US Residents' Recognition of Proper Use of Firearm Cable Locks.

This survey study examines the ability of firearm owners and nonowners to determine correct and incorrect cable lock use across different types of firearms.

Public health framing of firearm violence on local television news in Philadelphia, PA, USA: a quantitative content analysis.

BACKGROUND: Firearm violence is an intensifying public health problem in the United States. News reports shape the way the public and policy makers understand and respond to health threats, including firearm violence. To better understand how firearm violence is communicated to the public, we aimed to determine the extent to which firearm violence is framed as a public health problem on television news and to measure harmful news content as identified by firearm-injured people. METHODS: This is a quantitative content analysis of Philadelphia local television news stories about firearm violence using a database of 7,497 clips. We compiled a stratified sample of clips aired on two randomly selected days/month from January-June 2021 from the database (n = 192 clips). We created a codebook to measure public health frame elements and to assign a harmful content score for each story and then coded the clips. Characteristics of stories containing episodic frames that focus on single shooting events were compared to clips with thematic frames that include broader social context for violence. RESULTS: Most clips employed episodic frames (79.2%), presented law enforcement officials as primary narrators (50.5%), and included police imagery (79.2%). A total of 433 firearm-injured people were mentioned, with a mean of 2.8 individuals shot included in each story. Most of the firearm-injured people featured in the clips (67.4%) had no personal information presented apart from age and/or gender. The majority of clips (84.4%) contained at least one harmful content element. The mean harmful content score/clip was 2.6. Public health frame elements, including epidemiologic context, root causes, public health narrators and visuals, and solutions were missing from most clips. Thematic stories contained significantly more public health frame elements and less harmful content compared to episodic stories. CONCLUSIONS: Local television news produces limited public health coverage of firearm violence, and harmful content is common. This reporting likely compounds trauma experienced by firearm-injured people and could impede support for effective public health responses to firearm violence. Journalists should work to minimize harmful news content and adopt a public health approach to reporting on firearm violence.

Evaluating Firearm Violence After New Jersey's Cash Bail Reform.

Importance: Reducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence. Objective: To evaluate changes in firearm violence after New Jersey's 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention. Design, Setting, and Participants: This case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024. Exposure: Implementation of New Jersey's cash bail reform law in 2017. Main Outcomes and Measures: Quarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people. Results: Although New Jersey's pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, -0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, -0.24 deaths per 100 000), or within racialized groups during the postpolicy period. Conclusions and Relevance: Incarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.

Addressing Systemic Racism and Racialized Violence to Reduce Firearm Injury and Mortality Inequities.

This JAMA Forum discusses systemic racism and racialized violence, promising approaches to address inequities in firearm violence, and ways to treat the trauma of gun violence.

Receptivity of providing firearm safety storage devices to parents along with firearms safety education.

Background: In the United States, 33% of households with children contain firearms, however only one-third reportedly store firearms securely. It's estimated that 31% of unintentional firearm injury deaths can be prevented with safety devices. Our objective was to distribute safe storage devices, provide safe storage education, evaluate receptivity, and assess impact of intervention at follow-up. Method: At five independent, community safety events, parents received a safe storage device after completing a survey that assessed firearms storage methods and parental comfort with discussions regarding firearm safety. Follow-up surveys collected 4 weeks later. Data were evaluated using descriptive analysis. Result: 320 participants completed the surveys, and 288 participants were gunowners living with children. Most participants were comfortable discussing safe storage with healthcare providers and were willing to talk with friends about firearm safety. 54% reported inquiring about firearm storage in homes their children visit, 39% stored all their firearms locked-up and unloaded, 32% stored firearms/ammunition separately. 121 (37%0.8) of participants completed the follow-up survey, 84% reported using the distributed safety device and 23% had purchased additional locks for other firearms. Conclusion: Participants were receptive to firearm safe storage education by a healthcare provider and distribution of a safe storage device. Our follow up survey results showed that pairing firearm safety education with device distribution increased overall use of safe storage devices which in turn has the potential to reduce the incidence of unintentional and intentional self-inflicted firearm injuries. Providing messaging to promote utilization of safe storage will impact a firearm safety culture change.

