The association between permit-to-purchase laws and shootings by police.

BACKGROUND: Fatal and nonfatal shootings by police are a public health issue that warrants additional research. Prior research has documented associations between fatal shootings by police and gun ownership, legislative strength scores, and lax concealed carry weapons laws. Despite research on other firearm-related outcomes, little is known about the impact of permit-to-purchase (PTP) laws on shootings by police. We generated counts of fatal and nonfatal OIS from the Gun Violence Archive from 2015 to 2020. We conducted cross-sectional regression modeling with a Poisson distribution and robust standard errors. In addition to PTP, we included several state-level policies that may be associated with shootings by police: comprehensive background check only (CBC-only) laws, concealed carry licensing laws, stand your ground laws, violent misdemeanor prohibitions, and extreme risk protection orders (ERPO). We controlled for state-level demographic characteristics and included a population offset to generate incidence rate ratios (IRR). FINDINGS: PTP laws were associated with a 28% lower rate in shootings by police [IRR = 0.72, 95% confidence interval (CI) 0.64-0.81]. Shall Issue (IRR = 1.34, 95% CI 1.17-1.53) and Permitless (IRR = 1.61, 95% CI 1.35-1.91) concealed carry laws and CBC-only laws (IRR = 1.12, 95% CI 1.01-1.25) were associated with higher rates of shootings by police. Stand your ground, violent misdemeanor prohibitions, and ERPO laws were not associated with shootings by police. CONCLUSIONS: Our study found that PTP laws were associated with significantly lower rates of shootings by police. Removing restrictions on civilian concealed carry was associated with significantly higher rates. State-level firearm policies may be a lever to address shootings by police.

Impact of Changes to Concealed-Carry Weapons Laws on Fatal and Nonfatal Violent Crime, 1980-2019.

The United States faces rapidly rising rates of violent crime committed with firearms. In this study, we sought to estimate the impact of changes to laws that regulate the concealed carrying of weapons (concealed-carry weapons (CCW) laws) on violent crimes committed with a firearm. We used augmented synthetic control models and random-effects meta-analyses to estimate state-specific effects and the average effect of adopting shall-issue CCW permitting laws on rates of 6 violent crimes: homicide with a gun, homicide by other means, aggravated assault with a gun, aggravated assault with a knife, robbery with a gun, and robbery with a knife. The average effects were stratified according to the presence or absence of several shall-issue permit provisions. Adoption of a shall-issue CCW law was associated with a 9.5% increase in rates of assault with a firearm during the first 10 years after law adoption and was associated with an 8.8% increase in rates of homicide by other means. When shall-issue laws allowed violent misdemeanants to acquire CCW permits, the laws were associated with higher rates of gun assaults. It is likely that adoption of shall-issue CCW laws has increased rates of nonfatal violent crime committed with firearms. Harmful effects of shall-issue laws are most clear when provisions intended to reduce risks associated with civilian gun-carrying are absent.

Nonfatal Violence Involving Days Away From Work Following California's 2017 Workplace Violence Prevention in Health Care Safety Standard.

Objectives. To examine the impact of the California Occupational Safety and Health Administration's (Cal/OSHA's) 2017 workplace violence (WPV) prevention in health care safety standard on nonfatal violent injuries among health care workers (HCWs). Methods. We accessed estimated counts of WPV from the survey of occupational injuries and illness from 2011 to 2019 specific to HCWs. We used the Current Population Survey estimates of HCWs to create rates per 10 000. We conducted a longitudinal panel analysis and a comparative interrupted time-series analysis to examine the change in incidence and in rates associated with California's new standard. Results. Adoption of the 2017 safety standard led to an additional 3.48 reported WPV injuries per 10 000 HCWs in California, or an additional 473 injuries. Sensitivity analyses suggest other injuries did not change in the same period. Conclusions. It appears that the Cal/OSHA standard increased reporting of WPV injuries among HCWs in the first year of its adoption compared with the United States. Mandating reporting of all WPV incidents in the health care setting may be a means to ensure a more complete understanding of this public health problem. (Am J Public Health. 2022;112(11):1668-1675. https://doi.org/10.2105/AJPH.2022.307029).

Officer-Involved Shootings and Concealed Carry Weapons Permitting Laws: Analysis of Gun Violence Archive Data, 2014-2020.

