Garen J. Wintemute

Firearms as a cause of death in the United States, 1920-1982

We present the epidemiologic history of firearms in the United States. Firearms are among the nations ten leading causes of death. Nearly one million firearm deaths occurred in the half-century 1933-1982. Suicide is the leading type of firearm death. Teenagers, young adults, and males 75 years old and older are currently at highest risk. An individuals risk of suffering a firearm death has generally risen with age. Increased firearm availability is associated with increased rates of firearm homicide and suicide. Strategies to prevent firearm deaths and injuries should be formulated in light of these findings, and heightened efforts to design, implement, and evaluate preventive measures are urgently needed.

Interpreting the Empirical Evidence on Illegal Gun Market Dynamics

Thousands of Americans are killed by gunfire each year, and hundreds of thousands more are injured or threatened with guns in robberies and assaults. The burden of gun violence in urban areas is particularly high. Critics suggest that the results of firearm trace data and gun trafficking investigation studies cannot be used to understand the illegal supply of guns to criminals and, therefore, that regulatory and enforcement efforts designed to disrupt illegal firearms markets are futile in addressing criminal access to firearms. In this paper, we present new data to address three key arguments used by skeptics to undermine research on illegal gun market dynamics. We find that criminals rely upon a diverse set of illegal diversion pathways to acquire guns, gun traffickers usually divert small numbers of guns, newer guns are diverted through close-to-retail diversions from legal firearms commerce, and that a diverse set of gun trafficking indicators are needed to identify and shut down gun trafficking pathways.

Implementing a public health approach to gun violence prevention: the importance of physician engagement

Evidence-based, well-implemented, and enforced gun policies can reduce gun violence, and this vision can be realized with the help of physicians. As the details of policy proposals unfold and the p...

Unintentional firearm deaths in California

We conducted a two-part study of unintentional firearm deaths in California. First, we analyzed death certificate data for the 688 unintentional firearm deaths of California residents occurring during 1977-1983. Mortality rates were 7.5 for males, 0.9 for females, 4.8 for whites, and 5.3 for blacks, all per million persons per year. Males ages 15-24 had the highest rate (17 per million persons per year). We then investigated the 131 childhood deaths in greater detail, using coroners or medical examiners reports. Most of these shootings occurred at a residence. Handguns were involved more frequently than predicted by their reported availability in homes in the region. Almost two thirds of child deaths resulted from head wounds, reinforcing the importance of primary prevention. At least 40% of child deaths in this study appeared in part to be attributable to defects in firearm performance or current firearm design practices, suggesting that improvements should be sought and mandated.

Guns, Fear, the Constitution, and the Public's Health

On March 18, the Supreme Court heard oral arguments in the case of District of Columbia v. Heller, a case challenging handgun control statutes adopted in 1976. Dr. Garen Wintemute argues that the overturning of gun control statutes could weaken the framework of ordered liberty that makes civil society possible.

Where the guns come from: the gun industry and gun commerce.

Under federal law, it is illegal for youth under age 18 to purchase rifles or shotguns, and for those under age 21 to purchase handguns. However, fatality and injury statistics clearly show that guns are finding their way into young peoples hands. Many of these youth obtain guns through illegal gun markets. This article focuses on how guns in the United States are manufactured, marketed, and sold. The article shows how the legal and illegal gun markets are intimately connected and make guns easily accessible to youth. Although the domestic gun manufacturing industry is relatively small and has experienced declining sales in recent years, it has significant political clout and a large market for its products, and has engaged in aggressive marketing to youth. Lax oversight of licensed firearms dealers, combined with little or no regulation of private sales between gun owners, mean that guns can quickly moved from the legal gun market into the illegal market, where they can be acquired by young people. Certain guns, especially inexpensive, poorly made small handguns, are particularly attractive to criminals and youth. The author observes that several policy innovations--including increased regulation of licensed firearms dealers, intensified screening of prospective buyers, regulation of private sales, gun licensing and registration, and bans on some types of weapons--hold promise for decreasing the flow of guns into the hands of youth.

Removing Guns From Batterers Findings From a Pilot Survey of Domestic Violence Restraining Order Recipients in California

Persons under certain domestic violence restraining orders in California are required to surrender any firearms in their possession within 24 hours of service. The California Department of Justice funded a pilot program in which Sheriff’s Offices in two counties developed a system for better enforcing the firearm surrender requirement. As part of a larger process evaluation, 17 restraining order recipients were interviewed about their experiences with and feelings about the removal of firearms from their abusers. Most women surveyed wanted firearms removed and felt safer as a result of their removal. Implications of the findings are discussed.

Gunshot injuries in children served by emergency services

OBJECTIVE: To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms. METHODS: This was a population-based, retrospective cohort study (January 1, 2006–December 31, 2008) including all injured children age ≤19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score ≥16, major surgery, blood transfusion, mortality, and average per-patient acute care costs. RESULTS: A total of 49u2009983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15–19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100u2009000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6–28.4), major surgery (32%, 95% CI 26.1–38.5), in-hospital mortality (8.0%, 95% CI 4.7–11.4), and costs (

Tragedy's Legacy

28u2009510 per patient, 95% CI 22u2009193–34u2009827). CONCLUSIONS: Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children.

Characteristics of federally licensed firearms retailers and retail establishments in the United States: initial findings from the Firearms Licensee Survey.

U.S. civilians own nearly 300 million firearms, and our policies generally provide the widest possible array of firearms to the widest possible array of people, for use under the widest possible array of conditions. Changing our laws could produce measurable benefits.