Gun violence prevention policy: Perceived and actual levels of gun owner support.

Gun violence prevention is often viewed as polarizing, although gun owners actually support many gun safety policies. The aim of this paper was to investigate the relationship between gun owners' perceptions of other gun owners' support for gun policies and their own individual support for such policies. NORC at the University of Chicago, which uses a panel of adults recruited through probability sampling, conducted an online/phone survey of 1,078 adult gun owners. Respondents were asked about their individual support for seven gun safety policies and their perceptions of other gun owners' support for those policies. We used two-sample t-tests and multivariate logistic regression analyses to explore the relationship between perceived and individual support. We found that gun owners underestimated fellow gun owners' support for gun violence prevention policy, especially if they personally opposed that policy. Gun owners' perception of fellow gun owners' support for a policy was significantly associated with the likelihood of individual support for that policy for all laws examined. These findings have important implications for correcting misperceptions of the level of gun owner support for gun safety policies as well as conducting and targeting educational campaigns to respond to and correct media misinformation.

Distinct groups of firearm owners with differential risk for suicide in the United States: A latent class analysis.

Suicide is a leading cause of mortality and firearm suicide accounts for the majority of fatalities. Firearm owners are a diverse population and firearm-specific suicide prevention programs should be tailored to distinct at-risk firearm-owning groups. This study set out to identify groups of firearm owners with differential suicide risk having unique characteristics that could be used to customize suicide prevention efforts. We conducted a nationally-representative survey of 2646 firearm owners to assess individual suicide risk, suicide risk factors, and demographic characteristics. A Latent Class Analysis identified unique segments of firearm owners at increased risk of suicide with similar underlying suicide risk factors and demographic characteristics. We found almost one in ten (9.6%) of firearm owners were at increased risk of suicide with 25% reporting suicide ideation, 6.6% reporting suicide planning, and 1.8% reporting previous suicide attempts. We identified three unique groups of firearm owners with higher than average suicide risk. Relative to other groups of firearm owners, one at-risk group were more affluent with a history of adverse experiences and mental health challenges, a second group had more male veterans with high levels of alcohol consumption, and third group had more non-heterosexual women who experienced trauma. We conclude that there are three unique groups of firearm owners with higher than average suicide risk with very different characteristics. In addition to broad suicide prevention efforts, customized firearm suicide prevention programs should be developed individually for these different firearm-owning populations, taking into consideration the unique suicide risk factors and demographics of each group.

State firearm laws and nonfatal firearm injury-related inpatient hospitalizations: A nationwide panel study.

BACKGROUND: Firearm injury remains a major cause of morbidity and mortality in the United States. Because of prior lack of comprehensive data sources, there is a paucity of literature on nonfatal firearm injury. Associations have previously been shown between state-level firearm laws and firearm fatalities, but few studies have examined the effects of these laws on nonfatal firearm hospitalization rates. Our objective was to examine the relationship between state firearm laws and firearm injury-related hospitalization rates across all 50 states over a 17-year period. METHODS: In this panel study design, we used fixed effects multivariate regression models to analyze the relationship between 12 laws and firearm state-level injury-related hospitalization rates from 2000 to 2016 using the RAND Corporation Inpatient Hospitalizations for Firearm Injury Database. We used difference-in-differences to determine the impact of law passage in a given state compared with those states without the law, controlling for state-level covariates. The main outcome measure was the change in annual firearm injury-related inpatient hospitalization rates after passage or repeal of a state-level firearm law. RESULTS: Examining each law individually, passage of violent misdemeanor, permitting, firearm removal from domestic violence offenders, and 10-round limit laws were associated with significant firearm injury-related hospitalization rate reductions. Examining multiple laws in the same model, passage of violent misdemeanor laws was associated with a 19.9% (confidence interval, 11.6%-27.4%) reduction, and removal of firearms from domestic violence offenders was associated with a 17.0% (confidence interval, 9.9%-23.6%) reduction in hospitalization rates. CONCLUSION: State laws related to preventing violent offenders from possessing firearms are associated with firearm injury-related hospitalization rate reductions. Given significant physical, mental, and social burdens of nonfatal firearm injury, determining the efficacy of firearm-related policy is critical to violence and injury prevention efforts. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.