About 1,000 civilians are killed every year by a law enforcement officer in the USA, more than 90% by firearms. Most civilians who are shot are armed with a firearms. Higher rates of officer-involved shootings (OIS) are positively associated with state-level firearm ownership. Laws relaxing restrictions on civilians carrying concealed firearms (CCW) have been associated with increased violent crime. This study examines associations between CCW laws and OIS. We accessed counts of fatal and nonfatal OIS from the Gun Violence Archive (GVA) from 2014-2020 and calculated rates using population estimates. We conducted legal research to identify passage years of CCW laws. We used an augmented synthetic control models with fixed effects to estimate the effect of Permitless CCW law adoption on OIS over fourteen biannual semesters. We calculated an inverse variance weighted average of the overall effect. On average, Permitless CCW adopting states saw a 12.9% increase in the OIS victimization rate or an additional 4 OIS victimizations per year, compared to what would have happened had law adoption not occurred. Lax laws regulating civilian carrying of concealed firearms were associated with higher incidence of OIS. The increase in concealed gun carrying frequency associated with these laws may influence the perceived threat of danger faced by law enforcement. This could contribute to higher rates of OIS.

Evaluation of motor vehicle crash rates during and after the COVID-19-associated stay-at-home order in Connecticut.

INTRODUCTION: Recent research suggests that COVID-19 associated stay-at-home orders, or shelter-in-place orders, have impacted intra-and-interstate travel as well as motor vehicle crashes (crashes). We sought to further this research and to understand the impact of the stay-at-home order on crashes in the post order period in Connecticut. METHODS: We used a multiple-comparison group, interrupted time-series analysis design to compare crashes per 100 million vehicle miles traveled (VMT) per week in 2020 to the average of 2017-2019 from January 1-August 31. We stratified crash rate by severity and the number of vehicles involved. We modeled two interruption points reflecting the weeks Connecticut implemented (March 23rd, week 12) and rescinded (May 20th, week 20) its stay-at-home order. RESULTS: During the initial week of the stay-at-home order in Connecticut, there was an additional 28 single vehicle crashes compared to previous years (95% confidence interval (CI): [15.8, 36.8]). However, the increase at the order onset was not seen throughout the duration. Rescinding the stay-at-home order by and large did not result in an immediate increase in crash rates. Crash rates steadily returned to previous year averages during the post-stay-at-home period. Fatal crash rates were unaffected by the stay-at-home order and remained similar to previous year rates throughout the study duration. DISCUSSION: The initial onset of the stay-at-home order in Connecticut was associated with a sharp increase in the single vehicle crash rate but that increase was not sustained for the remainder of the stay-at-home order. Likely changes in driver characteristics during and after the order kept fatal crash rates similar to previous years.

Effect of Washington State and Colorado's cannabis legalization on death by suicides.

In the U.S., death by suicide is a leading cause of death and was the 2nd leading cause of death for ages 15-to-34 in 2018. Though incomplete, much of the scientific literature has found associations between cannabis use and death by suicide. Several states and the District of Columbia have legalized cannabis for general adult use. We sought to evaluate whether cannabis legalization has impacted suicide rates in Washington State and Colorado, two early adopters. We used a quasi-experimental research design with annual, state-level deaths by suicide to evaluate the legalization of cannabis in Washington State and Colorado. We used synthetic control models to construct policy counterfactuals as our primary method of estimating the effect of legalization, stratified by age, gender, and race/ethnicity. Overall death by suicide rates were not impacted in either state. However, when stratified by age categories, deaths by suicide increased 17.9% among 15-24-year-olds in Washington State, or an additional 2.13 deaths per 100,000 population (p-value ≤0.001). Other age groups did not show similar associations. An ad hoc analysis revealed, when divided into legal and illegal consumption age, 15-20-year olds had an increase in death by suicides of 21.2% (p-value = 0.026) and 21-24-year olds had an increase in death by suicides of 18.6% (p-value ≤0.001) in Washington State. The effect of legalized cannabis on deaths by suicide appears to be heterogeneous. Deaths by suicide among 15-24-year-olds saw significant increases post-implementation in Washington State but not in Colorado.

Impact of ShotSpotter Technology on Firearm Homicides and Arrests Among Large Metropolitan Counties: a Longitudinal Analysis, 1999-2016.

Over the past decade, large urban counties have implemented ShotSpotter, a gun fire detection technology, across the USA. It uses acoustic listening devices to identify discharged firearms' locations. We examined the effect of ShotSpotter with a pooled, cross-sectional time-series analysis within the 68 large metropolitan counties in the USA from 1999 to 2016. We identified ShotSpotter implementation years through publicly available media. We used a Poisson distribution to model the impact of ShotSpotter on firearm homicides, murder arrests, and weapons arrests. ShotSpotter did not display protective effects for all outcomes. Counties in states with permit-to-purchase firearm laws saw a 15% reduction in firearm homicide incidence rates; counties in states with right-to-carry laws saw a 21% increase in firearm homicide incidence rates. Results suggest that implementing ShotSpotter technology has no significant impact on firearm-related homicides or arrest outcomes. Policy solutions may represent a more cost-effective measure to reduce urban firearm violence.