Strengthening the Role of the NIH in the Firearm Violence Epidemic: A Modest Proposal.

This Viewpoint discusses the potential for the National Institutes of Health (NIH), the premier research entity in the world, to significantly strengthen its investment in preventing and reducing firearm-related harms.

A PRISMA Scoping Review to Explore Interventions to Prevent Firearm-Related Injury and Suicide in Older Adults.

OBJECTIVES: This scoping review aims to examine existing research into firearm safety interventions designed to prevent firearm injury and suicide in older adults. METHODS: Select databases were searched in 5/2023. Included articles involved an/a 1. aim to develop or investigate firearm safety interventions, 2. focus on adults 50 years and older, and 3. primary analysis. RESULTS: The search yielded 10 articles which primarily focused on firearm safety counseling with older adults with suicide risk or emerging impairment. The review found that older adults may be open to receiving firearm safety counseling but that providers feel ill-equipped to have these conversations and to reliably identify suicide risk. Two studies presented promising data on the impact and acceptability of training providers in a firearm safety intervention. The review also identified the importance of building trust between older patients and providers to have helpful discussions regarding firearms, and highlighted specific approaches that facilitate openness to participate in these exchanges. CONCLUSIONS: Further research into adapting interventions to meet the clinical needs of older adults and treatment efficacy trials is necessary. CLINICAL IMPLICATIONS: Training healthcare providers to conduct firearm safety interventions with older adults may be an acceptable and impactful avenue to prevent suicide.

Emergency Preparedness Drills for Active and Mass Shootings in Schools.

PURPOSE OF REVIEW: There is widespread use of emergency preparedness drills in public K-12 schools across the US, but considerable variability exists in the types of protocols used and how these practices are conducted. This review examines research into both "lockdown drills" and "active shooter drills" as it relates to their impact on participants across different outcomes and evaluations of their procedural integrity. RECENT FINDINGS: A number of studies on lockdown drills yielded largely consistent findings about their impacts, whereas findings related to the effects of active shooter drills are less uniform. The research also demonstrated that lockdown drills, though not active shooter drills, can help participants build skill mastery to be able to successfully deploy the procedure. Differences in how drills impact participants and whether they cultivate skill mastery are largely attributable to the type of drill being conducted. This review suggests that employing clearly defined drill procedures incorporating best practices, coupled with instructional training, can help schools prepare for emergencies without creating trauma for participants.

Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare® providers in the U.S.

Background: Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs. Methods: Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors. Results: Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury. Conclusion: SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.

Trends in Firearm Injury Prevention Research Funding, Clinical Trials, and Publications in the US, 1985-2022.

This cross-sectional study examines federal funding, registered clinical trials, and publications to quantify trends in firearm injury prevention research in the US from 1985 to 2022.

Urban Teen Perspectives on Gun Violence: a Mixed Methods Study.

We aimed to explore perspectives of teenagers on their exposure to gun violence (GV), their knowledge and attitudes towards firearm injury prevention (FIP) efforts, and how to counsel them about FIP. Teens from two single-sex Bronx Catholic high schools participated in videoconferencing focus groups. Participants completed an online survey collecting demographic information and Likert-scale scoring of attitudes towards GV. Quantitative data was analyzed with descriptive statistics. Focus group discussions were recorded and transcribed. Using Dedoose, two investigators independently coded data and achieved consensus using content analysis. Six focus groups (3 from each school, n = 28 participants) were held from October-November 2020. A total of 27 participants completed the survey. Eighty-one percent of respondents agreed "Doctors should talk to teens about gun safety." During focus groups, participants reported personal, community, and entertainment media exposure to GV. GV elicited many emotions, including fear and frustration. Teens identified factors contributing to GV that should be addressed, including poverty, racism, and mental illness. Most had not received prior FIP education and desired more information from trusted adults. They preferred discussions over written materials and information given over time. Teens were open to doctors counseling on FIP during healthcare visits and suggested including screening questions on surveys, conversations during healthcare maintenance visits, and classroom talks by physicians. Bronx teens are exposed to and distressed by community GV. They desired more FIP education, including physician counseling during healthcare visits. Next steps are to create and test FIP guidance for adolescents.