The Meaning of Guns to Gun Owners in the U.S.: The 2019 National Lawful Use of Guns Survey.

INTRODUCTION: A better understanding of the lawful use of guns and the symbolic meaning of guns to gun owners is essential to bridge the divide in public opinion regarding policies to reduce gun violence in the U.S. METHODS: A national, prerecruited Internet panel of U.S. adults in 2019 was used to survey gun owners (n=2,086) to ascertain their gun-related attitudes and practices. Data were analyzed in 2020. RESULTS: The primary reason given for owning a gun was defense (59.4%), followed by recreation (26.8%). A minority of the gun owners in the sample (22.9%) reported taking part in any gun-related activity more than rarely. The proportion of respondents who agreed that guns are an important part of their identity was just 10.0%. The majority of the gun owners viewed gun control advocates as wanting to take away all guns (58.5%). Nearly 70% of gun owners reported that a reason for their reluctance to engage in gun violence prevention was that they feel alienated because they perceive gun control advocates as blaming them for the gun violence problem, not understanding gun ownership, and not understanding much about guns. CONCLUSIONS: For most of the gun owners, gun ownership plays a practical role as a method of self-protection and has a symbolic association with freedom. Public health practitioners must develop novel communication strategies that avoid alienating gun owners by creating a perception that the ultimate aim is to take their guns away.

Household Gun Ownership and Youth Suicide Rates at the State Level, 2005-2015.

INTRODUCTION: Determining whether the prevalence of gun ownership is associated with youth suicide is critical to inform policy to address this problem. The objective of this study is to investigate the relationship between the prevalence of household gun ownership in a state and that state's rate of youth suicide. METHODS: This study, conducted in 2018, involved a secondary analysis of state-level data for the U.S. using multivariable linear regression. The relationship between the prevalence of household gun ownership and youth (aged 10-19 years) suicide rates was examined in a time-lagged analysis of state-level household gun ownership in 2004 and youth suicide rates in the subsequent decade (2005-2015), while controlling for the prevalence of youth suicide attempts and other risk factors. RESULTS: Household gun ownership was positively associated with the overall youth suicide rate. For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9% (95% CI=14.0%, 39.8%). CONCLUSIONS: Because states with high levels of household gun ownership are likely to experience higher youth suicide rates, these states should be especially concerned about implementing programs and policies to ameliorate this risk.

E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013-2015.

BACKGROUND: The role of electronic cigarettes (e-cigarettes) in product transitions has been debated. METHODS: We used nationally representative data from the Population Assessment of Tobacco and Health Study waves 1 (2013-2014) and 2 (2014-2015) to investigate the associations between e-cigarette initiation and cigarette cessation/reduction in the USA. We limited the sample to current cigarette smokers aged 25+ years who were not current e-cigarette users at wave 1. We modelled 30-day cigarette cessation and substantial reduction in cigarette consumption as a function of e-cigarette initiation between surveys using multivariable logistic regression. RESULTS: Between waves 1 and 2, 6.9% of cigarette smokers who were not current e-cigarette users transitioned to former smokers. After adjusting for covariates, cigarette smokers who initiated e-cigarette use between waves and reported they used e-cigarettes daily at wave 2 had 7.88 (95% CI 4.45 to 13.95) times the odds of 30-day cigarette cessation compared with non-users of e-cigarettes at wave 2. Cigarette smokers who began using e-cigarettes every day and did not achieve cessation had 5.70 (95% CI 3.47 to 9.35) times the odds of reducing their average daily cigarette use by at least 50% between waves 1 and 2 compared with e-cigarette non-users. CONCLUSIONS: Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.

A multi-decade joinpoint analysis of firearm injury severity.