Assessing the Magnitude of Nonworker Deaths During Workplace Homicide Incidents: An Epidemiological Analysis Using the National Violent Death Reporting System (NVDRS).

BACKGROUND: Recent workplace homicide investigations have noted that the Census of Fatal Occupational Injuries (CFOI) has several limitations that reduce our ability to understand who dies as part of a workplace homicide incident. We sought to assess the magnitude of nonworker deaths associated with workplace homicide incidents. METHODS: Using National Violent Death Reporting System (NVDRS) data from 2003 to 2017, we employed a descriptive epidemiological investigation. The counts of worker and nonworker deaths during a workplace homicide incident were ascertained, as well as other characteristics (e.g., gender, age, mechanism of death, and race/ethnicity). We used multiple logistic regression to estimate the relationship between incident characteristics and the odds of having a nonworker death. RESULTS: Across the study period, there were 2,020 workplace homicides. The number of deaths associated with workplace homicide incidents increased 8.2% when considering nonworker deaths (n = 2,186). Including those nonfatally shot as part of a workplace homicide incident increased causalities by 18.2% (n = 2,388). If a firearm was used during perpetration, the odds that a nonworker was killed during a workplace homicide incident increased 3.76 times (95% confidence interval: 2.03, 6.96). CONCLUSION/APPLICATION TO PRACTICE: Considering nonworkers killed as part of workplace homicide incidents is essential to understanding the true magnitude of violence associated with these incidents. Likely, it is the lethality of firearms that greatly increases the likelihood that nonworkers are killed as part a workplace homicide incident. To best understand the epidemiology of workplace homicide incident, we recommend CFOI adopt an incident-based method for coding workplace deaths.

Initial impact of COVID-19's stay-at-home order on motor vehicle traffic and crash patterns in Connecticut: an interrupted time series analysis.

INTRODUCTION: Understanding how the COVID-19 pandemic has impacted our health and safety is imperative. This study sought to examine the impact of COVID-19's stay-at-home order on daily vehicle miles travelled (VMT) and MVCs in Connecticut. METHODS: Using an interrupted time series design, we analysed daily VMT and MVCs stratified by crash severity and number of vehicles involved from 1 January to 30 April 2017, 2018, 2019 and 2020. MVC data were collected from the Connecticut Crash Data Repository; daily VMT estimates were obtained from StreetLight Insight's database. We used segmented Poisson regression models, controlling for daily temperature and daily precipitation. RESULTS: The mean daily VMT significantly decreased 43% in the post stay-at-home period in 2020. While the mean daily counts of crashes decreased in 2020 after the stay-at-home order was enacted, several types of crash rates increased after accounting for the VMT reductions. Single vehicle crash rates significantly increased 2.29 times, and specifically single vehicle fatal crash rates significantly increased 4.10 times when comparing the pre-stay-at-home and post-stay-at-home periods. DISCUSSION: Despite a decrease in the number of MVCs and VMT, the crash rate of single vehicles increased post stay-at-home order enactment in Connecticut after accounting for reductions in VMT.

Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol.

OBJECTIVES: Using available literature, our aim was to design a firearm safety counseling protocol tool for dementia patients. DESIGN: We conducted a literature review on firearm safety counseling by healthcare providers using several databases to inform the creation of our evidence-based protocol. SETTING: Roughly 5.7 million Americans currently live with some form of dementia with approximately 60% of persons with dementia (PWD) owning a firearm. The mental deterioration associated with dementia creates an opportunity for firearm abuse, misuse, and injury. Patient and family safety counseling from a healthcare provider is one potential opportunity for reducing the level of danger. This literature review identifies the available clinical guidelines for firearm safety for PWD and creates a firearm safety counseling protocol based on existing literature. PARTICIPANTS: Persons with dementia and their families or care takers. MEASUREMENTS: Databases were searched using variations of the terms "Firearms," "Dementia," and "Alzheimer's disease." Studies were included for review if they provided either recommendations or guidelines for healthcare provider's counseling around firearm safety for PWD or their families. RESULTS: Search terms yielded 456 articles, of which 12 met inclusion criteria. Using the available literature, we developed a firearm safety counseling protocol that provides measurable means to assess risk and offer harm mitigation strategies for patients and their families. Mitigation strategies are based on Clinical Dementia Rating scale assessment at time of patient interaction and results of risk assessment. CONCLUSION: Providing standardized and effective clinical guidelines to healthcare providers who interact with firearm-owning PWD can act as a means to reduce firearm injury and violence. The protocol proposed in this article needs further testing and validation to determine if it will help reduce firearm-related events in PWD.

