Jon S. Vernick

Effects of high school driver education on motor vehicle crashes, violations, and licensure

OBJECTIVE We sought evidence in the research literature to determine if (1) high school-aged persons who enroll in a driver education course have fewer motor vehicle-related crashes or violations, or are more likely to obtain a drivers license, than those who do not enroll in driver education courses, and (2) the availability of high school driver education courses is associated with lower community rates of motor vehicle crashes among young drivers. METHODS To be included, a study must: (1) assess the effects of driver education courses or legislation for high school-aged persons; (2) present non-self-reported data for at least one of the following outcome measures: driver licensure rates, motor vehicle-related violations, or crashes; (3) include some form of no intervention comparison group; (4) adequately control for potentially confounding variables; (5) randomly assign participants to control or treatment groups, if a controlled trial. RESULTS Nine studies met our inclusion criteria. Based on these studies, there is no convincing evidence that high school driver education reduces motor vehicle crash involvement rates for young drivers, either at the individual or community level. In fact, by providing an opportunity for early licensure, there is evidence that these courses are associated with higher crash involvement rates for young drivers. CONCLUSIONS Although few driver education curricula have been carefully evaluated, in the absence of evidence that driver education reduces crash involvement rates for young persons, schools and communities should consider other ways to reduce motor vehicle-related deaths in this population, such as graduated licensing.

Interventions for the primary prevention of work-related carpal tunnel syndrome

OBJECTIVE To evaluate interventions for the primary prevention of work-related carpal tunnel syndrome (CTS). SELECTION CRITERIA Studies had to include an engineering, administrative, personal, or multiple component intervention applied to a working or working-age population. All study designs that included comparison data were considered. Outcome measures included the incidence, symptoms, or risk factors for CTS, or a work-related musculoskeletal disorder of the upper extremity that included CTS in the definition. RESULTS Twenty-four studies met our inclusion criteria. Engineering interventions included alternative keyboards, computer mouse designs and wrist supports, keyboard support systems, and tool redesign. Personal interventions included ergonomics training, splint wearing, electromyographic biofeedback, and on-the-job exercise programs. Multiple component interventions (e.g., ergonomic programs) included workstation redesign, establishment of an ergonomics task force, job rotation, ergonomics training, and restricted duty provisions. Multiple component programs were associated with reduced incidence rates of CTS, but the results are inconclusive because they did not adequately control for potential confounders. Several engineering interventions positively influenced risk factors associated with CTS, but the evaluations did not measure disease incidence. None of the personal interventions alone was associated with significant changes in symptoms or risk factors. All of the studies had important methodologic limitations that may affect the validity of the results. CONCLUSIONS While results from several studies suggest that multiple component ergonomics programs, alternative keyboard supports, and mouse and tool redesign may be beneficial, none of the studies conclusively demonstrates that the interventions would result in the primary prevention of carpal tunnel syndrome in a working population. Given the societal impact of CTS, the growing number of commercial remedies, and their lack of demonstrated effec- tiveness, the need for more rigorous and long-term evaluation of interventions is clear. Fund- ing for intervention research should prioritize randomized controlled trials that include: (1) adequate sample size, (2) adjustment for relevant confounding variables, (3) isolation of speci- fic program elements, and (4) measurement of long-term primary outcomes such as the inci- dence of CTS, and secondary outcomes such as employment status and cost.

Support for New Policies to Regulate Firearms — Results of Two National Surveys

BACKGROUND New policy options are emerging in the debate regarding the regulation of firearms in the United States. These options include the treatment of firearms as consumer products, the design of which can be regulated for safety; denial of gun ownership to those convicted of misdemeanors; and strategies to curtail the illegal sale of guns. The publics opinion of these innovative gun-policy options has not been thoroughly assessed. METHODS We conducted two telephone surveys of 1200 adults each in the United States in 1996 and 1997-1998. Cognitive interviews and pretests were used in the development of the survey instruments. Potential participants were then contacted by random-digit dialing of telephone numbers. RESULTS A majority of the respondents favored safety standards for new handguns. These standards included childproofing (favored by 88 percent of respondents), personalization (devices that permit firing only by an authorized person; 71 percent), magazine safeties (devices that prevent firing after the magazine or clip is removed; 82 percent), and loaded-chamber indicators (devices that show whether the handgun is loaded; 73 percent). There was strong support for policies prohibiting persons convicted of specific misdemeanors from purchasing a firearm. Support for such prohibitions was strongest for crimes involving violence or the illegal use of a firearm (83 to 95 percent) or substance abuse (71 to 92 percent). There was also widespread support for policies designed to reduce the illegal sale of guns, such as mandatory tamper-resistant serial numbers (90 percent), a limit of one handgun purchase per customer per month (81 percent), and mandatory registration of handguns (82 percent). Even among the subgroup of respondents who were gun owners, a majority were in favor of stricter gun regulations with regard to 20 of the 22 proposals covered in the poll. CONCLUSIONS Strong public support, even among gun owners, for innovative strategies to regulate firearms suggests that these proposals warrant serious consideration by policy makers.