BACKGROUND: Non-fatal firearm injuries constitute approximately 70% of all firearm trauma injuries in the United States. Patterns of severity of these injuries are poorly understood. We analyzed the overall, age-, sex- and intent-specific temporal trends in the injury severity of firearm hospitalizations from 1993 to 2014. METHODS: We assessed temporal trends in the severity of patients hospitalized for firearm using Nationwide Inpatient Sample (NIS) data over a 22 year period. Firearm hospitalization was identified using assault (E965x), unintentional (E922x), intentional self-harm (E955x), legal (E970) and undetermined (E985x) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes. Injury severity was measured using the computed New Injury Severity Score (NISS). We used survey weighted means, SD and annual percent change (APC), and joinpoint regression to analyze temporal trends. RESULTS: A weighted total of 648 662 inpatient admissions for firearm injury were analyzed. Firearm injury severity demonstrated a significant annual increase of 1.4% (95% CI=1.3 to 1.6), and was driven by annual increases among young adults (APC=1.4%, 95% CI=1.3 to 1.5), older adults (APC=1.5%, 95% CI=1.3 to 1.6), female (APC=1.5%, 95% CI=1.3 to 1.6) and male (APC=1.4%, 95% CI=1.3 to 1.6) hospitalizations. The annual increase among assault/legal injuries was 1.4% (95% CI=1.3 to 1.5), similar to unintentional (APC=1.4%, 95% CI=1.3 to 1.6), intentional self-harm (APC=1.5%, 95% CI=1.4 to 1.6) and undetermined (APC=1.4%, 95% CI=1.3 to 1.6). CONCLUSIONS: The severity of hospitalized firearm injuries increased significantly from 1993 to 2014. This annual increase reflects a move towards hospitalization of more serious injuries, and outpatient management of less serious injuries across the board, suggesting a mounting burden on the US healthcare system. LEVEL OF EVIDENCE: Level IV.

Electronic Cigarette Prevalence and Patterns of Use in Adults with a History of Cardiovascular Disease in the United States.

BACKGROUND: Characterizing electronic cigarette (e-cigarette) use patterns is important for guiding tobacco regulatory policy and projecting the future burden of tobacco-related diseases. Few studies have examined patterns of e-cigarette use in individuals with cardiovascular disease (CVD). METHODS AND RESULTS: We examined e-cigarette use in adults aged 18 to 89 years with a history of CVD, using data from the 2014 National Health Interview Survey. We investigated associations between ever and current e-cigarette use and smoking with multivariable logistic regression. In a secondary analysis, we modeled the association between e-cigarette use and a quit attempt over the past year. Former smokers with CVD who quit smoking within the past year showed 1.85 (95% confidence interval, 1.03, 3.33) times the odds of having ever used e-cigarettes as compared with those who reported being "some days" current smokers. Current smokers who attempted to quit smoking within the past year showed significantly increased odds of ever having used e-cigarettes (odds ratio, 1.70; 95% confidence interval, 1.25, 2.30) and currently using e-cigarettes (odds ratio, 1.97; 95% confidence interval, 1.32, 2.95) as compared with smokers who had not attempted to quit over the past year. CONCLUSIONS: Individuals with CVD who recently quit smoking or reported a recent quit attempt were significantly more likely to use e-cigarettes than current smokers and those who did not report a quit attempt. Our findings may indicate that this population is using e-cigarettes as an aid to smoking cessation. Characterizing emerging e-cigarette use behaviors in adults with CVD may help to inform outreach activities aimed at this high-risk population.

Barriers to and Facilitators of Alcohol Use Disorder Pharmacotherapy in Primary Care: A Qualitative Study in Five VA Clinics.

