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.

Unintentional and undetermined firearm related deaths: a preventable death analysis for three safety devices.

OBJECTIVE: To determine the proportion of unintentional and undetermined firearm related deaths preventable by three safety devices: personalization devices, loaded chamber indicators (LCIs), and magazine safeties. A personalized gun will operate only for an authorized user, a LCI indicates when the gun contains ammunition, and a magazine safety prevents the gun from firing when the ammunition magazine is removed. DESIGN: Information about all unintentional and undetermined firearm deaths from 1991-98 was obtained from the Office of the Chief Medical Examiner for Maryland, and from the Wisconsin Firearm Injury Reporting System for Milwaukee. Data regarding the victim, shooter, weapon, and circumstances were abstracted. Coding rules to classify each death as preventable, possibly preventable, or not preventable by each of the three safety devices were also applied. RESULTS: There were a total of 117 firearm related deaths in our sample, 95 (81%) involving handguns. Forty three deaths (37%) were classified as preventable by a personalized gun, 23 (20%) by a LCI, and five (4%) by a magazine safety. Overall, 52 deaths (44%) were preventable by at least one safety device. Deaths involving children 0-17 (relative risk (RR) 3.3, 95% confidence interval (CI) 2.1 to 5.1) and handguns (RR 8.1, 95% CI 1.2 to 53.5) were more likely to be preventable. Projecting the findings to the entire United States, an estimated 442 deaths might have been prevented in 2000 had all guns been equipped with these safety devices. CONCLUSION: Incorporating safety devices into firearms is an important injury intervention, with the potential to save hundreds of lives each year.

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.

Factors preventing gun acquisition and carrying among incarcerated adolescent males.

CONTEXT: Despite the wide availability of guns in the United States, not all delinquent adolescents own guns and not all adolescent gun owners carry them at all times. Research about the factors that prevent high-risk youth from acquiring and carrying guns is limited. OBJECTIVE: To determine, from the perspective of incarcerated adolescent males, factors that prevent acquiring or carrying guns, either on a temporary or permanent basis. DESIGN AND SETTING: In-depth, semistructured interviews were conducted with randomly selected incarcerated adolescent males at a residential juvenile justice facility from January to May 1998. Transcribed interviews were examined for recurrent themes. PARTICIPANTS: Forty-five incarcerated adolescent males. MAIN OUTCOME MEASURES: Reported factors limiting gun acquisition and carrying. RESULTS: Seventy-one percent of the sample had either owned or carried a gun out of their home. We identified 6 recurring themes that, at least on occasion, prevented or delayed delinquent youth from acquiring or carrying guns. The most commonly cited factors were fear of being arrested and incarcerated and lack of perceived need for a gun. Other themes included not wanting to hurt oneself or others, respect for the opinions of others, inability to find a source for a desired gun, and lack of money to acquire a desired gun. CONCLUSIONS: We identified 6 factors that limited gun acquisition and carrying among a sample of incarcerated male adolescents. Knowledge of these factors should inform intervention efforts to reduce youth gun acquisition and carrying.

Reexamining the association between child access prevention gun laws and unintentional shooting deaths of children.

CONTEXT: A previous study estimated that child access prevention (CAP) laws, which hold adults criminally liable for unsafe firearm storage in the environment of children, were associated with a 23% decline in unintentional firearm mortality rates among children. OBJECTIVE: To reassess the effects of CAP laws and more fully examine the consistency of the estimated law effects across states. DESIGN: A pooled time-series study of unintentional firearm mortality among children from 1979 through 1997. Setting. The 50 states and the District of Columbia. PARTICIPANTS: All children <15 years. MAIN OUTCOME MEASURES: Rates of unintentional deaths attributable to firearms. RESULTS: When the effects of all 15 state CAP laws enacted before 1998 were aggregated, the laws were associated with a 17% decline unintentional firearm death rates among children. The laws' effects were not equal across states. Florida's CAP law was associated with a 51% decline; however, there were no statistically significant aggregate or state-specific law effects in the other 14 states with CAP laws. CONCLUSIONS: Florida's CAP law-1 of only 3 such laws allowing felony prosecution of violators-appears to have significantly reduced unintentional firearm deaths to children. However, there is no evidence of effects in the other 14 states with CAP laws.