Right-to-Carry Laws and Firearm Workplace Homicides: A Longitudinal Analysis (1992-2017).

Objectives. To examine the impact of right-to-carry (RTC) firearm laws on firearm workplace homicides (WPHs) in the United States from 1992 to 2017.Methods. We employed 2 longitudinal methods to examine the average effect (pooled, cross-sectional, time-series analysis) and the state-specific effect (random effects meta-analysis) of RTC laws on WPHs committed by firearms from 1992 to 2017 in a 50-state panel. Both methods utilized a generalized linear mixed model with a negative binomial distribution.Results. From 1992 to 2017, the average effect of having an RTC law was significantly associated with 29% higher rates of firearm WPHs (95% confidence interval [CI] = 1.14, 1.45). No other state-level policies were associated with firearm WPHs. Sensitivity analyses suggest robust findings. State-specific estimates suggest that passing an RTC law during our study period was significantly associated with 24% increase in firearm WPH rates (95% CI = 1.09, 1.40).Conclusions. This is the first study to our knowledge to examine the link between RTC firearm laws and firearm WPHs. Findings indicate that RTC laws likely pose a threat to worker safety and contribute to the recent body of literature that finds RTC laws are associated with increased incidence of violence.

Workplace homicides committed by firearm: recent trends and narrative text analysis.

BACKGROUND: Firearm workplace homicides are a significant problem in the United States. We sought to provide a current, national-level examination of these crimes and examine how perpetrators accessed firearms used in workplace homicides. METHODS: We abstracted information on all firearm workplace homicides from the Bureau of Labor Statistics' Census of Fatal Occupational Injuries from 2011 to 2015. We classified deaths by perpetrator's relationship to the workplace/victim, motive (robbery v. non-robbery), circumstance (argument v. other circumstances), and firearm access points using narrative text fields. RESULTS: There were 1553 firearm workplace homicides during the study period. Robbery crime trended downward from 2011 to 2015. In contrast, non-robbery crimes constituted almost 50% of the homicides and trended upward in recent years. Customers and co-workers were the most frequent perpetrators of non-robbery crimes, most after an argument. While customers and co-workers who commit these crimes were often armed at the time of the argument, some were not and retrieved a firearm from an unspecified location before committing a homicide. Thus, immediate and ready firearm access was commonly observed in argumentative workplace deaths. CONCLUSIONS: Limiting firearm access in the workplace is a possible measure for preventing deadly workplace violence and should be considered as part of a comprehensive strategy for addressing this reemerging public health concern.

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.

Oral fluid testing for marijuana intoxication: enhancing objectivity for roadside DUI testing.

Reducing marijuana-impaired driving is an important part of any strategy to prevent motor vehicle traffic injuries. In Colorado, the first of eight US states and the District of Columbia to legalise marijuana for recreational use, drivers with positive tests for the presence of marijuana accounted for a larger proportion of fatal MVCs after marijuana commercialisation. The use of blood tests to screen for marijuana intoxication, in Colorado and elsewhere in the USA, poses a number of challenges. Many high-income countries use oral fluid drug testing (OF) to provide roadside evidence of marijuana intoxication. A 2009 Belgium policy implementing OF roadside testing increased true positives and decreased false positives of suspected marijuana-related driving under the influence (DUI) arrests. US policy-makers should consider using roadside OF to increase objectivity and reliability for tests used in marijuana-related DUI arrests.

The Massachusetts School Sports Concussions Law: A Qualitative Study of Local Implementation Experiences.

BACKGROUND: Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. In 2010, Massachusetts passed legislation aimed at addressing the issue of concussions in school athletics. We sought to understand local-level implementation decisions of the Massachusetts concussion law. METHODS: A qualitative multiple-case study approach was utilized. Semi-structured interviews with school-employed actors associated with the law's implementation were used for analysis. Interview data were subjected to a conventional content analysis. RESULTS: A total of 19 participants from 5 schools were interviewed. Schools were purposefully selected from communities varying in socioeconomic status and population. Participants included 5 athletic directors, 5 coaches, 4 athletic trainers, 4 school nurses, and 1 health and wellness coordinator. Eight themes emerged regarding specific ways schools have implemented the law. Six themes emerged regarding factors influencing implementation. CONCLUSIONS: All cases employ neurocognitive testing as a means to assess concussions, place decision-making authority in athletic trainers' hands, and use a 30-minute online video to disseminate concussion education. Employing athletic trainers could pose challenges to school districts with limited financial capacity, as financial assistance from the state is not provided under the law. The validity of neurocognitive testing and the effectiveness of online concussion training need further study. Cooperation from student athletes, their parents, and physicians is necessary for full implementation of the law.