BACKGROUND: Three medications are FDA-approved and recommended for treating alcohol use disorders (AUD) but they are not offered to most patients with AUD. Primary care (PC) may be an optimal setting in which to offer and prescribe AUD medications, but multiple barriers are likely. OBJECTIVE: This qualitative study used social marketing theory, a behavior change approach that employs business marketing techniques including "segmenting the market," to describe (1) barriers and facilitators to prescribing AUD medications in PC, and (2) beliefs of PC providers after they were segmented into groups more and less willing to prescribe AUD medications. DESIGN: Qualitative, interview-based study. PARTICIPANTS: Twenty-four providers from five VA PC clinics. APPROACH: Providers completed in-person semi-structured interviews, which were recorded, transcribed, and analyzed using social marketing theory and thematic analysis. Providers were divided into two groups based on consensus review. KEY RESULTS: Barriers included lack of knowledge and experience, beliefs that medications cannot replace specialty addiction treatment, and alcohol-related stigma. Facilitators included training, support for prescribing, and behavioral staff to support follow-up. Providers more willing to prescribe viewed prescribing for AUD as part of their role as a PC provider, framed medications as a potentially effective "tool" or "foot in the door" for treating AUD, and believed that providing AUD medications in PC might catalyze change while reducing stigma and addressing other barriers to specialty treatment. Those less willing believed that medications could not effectively treat AUD, and that treating AUD was the role of specialty addiction treatment providers, not PC providers, and would require time and expertise they do not have. CONCLUSIONS: We identified barriers to and facilitators of prescribing AUD medications in PC, which, if addressed and/or capitalized on, may increase provision of AUD medications. Providers more willing to prescribe may be the optimal target of a customized implementation intervention to promote changes in prescribing.

The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001-2013.

Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001-2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (Ptrend < 0.0001). FFIs remained constant (change = 0.02; Ptrend = 0.22) while NFIs increased (change = 0.35; Ptrend < 0.0001). Homicide FFIs declined (change = -0.05; Ptrend < 0.0001) while homicide NFIs increased (change = 0.43; Ptrend < 0.0001). Suicide FFIs increased (change = 0.07; Ptrend < 0.0001) while unintentional FFIs and NFIs declined (changes = -0.01 and -0.09, respectively; Ptrend < 0.0001 and 0.005). Among whites, FFIs (change = 0.15; Ptrend < 0.0001) and NFIs (change = 0.13; Ptrend < 0.0001) increased; among blacks, FFIs declined (change = -0.20; Ptrend < 0.0001). Among Hispanics, FFIs declined (change = -0.28; Ptrend < 0.0001) while NFIs increased (change = 0.55; Ptrend = 0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.

Sponsorship of National Health Organizations by Two Major Soda Companies.

INTRODUCTION: Obesity is a pervasive public health problem in the U.S. Reducing soda consumption is important for stemming the obesity epidemic. However, several articles and one book suggest that soda companies are using their resources to impede public health interventions that might reduce soda consumption. Although corporate sponsorship by tobacco and alcohol companies has been studied extensively, there has been no systematic attempt to catalog sponsorship activities of soda companies. This study investigates the nature, extent, and implications of soda company sponsorship of U.S. health and medical organizations, as well as corporate lobbying expenditures on soda- or nutrition-related public health legislation from 2011 to 2015. METHODS: Records of corporate philanthropy and lobbying expenditures on public health legislation by soda companies in the U.S. during 2011-2015 were found through Internet and database searches. RESULTS: From 2011 to 2015, the Coca-Cola Company and PepsiCo were found to sponsor a total of 95 national health organizations, including many medical and public health institutions whose specific missions include fighting the obesity epidemic. During the study period, these two soda companies lobbied against 29 public health bills intended to reduce soda consumption or improve nutrition. CONCLUSIONS: There is surprisingly pervasive sponsorship of national health and medical organizations by the nation's two largest soda companies. These companies lobbied against public health intervention in 97% of cases, calling into question a sincere commitment to improving the public's health. By accepting funding from these companies, health organizations are inadvertently participating in their marketing plans.

Amount of Televised Alcohol Advertising Exposure and the Quantity of Alcohol Consumed by Youth.

