head, neck, or throat while nearly 50% of primary wounds in nonfatal assaults were received to the arms/hands or below the waist. The odds that an assault resulted in a fatality decreased by 57% (OR 0.43, 95% CI 0.32 to 0.58) when a LEO was wearing body armor. LEOs experiencing an ambush or unprovoked attack had significantly increased odds of an assault resulting in a fatality (OR 3.27, 95% CI 1.83 to 5.85 and OR 2.24, 95% CI 1.44 to 3.47 respectively). LEOs that were disarmed during an encounter with a suspect had more than 2-fold increased odds of an assault resulting in a fatality (OR 2.24, 95% CI 1.48 to 3.38).ConclusionsThere are specific situational and encounter characteristics that influence the lethality of an assault, which suggest strategies for prevention. Mandatory wear policies for the use of body armor could significantly reduce mortality among assaulted LEOs.

Correction to: Association between Firearm Laws and Homicide in Urban Counties

The authors would like to publish this erratum to correct estimates generated from regression analyses due to errors discovered in the coding of some state laws.

Changes in the legal environment and enforcement of firearm transfer laws in Pennsylvania and Maryland

The effectiveness of laws depends on circumstances affecting their enforcement. To assess such circumstances for comprehensive background check (CBC) and straw purchase laws for firearm sales, we examined prosecutions for CBC and straw purchase violations in Pennsylvania and CBC violations in Maryland. We generated pre-post variables and conducted t-tests to assess differences in the mean number of prosecutions filed following changes to the legal environments. The annual number of prosecutions for straw purchase violations increased significantly in Pennsylvania following the passage of a law that strengthened penalties for these violations (difference in means = +1310.86, P=0.003). The annual number of prosecutions for CBC violations decreased significantly in Maryland following a court decision that narrowed the definition of a firearm transfer making enforcement more difficult (difference in means = −20.52, P=0.026). Our findings suggest enforcement is likely influenced by the penalties associated with violating these laws and the interpretation of the language of the laws.

Gun Policy in the United States: Evidence-Based Strategies to Reduce Gun Violence

When horrific events such as the shootings in Parkland, Florida, Santa Fe, Texas, and Annapolis, Maryland occur the attention of the American people is captured by calls for changes to gun policy and funding for research to prevent mass shootings. While we should absolutely work to prevent mass shootings, the focus on these rare events can overshadow the daily toll of gun violence that claims nearly 100 lives every day in the USA. In 2016, the last year for which complete data are available, 38,658 individuals lost their lives to gun violence [1]. Nearly 60% of these deaths were the result of firearm suicide (22,938), and firearm homicide accounted for 37% (14,415) [1]. The burden of these firearm deaths is not experienced equally across gender, race, or geography. While firearm homicide tends to concentrate in urban areas, rural areas have higher rates of firearm suicide. Firearm suicide is the second leading cause of death among white males aged 10–34 years; firearms were used in 55% of suicides among this group [2]. Homicide is the leading cause of death for black males aged 15–24 years; 94% of these homicides were committed with a firearm [2]. This variation in firearm deaths across different groups could lead one to think that creating comprehensive strategies to reduce gun violence would be all but impossible. However, policies exist at the state level that are not only effective at reducing both firearm homicide and suicide but can also reduce the availability of guns in the underground gun market. Laws that require prospective handgun purchasers to obtain a permit prior to purchasing a handgun have a robust body of evidence supporting their effectiveness. These laws, often referred to as permit-to-purchase (PTP) laws, require individuals to apply directly to a state or local law-enforcement agency, and applicants are often required to submit fingerprints and/or a photograph. In addition, PTP laws provide law enforcement an average of 30 days to complete a more thorough background check compared to the usual 3 days allotted for a background check through the National Instant Check System (NICS). Law-enforcement agencies conducting background checks at the state level may have access to records that have not yet been reported to NICS. The additional length of time to complete the background check increases the likelihood that an individual with a prohibiting condition (e.g. criminal record or severe mental illness) would be screened out. The built-in waiting period that results from the extended time to conduct a background check can also reduce impulsive purchases where the firearm may then be used to harm oneself or others. Furthermore, PTP systems make it easier for people to follow laws requiring background checks for all sales; sellers, both licensed dealers and private sellers, can sell a firearm only to a purchaser with a valid permit. The interaction with law enforcement and increased accountability associated with PTP laws are likely the driving force behind the reductions in diversions of guns to criminals [3, 4]. Reducing impulsive purchases and better identifying and screening out prohibited individuals is associated with reductions in both firearm homicide [5–7] and firearm suicide [8]. The most rigorous evaluations of PTP laws have found beneficial effects across multiple outcomes and study designs. For those who are legally allowed to possess firearms, safe storage practices are a crucial element of responsible gun ownership to reduce gun violence. Safe storage practices are behaviors in which responsible gun owners engage to ensure their guns are not used in an inappropriate manner or without authorized access [9–11]. In addition to safe storage practices reducing the risk of children or adolescents in the home gaining unauthorized access, these practices can make theft of firearms more difficult, thereby reducing a source of guns in an illegal market [12]. However, current estimates find that less than half of gun owners engage in safe storage practices for all their guns [13]. When gun owners do not * Cassandra Crifasi crifasi@jhu.edu