Population-level effects on crime of recovering firearms from armed prohibited persons: intention-to-treat analysis of a pragmatic cluster-randomised trial in California cities.

BACKGROUND: Too little is known about the effectiveness of efforts to prevent firearm violence. We evaluated California's Armed and Prohibited Persons System (APPS), which identifies legal purchasers of firearms who have become prohibited persons and seeks to recover all firearms and ammunition to which they have access. DESIGN AND METHODS: This cluster-randomised pragmatic trial was made possible by APPS's expansion from a small pilot to a continuing statewide programme. We included 363 California cities, allocated to early (n=187) or later (n=176) intervention in blocks stratified by region within the state, and within region by population and violent crime rate. The study period began 1 February 2015; region-specific end dates ranged from 1 May 2015 to 1 February 2016. Analysis was on an intention-to-treat, difference-in-difference basis using generalised linear mixed models and generalised estimating equations with robust SEs. The population-level primary outcome measures were monthly city-level counts of firearm-related homicides, robberies and aggravated assaults. The primary model was adjusted for stratification variables; city-level population, population density, socioeconomic status and firearm purchasing; year; and month. FINDINGS: Allocation groups were well balanced on baseline characteristics and implementation measures. In adjusted models, allocation to early intervention was not associated with statistically significant differences in any primary outcome measure; these findings were robust to multiple sensitivity analyses. There was some heterogeneity across regions. CONCLUSIONS: The APPS intervention directly affects a very small percentage of the population, limiting its potential for population-level effects. Individual-level analyses may provide a better estimate of the intervention's effectiveness. TRIAL REGISTRATION NUMBER: NCT02318732.

Drugs, guns, and violent crime in California.

BACKGROUND: There is evidence linking use of controlled substances with perpetration of interpersonal violence. While the United States constitution protects the right to own a firearm, federal law prohibits firearm purchase and possession by persons believed to be at high risk for violence, including those who use controlled substances unlawfully. METHODS: We report here the results of a 13-year prospective observational study on the risk of violent crime associated with a history of criminal drug charges in a cohort of 79,678 legal purchasers of handguns in California in 2001. The main outcomes were post-purchase charges for any violent crime, violent Crime Index crimes (murder, rape, robbery, aggravated assault), and firearm-related violent crimes. The main exposure of interest was a history of pre-purchase charge(s) for drug-related offenses; we examined as a secondary exposure a history of marijuana-related charges. We estimated adjusted hazard ratios (aHR) with 95 % confidence intervals (CI) using Cox proportional hazards multiple events models. RESULTS: We found that legal handgun purchasers in California with a history of drug-related charges, even those with marijuana charges only, had triple the risk of a post-purchase violent crime charge compared to purchasers with no criminal charges (drug charges only: aHR=2.9, 95 % CI 2.2-3.8; marijuana charges only: aHR=3.3, 95 % CI 1.8-6.0). In addition, a criminal history of drug charges only vs. no criminal history was associated with increased risk of one or more violent crime charges after the first post-purchase arrest event (aHR=1.6, 95 % CI 1.2-2.3). CONCLUSION: It is incumbent on researchers and policy makers to understand the nature and causes of this risk in order to take effective steps towards mitigation.

Importance of categories of crime for predicting future violent crime among handgun purchasers in California.

BACKGROUND: Prohibiting the purchase and possession of firearms by those at risk of violence is an established approach to preventing firearm violence. Prior studies of legal purchasers have focused on convictions for specific crimes, such as violent misdemeanors and driving under the influence (DUI). We broaden that line of inquiry by investigating and comparing the associations between prior arrests for most categories of crime and subsequent arrest for violent offenses among legal handgun purchasers in California. METHODS: In this longitudinal cohort study of 79,678 legal handgun purchasers in California in 2001, we group arrest charges prior to their first purchases in 2001 according to categories defined by the Uniform Crime Report (UCR) Handbook. We use a gradient boosting machine to identify categories of offenses that are most important for predicting arrest for violent crime following firearm purchase. For each category identified, we then estimate the difference in risk of subsequent arrest for a violent offense using survival regression models. RESULTS: We identified eight crime categories with high predictive importance: simple assaults, aggravated assaults, vehicle violations, weapon, other crimes, theft, drug abuse, and DUI. Compared to purchasers with no prior arrests, those with a prior arrest for any one of the eight important categories and no other categories were found to be at increased risk of arrest for a Crime Index-listed violent crime (murder, rape, robbery, aggravated assault), with the greatest estimated risk corresponding to the simple assault UCR category (adjusted hazard ratio 4.0; 95% CI 2.8-5.9). Simple assault was also associated with the greatest risk for subsequent arrest for firearm violence (adjusted hazard ratio 4.6; 95% CI 2.4-9.0) and any violent offense (adjusted hazard ratio 3.7; 95% CI 2.7-5.0). CONCLUSION: The findings of this study suggest that prior arrests for a broad array of crimes, both violent and non-violent, are associated with risk of subsequent violent crimes, including Crime Index-listed violent crimes and firearm violence, among legal purchasers of firearms. Current policies aimed at restricting access to firearms for individuals at increased risk of violence should be re-examined considering these findings.