Effects of Maryland's law banning Saturday night special handguns on crime guns.

OBJECTIVES: To determine the effects of a 1988 Maryland law that banned "Saturday night special" handguns on the types of guns used in crime. To determine if controls on the lawful market for handguns affect the illegal market as well. SETTING: Baltimore, Maryland, and 15 other US cities participating in a crime gun tracing project. METHODS: Cross sectional comparison of the proportion of crime guns that are banned by the Maryland law, comparing Baltimore, MD with 15 other cities outside of Maryland. Multivariate linear regression analysis to determine if observed differences between Baltimore and 15 other cities are explained by demographic or regional differences among the cities rather than Maryland's law. RESULTS: Among crime guns, a gun banned by Maryland's law is more than twice as likely (relative risk (RR) 2.3, 95% confidence interval (CI) 2.0 to 2.5) to be the subject of a crime gun trace request in 15 other cities combined, than in Baltimore. Among homicide guns, a crime especially relevant for public safety, a comparable difference (RR 2.1, 95% CI 1.1 to 4.2) was observed. The proportion of Baltimore's crime guns that are banned is 12 percentage points lower than would be expected based on its demographic and regional characteristics alone. Among crime guns purchased after 1990, a much smaller proportion in Baltimore are banned models than in 15 other cities. CONCLUSIONS: Maryland's law has reduced the use of banned Saturday night specials by criminals in Baltimore. Contrary to the claims of some opponents of gun control laws, regulation of the lawful market for firearms can also affect criminals.

Beliefs about the risks of guns in the home: analysis of a national survey.

OBJECTIVES: While epidemiological evidence suggests homes with guns are more likely to be the site of a suicide or homicide than homes without guns, the public's perception of these risks remains unknown. This study assesses the prevalence of the belief that homes with guns are safer than homes without guns, and factors associated with this belief. METHODS: Telephone interviews were conducted with a random sample of 4138 registered voters in urban areas in the US. Multinomial logistic regression was used to assess correlates of beliefs about the safety of keeping a gun in the home. RESULTS: Twenty nine per cent of respondents believed keeping a gun in the home makes the home more safe, 40% said less safe, 23% said it depends, and 9% were unsure. The belief that a home is more safe with a gun was associated with being male, young, completing 12 years or fewer of education, having no children living at home, Republican party affiliation, and low levels of trust in the police for protection. Prior exposure to violence and fear of victimization were not associated with the outcome. CONCLUSIONS: Findings may increase understanding about the public's perception of the risk in keeping guns in the home and assist educational efforts to decrease the risk of these injuries.

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 public's 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.

Flawed gun policy research could endanger public safety.

A highly publicized recent study by Lott and Mustard concludes that laws easing restrictions on licenses for carrying concealed firearms in public substantially reduce violent crime. Several serious flaws in the study render the authors' conclusions insupportable. These flaws include misclassification of gun-carrying laws, endogeneity of predictor variables, omission of confounding variables, and failure to control for the cyclical nature of crime trends. Most of these problems should bias results toward overestimating the crime-reducing effects of laws making it easier to carry concealed firearms in public. Lott and Mustard's statistical models produce findings inconsistent with criminological theories and well-established facts about crime, and subsequent reanalysis of their data challenges their conclusions. Public health professionals should understand the methodological issues raised in this commentary, particularly when flawed research could influence the introduction of policies with potentially deleterious consequences.

Regulating firearm advertisements that promise home protection. A public health intervention.