OBJECTIVE: Although studies demonstrate that exposure to brand-specific alcohol advertising is associated with an increased likelihood of youth consuming particular brands, the relationship between quantity of brand-specific advertising exposure and quantity of brand-specific consumption has not been firmly established. METHOD: Using the Alcohol Brand Research Among Underage Drinkers (ABRAND) national sample of 1,031 young drinkers (ages 13-20), this study examined the relationship between their aggregated past-year exposure to advertising (in adstock units, a measure based on gross rating points) for 61 alcohol brands that advertised on the 20 most popular nonsports television programs viewed by underage youth and their aggregated total consumption of those same brands during the past 30 days. Predictive models adjusted for other media exposure, predictors of youth's alcohol consumption, and the consumption of brands not advertised on the 20 shows. RESULTS: For the fully adjusted models, each 100 adstock unit increase in exposure (about 1 SD) was associated with an increase of 5.9 drinks (95% CI [0.9, 11.0 drinks]) consumed during the past 30 days among those with less than 300 units of advertising exposure, and an increase of 55.7 drinks (95% CI [13.9, 97.4 drinks]) among those with 300 or more adstock units of exposure. CONCLUSIONS: Among underage youth, the quantity of brand-specific advertising exposure is positively associated with the total quantity of consumption of those advertised brands, even after controlling for the consumption of non-advertised brands. Future research should examine exposure-consumption relationships longitudinally and in other media.

Brands matter: Major findings from the Alcohol Brand Research Among Underage Drinkers (ABRAND) project.

BACKGROUND: Alcohol research focused on underage drinkers has not comprehensively assessed the landscape of brand-level drinking behaviors among youth. This information is needed to profile youth alcohol use accurately, explore its antecedents, and develop appropriate interventions. METHODS: We collected national data on the alcohol brand-level consumption of underage drinkers in the United States and then examined the association between those preferences and several factors including youth exposure to brand-specific alcohol advertising, corporate sponsorships, popular music lyrics, and social networking sites, and alcohol pricing. This paper summarizes our findings, plus the results of other published studies on alcohol branding and youth drinking. RESULTS: Our findings revealed several interesting facts regarding youth drinking. For example, we found that: 1) youth are not drinking the cheapest alcohol brands; 2) youth brand preferences differ from those of adult drinkers; 3) underage drinkers are not opportunistic in their alcohol consumption, but instead consume a very specific set of brands; 4) the brands that youth are heavily exposed to in magazines and television advertising correspond to the brands they most often report consuming; and 5) youth consume more of the alcohol brands to whose advertising they are most heavily exposed. CONCLUSION: The findings presented here suggests that brand-level alcohol research will provide important insight into youth drinking behaviors, the factors that contribute to youth alcohol consumption, and potential avenues for effective public health surveillance and programming.

Selection of branded alcoholic beverages by underage drinkers.

PURPOSE: The purpose of this study was to identify reasons why youth choose to drink specific brands of alcohol and to determine if these reasons are associated with problem drinking patterns and outcomes. METHODS: We conducted an Internet survey of 1,031 youth aged 13-20 years who reported drinking within the past 30 days. Of these, 541 youth who reported having a choice of multiple brands of alcohol the last time they drank stated (yes/no) whether each of 16 different reasons had influenced their choice of a specific brand. We reduced these 16 reasons to three principal components and used latent class modeling to identify five groups of youth with similar reasons for selecting a brand, which we then profiled. RESULTS: We grouped respondents into the following brand selection groups: "Brand Ambassadors" who were distinguished from other clusters by selecting a brand because they identified with it (32.5% of respondents), "Tasters" who selected a brand because they expected it to taste good (27.2%), "Bargain Hunters" who selected a brand because it was inexpensive (18.5%), "Copycats" who selected a brand because they had seen adults drinking it or seen it consumed in movies or other media (10.4%), and "Others" (11.5%). Brand ambassadors and copycats reported the largest amount of alcohol consumed and had the greatest prevalence of both heavy episodic drinking and negative alcohol-related health consequences. CONCLUSIONS: Underage drinkers who cite marketing influences and adult or media modeling of brand choices as their reasons for selecting alcohol brands are likely to drink more and incur adverse consequences from drinking.

Brand preferences of underage drinkers who report alcohol-related fights and injuries.