Prior Drug-Related Criminal Charges and Risk for Intimate Partner Violence Perpetration Among Authorized Purchasers of Handguns in California.

Intimate partner violence (IPV) is a considerable public health problem in the US, and evidence suggests that both drugs and firearms contribute to the risk of IPV and its severity. This study uses a retrospective, longitudinal cohort design to explore the association between past arrests, charges incurred in the legal process, and convictions for drug-related crimes, and risk of future arrest for IPV among legal handgun purchasers. The cohort included all legal purchasers of handguns in California in 2001 between the ages of 21 and 49 (n = 79,678), 156 of whom had pre-purchase drug charges and post-purchase IPV charges. We used Cox proportional hazards regression with age at time of handgun purchase, sex, and race/ethnicity, and an array of community characteristics as covariates. Over the study period (2001-2013), in comparison to handgun purchasers who had no charges or convictions prior to their index purchase, risk for future IPV arrest was increased for purchasers whose only prior charges were drug-related (aHR = 3.4 [95% CI: 2.4-4.9]) and purchasers who had both prior drug- and non-drug related charges (aHR = 4.9 [95% CI: 4.1-6.0]). The magnitude of the risk ratio was greater when multiple drug types were involved and when the person had been charged with both the use and sale of drugs. Our findings suggest that, among legal handgun purchasers, prior drug charges are associated with future risk of IPV arrests or convictions. Given the established link between firearm access and IPV severity and fatality, these findings may inform the development and enforcement of policies that reduce firearm access for those at elevated risk of perpetrating intimate partner violence.

Intimate Partner Violence and Subsequent Violent Offending Among Handgun Purchasers.

Perpetrators of intimate partner violence (IPV) often reoffend, and firearm access increases risk of severe injury or fatality. Prior research identifies an association between a history of violent misdemeanor convictions among handgun purchasers and increased risk of subsequent arrest for a violent crime; the risk associated specifically with an IPV criminal history remains largely unexplored. The current study examined a cohort of 76,311 California adults who legally purchased a handgun in 2001 and followed them through 2013. Compared with purchasers who had no criminal history at the time of purchase, those with a history of only IPV (n = 178) charges were at increased risk of subsequent arrest for a violent Crime Index crime (murder, rape, robbery, aggravated assault; adjusted hazard ratio [AHR], 2.6; 95% confidence interval [CI]: 1.4-5.1), any violent crime (AHR, 3.2; 95% CI: 2.0-5.1), and an IPV crime (AHR, 5.2; 95% CI: 3.0-9.0). Purchasers with both IPV and non-IPV charges demonstrated the greatest risk of re-arrest relative to those with no criminal history. Despite the strength of the relationship between IPV and subsequent arrest, a small proportion of handgun purchasers with an IPV criminal history were re-arrested for firearm violence crimes, limiting application for risk assessment purposes. Results affirm prior research identifying IPV as a risk factor for future offending.

Alcohol and drug offenses and suicide risk among men who purchased a handgun in California: A cohort study.

Firearm access is a risk factor for firearm suicide; substance use may confer additional risk. In this retrospective cohort study, we estimated the associations between prior alcohol and drug charges at the time of handgun purchase and subsequent suicide among men in California. The sample comprised all men who legally purchased a handgun in California in 2001 and who were age ≥ 21 at the time of acquisition (N = 101,377), identified in the California Department of Justice (CA DOJ) Dealer's Record of Sale database. Exposures included alcohol and drug criminal charges and convictions accrued January 1, 1990 until the first ('index') handgun acquisition in 2001, recorded in the CA DOJ Criminal History Information System. Outcomes included suicide and firearm suicide occurring after the index purchase and before January 1, 2016. A total of 1907 purchasers had alcohol charges, 1248 had drug charges, and 304 had both; 594 purchasers died by suicide (516 by firearm suicide). Compared with those with neither alcohol nor drug charges, those with alcohol charges had 2.20 times the hazard of suicide (95% confidence interval [CI], 1.39-3.46) and 2.22 times the hazard of firearm suicide (95% CI, 1.36-3.62). Risk was most elevated among those with more recent charges and those with 2 or more charges, and in the time period closest to the purchase. The associations for drug charges and the combination of alcohol and drug charges were not distinguishable from the null. Firearm owners with alcohol offenses may benefit from intervention to reduce firearm access and alcohol use.