Firearms are a consumer product responsible for 38500 deaths in the United States in 1994. Like other products, firearms are advertised. In the absence of rules governing the design of firearms, regulating the way guns are advertised may be a useful public health intervention. Some gun advertisements include messages suggesting that bringing a handgun into the home is generally protective for the occupants of the home. The best available scientific information contradicts this message. Given this disjunction, regulating those advertisements may be an appropriate response. Under federal law, the Federal Trade Commission (FTC) has authority to prohibit advertisements that are "deceptive" or "unfair." Under the FTC's deception analysis, the focus is on whether consumers are misled by an advertisement. For a finding of unfairness, the FTC looks for advertisements that may cause substantial injury to consumers. Under either analysis, a strong argument can be made that firearm advertisements promising home protection are unlawful. On February 14, 1996, several organizations sent separate petitions to the FTC asking it to consider the issues raised by firearm advertisements that promise home protection. The FTC is still reviewing the information presented. There are no First Amendment or Second Amendment impediments to FTC regulation of deceptive firearm advertising under the US Constitution.

Gun violence among youth and the pediatrician's role in primary prevention.

Adolescence is a developmental stage characterized by high rates of violent behavior. Increasingly, violent injury is involving preadolescent children. Evidence suggests that the availability of guns increases the lethality of violent acts. Because guns are ubiquitous in the United States and integral to the current epidemic of youth violence, pediatricians should participate in primary prevention of firearm injuries. Efforts should begin long before children reach adolescence. Pediatricians should: (1) Encourage parents to remove guns from the home, or at a minimum to keep guns unloaded and locked up; (2) Advise parents to limit viewing of gun violence in the media, and playing with toy guns and video games that involve shooting; (3) Be alert for early indicators of aggressive behavior; and (4) Become outspoken advocates for laws that restrict gun availability.

Weapon carrying among inner-city junior high school students: defensive behavior vs aggressive delinquency.

OBJECTIVES: The purpose of this study was to estimate associations between beliefs and experiences hypothesized to be related to weapon carrying among youths. METHODS: Students in two inner-city junior high schools completed anonymous questionnaires. Logistic regression models were fit for having ever carried a weapon for protection or use in a fight and were stratified by sex and weapon type. RESULTS: Among males, 47% had carried knives and 25% had carried guns. Key risk factors for knife carrying were being threatened with a knife, getting into fights, and disbelief that having a weapon increases the carrier's risk of injury. Gun carrying was associated with having been arrested, knowing more victims of violence, starting fights, and being willing to justify shooting someone. Among females, 37% had carried a knife; knowing many victims of violence and being willing to justify shooting someone predicted knife carrying. CONCLUSIONS: Knife carrying was associated with aggressiveness but did not appear to be related to serious delinquency. Gun carrying within this nonrandom sample appeared to be a component of highly aggressive delinquency rather than a purely defensive behavior.

A youth violence prevention program. Description and preliminary evaluation.

PROBLEM STATEMENT: In response to growing violence, primary prevention programs have been launched, but scientific rationale and credible evaluations have been lacking. METHODS: Fifth and seventh-grade students in three inner-city schools (n = 135) participated in a violence prevention program. Controls consisted of students from the same schools and grades during the following school year (n = 115). Students were taught social problem-solving skills and risk factors for violence. Multivariate analyses were performed on posttest measures while controlling for base-line differences. RESULTS: Program participants were much less likely to define social problems in adversarial ways, were less likely to provide violent solutions in hypothetical conflict situations, listed more negative consequences to using violence, and were less inclined to legitimatize violence. Risk factor knowledge also was significantly increased. No increase was shown in the students' abilities to identify viable nonviolent solutions. CONCLUSIONS: The program produced immediate influences on knowledge and some attitudes and social skills shown to be related to aggressive behavior.

Associated aortic rupture-pelvic fracture: an alert for orthopedic and general surgeons.