BACKGROUND: A significant body of research has demonstrated an association between adolescent alcohol consumption and subsequent fights and injuries. To date, however, no research has identified which brands are associated with alcohol-related fights and injuries among underage drinkers. OBJECTIVES: We aimed to: (1) report the prevalence of alcohol-related fights and injuries among a national sample of underage drinkers in the U.S. and (2) describe the relationship between specific alcohol brand consumption and these alcohol-related negative consequences. METHODS: We recruited 1,031 self-reported drinkers (ages 13-20 years) via an internet panel maintained by Knowledge Networks to complete an online survey. Respondents reported their past-month overall and brand-specific alcohol consumption, risky drinking behavior, and past-year alcohol-related fights and injuries. RESULTS: Over one-quarter of the respondents (26.7%, N = 232) reported at least one alcohol-related fight or injury in the past year. Heavy episodic drinkers were over six times more likely to report one of these negative alcohol-related consequences (AOR: 6.4, 95% CI: 4.1-9.9). Respondents of black race and those from higher-income households were also significantly more likely to report that experience (AOR: 2.2, 95% CI: 1.3-3.7; AOR: 1.8, 95% CI: 1.1-3.0 and 1.1-3.2, respectively). We identified eight alcohol brands that were significantly associated with alcohol-related fights and injuries. CONCLUSIONS/IMPORTANCE: Alcohol-related fights and injuries were frequently reported by adolescent respondents. Eight alcohol brands were significantly more popular among drinkers who experienced these adverse consequences. These results point to the need for further research on brand-specific correlates of underage drinking and negative health outcomes.

The relationships between alcohol source, autonomy in brand selection, and brand preference among youth in the USA.

AIMS: We aimed to describe the sources from which youth in the USA commonly obtain alcohol, their role in selecting the brands they drink and the relationship of these variables to their indicated alcohol brand preferences. METHODS: We recruited 1031 underage drinkers in the age range of 13-20 through an internet panel managed by Knowledge Networks. Respondents completed an online survey assessing their recent brand-specific alcohol use, the source of their most recently consumed alcohol and whether the respondent or another person selected the brand they drank. RESULTS: Alcohol sources were more often passive than transactional. Nearly equal proportions of youth reported that they did versus did not choose the brand of their most recent drink. Analysis revealed that the brand preferences of passive versus active source drinkers were highly similar, as were the brand preferences of respondent versus non-respondent choice drinkers. Stratification of respondents by age did not significantly change these results. CONCLUSION: Our findings suggest that youth are consuming a homogenous list of preferred brands regardless of the source of their most recently obtained alcohol or who selected the brand they drank.

A comparison between brand-specific and traditional alcohol surveillance methods to assess underage drinkers' reported alcohol use.

BACKGROUND: Adolescent alcohol consumption remains common and is associated with many negative health outcomes. Unfortunately, common alcohol surveillance methods often underestimate consumption. Improved alcohol use measures are needed to characterize the landscape of youth drinking. OBJECTIVES: We aimed to compare a standard quantity-frequency measure of youth alcohol consumption to a novel brand-specific measure. METHODS: We recruited a sample of 1031 respondents across the United States to complete an online survey. Analyses included 833 male and female underage drinkers ages 13-20. Respondents reported on how many of the past 30 days they consumed alcohol, and the number of drinks consumed on an average drinking day. Using our brand-specific measure, respondents identified which brands they consumed, how many days they consumed each brand, and how many drinks per brand they usually had. RESULTS: Youth reported consuming significantly more alcohol (on average, 11 drinks more per month) when responding to the brand-specific versus the standard measure (p < 0.001). The two major predictors of the difference between the two measures were being a heavy episodic drinker (p < 0.001, 95% CI = 4.1-12.0) and the total number of brands consumed (p < 0.001, 95% CI = 2.0-2.8). CONCLUSION: This study contributes to the field of alcohol and adolescent research first by investigating a potentially more accurate alcohol surveillance method, and secondly by promoting the assessment of alcohol use among adolescents vulnerable to risky alcohol use. Finally, our survey addresses the potential impact of alcohol marketing on youth and their subsequent alcohol brand preferences and consumption.