A novel gun law strength index and influential state gun laws for firearm homicide in the United States, 1999-2018.

OBJECTIVES: Although some existing indices quantified the mixture strength of state gun laws, methodological supports are still lacking. The study aimed to build a new state gun law strength (GLS) index, evaluate the contribution of all state gun laws to the new index, and assess the association between the new index and firearm homicide mortality. STUDY DESIGN: This is a population-based ecological study. METHODS: We condensed 134 state gun laws into a mixture GLS index at the state level to quantify each state's overall GLS by using the weighted quantile sum regression in each year from 1999 to 2018. The weights of state gun laws in the GLS index revealed their influence on GLS. The model also estimated the association between the GLS index and state-level firearm homicide mortality. RESULTS: From 1999 to 2018, 15 of 134 (11.19%) state gun laws significantly contributed to the GLS index for firearm homicide every year, five of which related to the minimum age of possessing firearms. The most influential gun law was "no possession of handguns until age 21." The GLS index was significantly and negatively associated with firearm homicide mortality; however, the association gradually diminished over time. CONCLUSIONS: The GLS index has methodological support and can take different gun violence outcomes into account. Future research can adopt the GLS index to conduct additional gun violence research or apply the modeling approach to build new GLS indexes for other gun violence outcomes.

The lagged effect of state gun laws on the reduction of state-level firearm homicide mortality in the United States from 1999 to 2017.

OBJECTIVES: Gun violence is a pressing concern in the United States, where many laws targeting gun violence vary across states and localities. Studies have investigated the association between gun laws and gun violence, but not many focus on the role of time, which is critical for implementation. This study aims to determine the lagged association of gun laws with firearm homicide mortality to better understand the impacts of state gun laws over time. STUDY DESIGN: The design of this study is a longitudinal study. METHODS: This study applied the distributed lag non-linear model to assess the lagged association between firearm homicide mortality and the number of gun law provisions at the state level from 1999 to 2017. State gun law provisions were analyzed in aggregate and also across five groups of regulations. All estimates were transformed into relative risks (RRs). RESULTS: Regarding all state gun laws, regardless of how many gun law provisions were on the books in any year, a significantly reduced RR of firearm homicide mortality was not observed until 7 years later. Among the five regulation groups, a significant RR less than 1 was more likely to happen in longer lags ≥5. The lowest significant RR = 0.24 (95% confidence interval = 0.15, 0.39) was observed in the gun types, components, and trafficking group at lag 8. All regulation groups had an overall impact to reduce significantly the RR of firearm homicide mortality with more gun law provisions, except for the dealer regulation group. CONCLUSIONS: State gun law provisions appear to impact firearm homicide mortality differently over time. This emphasizes the centrality of enforcement. Firearm policy researchers need to consider how specific gun laws are implemented over time to help inform law-based interventions.

Health impact assessment as an instrument to examine the health implications of education policies.

OBJECTIVES: Health impact assessment (HIA) is a systematic process that can be used by public health professionals to examine the potential health effects of a policy, plan, program, or project that originates outside of the health sector. This article presents a case study of how an interdisciplinary team utilized an HIA to analyze the potential health impact of full-day kindergarten (FDK) on communities in Nevada. STUDY DESIGN: Case study. METHODS: With stakeholder and community engagement, we conducted a multistage HIA that included qualitative and quantitative data collection and analysis, a review of existing literature, and projections. The team considered several pathways through which FDK could impact health in Nevada: (1) school performance; (2) physical development (physical activity and nutrition education); and (3) access to school-based meals and health screenings. RESULTS: Findings indicated that access to FDK could enhance opportunities for Nevada's children to harness school-based services, increase physical activity, and promote nutrition education. In addition, based on existing research that suggests relationships between (1) FDK attendance and 3rd and 5th grade math and reading standardized test scores and (2) 3rd and 5th grade test scores and high school graduation, as well as available state and national data, we estimated that access to FDK could increase high school graduation in Nevada by 499-820 students per year. CONCLUSIONS: This HIA demonstrated that access to FDK could impact both student and adult health in Nevada. Our engagement of public health professionals along with stakeholders and the community in the HIA process demonstrated that HIAs can be an important tool for public health professionals to examine the effects on community health of policies, programs, plans or projects that arise outside of the health sector.