Effects of Baltimore’s Safe Streets Program on Gun Violence: A Replication of Chicago’s CeaseFire Program

Chicago’s CeaseFire program is an evidence-based public health approach to preventing gun violence. Baltimore is one of many US cities attempting to replicate the program. We compared changes in the number of homicide and nonfatal shooting incidents per month in four intervention neighborhoods with changes in high-crime comparison areas (police posts) without the intervention, while controlling for several measures of police activity and baseline levels of homicide and nonfatal shootings. In South Baltimore there were large program-related reductions in homicide and nonfatal shooting incidents. Among three East Baltimore program sites, the program was associated with a reduction of homicides in one area, a reduction in nonfatal shootings in another area, and a simultaneous increase in homicides and decrease in nonfatal shootings in another area. In some instances, program effects extended to neighborhoods bordering the intervention areas. Program-related reductions in homicides appear to be linked with conflict mediations conducted by program outreach workers.

Relationship between licensing, registration, and other gun sales laws and the source state of crime guns

Objective—To determine the association between licensing and registration of firearm sales and an indicator of gun availability to criminals. Methods—Tracing data on all crime guns recovered in 25 cities in the United States were used to estimate the relationship between state gun law categories and the proportion of crime guns first sold by in-state gun dealers. Results—In cities located in states with both mandatory registration and licensing systems (five cities), a mean of 33.7% of crime guns were first sold by in-state gun dealers, compared with 72.7% in cities that had either registration or licensing but not both (seven cities), and 84.2% in cities without registration or licensing (13 cites). Little of the difference between cities with both licensing and registration and cities with neither licensing nor registration was explained by potential confounders. The share of the population near a city that resides in a neighboring state without licensing or registration laws was negatively associated with the outcome. Conclusion—States with registration and licensing systems appear to do a better job than other states of keeping guns initially sold within the state from being recovered in crimes. Proximity to states without these laws, however, may limit their impact.

Effects of State-Level Firearm Seller Accountability Policies on Firearm Trafficking

Criminals illegally obtaining firearms represent a great risk to many urban residents. This cross-sectional study of 54 US cities uses data on state laws governing gun sales, a survey of law enforcement agencies’ practices to promote compliance with gun sales laws, and crime gun trace data to examine associations between these policies and practices with gun trafficking indicators. Higher levels of local gun ownership were linked with greater intrastate gun trafficking. Regression models estimate that comprehensive regulation and oversight of gun dealers and state regulation of private sales of handguns were each associated with significantly lower levels of intrastate gun trafficking. Discretionary permit-to-purchase licensing laws’ negative association with intrastate trafficking disappeared when local gun ownership is controlled. The effects of these relatively restrictive gun purchase laws on trafficking may be mediated by the laws’ lowering of gun ownership. Relatively low prevalence of gun ownership may also be a prerequisite for passage of discretionary purchase. We observed no effect on intrastate trafficking of laws limiting handgun sales to a maximum of one per person per month.

Association Between Connecticut’s Permit-to-Purchase Handgun Law and Homicides

OBJECTIVES We sought to estimate the effect of Connecticuts implementation of a handgun permit-to-purchase law in October 1995 on subsequent homicides. METHODS Using the synthetic control method, we compared Connecticuts homicide rates after the laws implementation to rates we would have expected had the law not been implemented. To estimate the counterfactual, we used longitudinal data from a weighted combination of comparison states identified based on the ability of their prelaw homicide trends and covariates to predict prelaw homicide trends in Connecticut. RESULTS We estimated that the law was associated with a 40% reduction in Connecticuts firearm homicide rates during the first 10 years that the law was in place. By contrast, there was no evidence for a reduction in nonfirearm homicides. CONCLUSIONS Consistent with prior research, this study demonstrated that Connecticuts handgun permit-to-purchase law was associated with a subsequent reduction in homicide rates. As would be expected if the law drove the reduction, the policys effects were only evident for homicides committed with firearms.

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.

Effects of undercover police stings of gun dealers on the supply of new guns to criminals

Objective: To assess the effects of undercover police stings and lawsuits against gun dealers suspected of facilitating illegal gun sales in three US cities (Chicago, Detroit, Gary) on the flow of new firearms to criminals. Methods: An interrupted time series design and negative binomial regression analyses were used to test for temporal change in the recovery of guns used in crimes within one year of retail sale in both intervention and comparison cities. Results: The stings were associated with an abrupt 46.4% reduction in the flow of new guns to criminals in Chicago (95% confidence interval, −58.6% to −30.5%), and with a gradual reduction in new crime guns recovered in Detroit. There was no significant change associated with the stings in Gary, and no change in comparison cities that was coincident with the stings in Chicago and Detroit. Conclusions: The announcement of police stings and lawsuits against suspect gun dealers appeared to have reduced the supply of new guns to criminals in Chicago significantly, and may have contributed to beneficial effects in Detroit. Given the important role that gun stores play in supplying guns to criminals in the US, further efforts of this type are warranted and should be evaluated.

Separating Batterers and Guns: A Review and Analysis of Gun Removal Laws in 50 States.

Firearms play an important role in lethal domestic violence incidents. The authors review state laws regarding two policies to separate batterers from firearms: laws authorizing police to remove firearms when responding to a domestic violence complaint (“police gun removal laws”) and laws authorizing courts to order guns removed from batterers through a protective order (“court-ordered removal laws”). As of April 2004, 18 states had police gun removal laws; 16 states had court-ordered removal laws. The authors examine relevant characteristics of the laws and recommend that these laws be mandatory, apply to all guns and ammunition possessed by an abuser, and include clear procedures to enhance implementation.