Blunt trauma patients with pelvic fractures have been shown to have a two-fold to five-fold increased risk of aortic rupture compared with the overall blunt trauma population. A retrospective review was performed to determine whether the relationship between aortic rupture and pelvic fracture could be further delineated using a pelvic fracture classification based on mechanism of injury. Of 4,157 consecutive blunt trauma patients, 371 (8.9%) had pelvic fractures, 34 (0.8%) had ruptured thoracic aortas and 12 had both injuries. When pelvic fractures were classified according to vector of force, 10 of 12 (83%) aortic ruptures occurred in patients with an anterior-posterior compression fracture pattern, an incidence of aortic rupture eight times greater than that of the overall blunt trauma population. There was no increased incidence of aortic rupture among patients with any other pelvic fracture pattern. We conclude that the previously reported association between aortic rupture and pelvic fracture can be further specified to include, predominantly, those patients with an anterior-posterior compression fracture pattern.

Epidemiologic changes in gunshot wounds in Washington, DC, 1983-1990.

The purpose of this study was to examine temporal patterns in gunshot wound admission rates and wound profiles from 1983 through 1990 at a level I trauma center in Washington, DC. Data on trauma admissions were collected at the time of admission. Records were reviewed to identify patients admitted for gunshot wounds from assaults. Data on the number and location of entrance gunshot wounds, survival, complications, length of stay in the intensive care unit, and total inpatient days were recorded. Admissions due to gunshot wounds grew at an exponential rate beginning in 1987 and reached a level from 1989 through 1990 three times higher than the preepidemic rate. The mean number of entrance gunshot wounds per patient grew from 1.44 before the epidemic to 2.04 from 1988 through 1990. Multiple thoracic wounds became relatively more common from 1988 through 1990. This increase was partially responsible for reversing a downward trend in patient mortality. Temporal changes in admission rates and wound profiles were consistent with the city's epidemic of drug-related violence and with a shift in weaponry toward high-capacity, semiautomatic handguns.

Firearm injury prevention counseling: a study of pediatricians' beliefs and practices.

Members of the Maryland Chapter of the American Academy of Pediatrics completed a mail survey on their beliefs and counseling practices related to firearm injury prevention. Respondents were skeptical of the protective value of firearms in the home and most were supportive of gun control measures. Only a fifth believed that most families with handguns keep them inaccessible to children; however, many seemed to believe that the children at risk were in practices other than their own. Among those providing direct ambulatory care, 40% had had a patient who had been shot. Seventy-four percent believed pediatricians have a responsibility to counsel families about firearms. Only 13% believed parents would be offended if guns were included in anticipatory guidance discussions. Even so, only 30% had ever provided such counseling. Just half of the respondents agreed that they knew what to tell families about firearms. Ninety percent were very likely to counsel parents to store guns unloaded and locked up, whereas 54% were very likely to advise parents to remove guns from the home. More than two thirds believed parents would heed their advice about storing firearms, and 30% believed parents would follow advice about having guns. Results suggest pediatricians are ready to counsel about firearm injury prevention, but are not yet doing so.

Parents' beliefs about preventing gun injuries to children.

Data were collected from parents bringing children to selected pediatric practices in Maryland using questionnaires and focus group discussions. Gun ownership ranged from 27% in the suburban practice to 53% in the rural practice. Unrealistic perceptions of children's capabilities and behavioral tendencies with regard to guns were common among gun owners. Half of all gun-owning parents believed that active strategies (eg, education, supervision) were the best method of preventing gun injuries to children older than 12 years of age. Nearly all gun owners indicated a willingness to follow their pediatrician's advice about gun storage, but only 19% of the mothers and 10% of the fathers said they would follow advice to remove guns from the home. Among parents who did not have a gun in the home, 40% said they would consider obtaining one if they felt threatened; however, 73% of these parents indicated they would be dissuaded from doing so by a pediatrician's advice about the risks of keeping guns in the home. Results suggested that pediatricians will be most effective if they recommend passive strategies (eg, removing guns from the home or storing guns unloaded and locked) on the basis of children's developmental capabilities and behavioral tendencies and make their recommendations part of general counseling about child safety.