Strategies for recruiting adolescents in rural areas in firearm injury research.

BACKGROUND: Participant recruitment is a central aspect of human sciences research. Barriers to participant recruitment can be categorised into participant, recruiter and institutional factors. Firearm injury research poses unique barriers to recruitment. This is especially true for rural adolescents, who are at high risk for firearm-related injury and death, and whose voice is often absent in firearms research. In particular, recruitment strategies targeting adolescents should align with developmental changes occurring during this life stage. Identifying strategies to address recruitment barriers tailored to firearm-related research can help future researchers engage rural adolescents in injury prevention efforts. PURPOSE: The purpose of the current methodology paper is to outline barriers and provide strategies for recruiting rural adolescents in firearms research informed by the Youth Experiences in Rural Washington: Research on Firearm Safety project, a mixed-methods, community-based participatory research study of 13-18 year-olds residing in rural Washington. STRATEGIES: Recruitment barriers and related strategies were organised by participant-related and recruiter-related/institutional-related factors. While carrying out the study, key considerations or strategies which addressed multiple participant and recruiter/institutional factors, emerged with potential to enhance firearm-related research with rural adolescents more broadly. Key considerations included logistics (ie, scheduling flexibility, adequate and aligned incentives), use of a community-based participatory research approach and accounting for developmental stage. CONCLUSION: Reducing the burden of firearm injury and death for rural adolescents and developing effective interventions requires understanding and navigating recruitment barriers. Strategies used in the current project can guide future qualitative or mixed methods data collection informing firearm injury prevention.

Trends in Legal Firearm Transactions: A Possible Protective Role of Gun Law Strength.

INTRODUCTION: The United States (US) holds the highest personal firearm ownership among industrialized nations, with implications for firearm-related deaths tied to increased per capita gun ownership and varying gun laws. This study examines the influence of gun law strength on legal firearm transactions, positing a correlation between stronger laws and reduced transactions. The analysis, focused on the stress-laden COVID-19 pandemic, evaluates handgun, long gun, and multiple gun transactions in 2020 and 2021 compared to 2018-2019. METHODS: The Giffords Gun Law scorecard categorized states into the top 25 "strong" and bottom 25 "weak" gun law groups. Multivariate linear regressions assessed the association between strong gun law states and monthly National Instant Criminal Background Check System (NICS) data from 2018 to 2021. The study queried NICS for handgun, long gun, and multiple gun transactions, comparing median monthly transactions in 2018 and 2019 to 2020 and 2018-2020 to 2021. RESULTS: When evaluating gun law strength through multivariate linear regression models, stronger gun law states had fewer monthly NICS transactions for handguns, long guns, and multiple guns in 2020 and 2021 versus all comparison years (all P < .05). However, from 2018-2019 to 2020 and 2018-2020 to 2021, median monthly NICS transactions per 100,000 people for all gun types increased (all P < .05). CONCLUSION: Stricter gun laws correlated with decreased firearm transactions in stronger law states, yet handgun, long gun, and multiple gun transactions increased during the pandemic years of 2020 and 2021. Therefore, strengthening firearm legislation may be protective against the proliferation of firearms, which warrants further research.

Need More Reasons to Curb Gun Violence?

This collection of images considers complex ethical, public health, and sociopolitical dimensions of firearm injuries. Since many firearm bullets contain lead, visual parallels are drawn between clinical and public health approaches to managing lead poisoning and efforts to reduce gun violence. Like lead toxicity from paint or water, gun violence and toxicity from retained ballistic fragments can adversely influence health and should be a source of concern to clinicians.