Criminal charge history, handgun purchasing, and demographic characteristics of legal handgun purchasers in California.

BACKGROUND: The prevalence and characteristics of handgun purchasers' criminal charge histories have never been described for a large population of firearm owners, but such information is critical to understanding risk factors for subsequent violence in this population. We sought to characterize legal handgun purchasers in California and compare this group to the state population, to quantify the proportion with a criminal charge history at purchase, and to identify modifiable factors associated with of having such a history. METHODS: This cross-sectional study of all 79,927 legal handgun purchasers aged 21-49 years in California in 2001 used log-linear generalized additive models to identify factors associated with having a criminal charge history at purchase. Subjects are from a longitudinal study of incident criminal activity among handgun purchasers. RESULTS: The majority (91.03%) of purchasers were male; whites were overrepresented and Hispanics were underrepresented relative to their population size. At the time of purchase, 16.68%  had a criminal charge history and 10.71% had a criminal conviction. Among men with such a history, 31.28% had been charged with a violent crime and 16.54% had been charged with a firearm-related crime. The strongest factor associated with having a criminal charge history was redeeming a pawned handgun (prevalence ratio: 1.82; 95% confidence interval: 1.71, 1.93). CONCLUSIONS: Despite California's stringent firearm purchase laws, more than 1-in-6 handgun purchasers had a criminal charge history at purchase. This proportion may be higher in states with less restrictive firearm purchasing eligibility criteria.

Armed and prohibited: characteristics of unlawful owners of legally purchased firearms.

BACKGROUND: A substantial proportion of individuals who lawfully purchase firearms later become unlawful owners ('prohibited firearm owners'), usually following events associated with an increased risk for future violence. This high-risk population has not previously been described. We aimed to characterise all individuals in California's Armed and Prohibited Persons System (APPS), a statewide programme for recovering firearms from individuals who legally purchased them and later became prohibited from ownership. METHODS: We used univariate and bivariate statistics to describe and compare prohibited firearm owners in APPS with a random sample of non-prohibited firearm owners in relation to age, sex, race/ethnicity and type of firearms owned as of 1 February 2015. We also characterised the geographical distribution of prohibited firearm owners and described their prohibitions. RESULTS: Of the 18 976 prohibited firearm owners, most were men (93%), half were white (53%) and the mean age was 47 years. Prohibited firearm owners were more likely to be male and to be black or Hispanic people than non-prohibited owners. Both prohibited and non-prohibited firearm owners had an average of 2.6 firearms, mostly handguns. Nearly half (48%) of prohibited firearm owners had a felony conviction. Extrapolating from our findings, we estimated that there are approximately 100 000 persons in the USA who unlawfully maintained ownership of their firearms following a felony conviction. CONCLUSIONS: Retention of firearms among persons who become lawfully prohibited from possessing them is common in California. Given the nationwide dearth of a programme to recover such weapons, this is likely true in other states as well.

Association of Prior Convictions for Driving Under the Influence With Risk of Subsequent Arrest for Violent Crimes Among Handgun Purchasers.

Importance: Alcohol use is a risk factor for firearm-related violence, and firearm owners are more likely than others to report risky drinking behaviors. Objective: To study the association between prior convictions for driving under the influence (DUI) and risk of subsequent arrest for violent crimes among handgun purchasers. Design: In this retrospective, longitudinal cohort study, 79 678 individuals were followed up from their first handgun purchase in 2001 through 2013. The study cohort included all legally authorized handgun purchasers in California aged 21 to 49 years at the time of purchase in 2001. Individuals were identified using the California Department of Justice (CA DOJ) Dealer's Record of Sale (DROS) database, which retains information on all legal handgun transfers in the state. Exposures: The primary exposure was DUI conviction prior to the first handgun purchase in 2001, as recorded in the CA DOJ Criminal History Information System. Main Outcomes and Measures: Prespecified outcomes included arrests for violent crimes listed in the Crime Index published by the Federal Bureau of Investigation (murder, rape, robbery, and aggravated assault), firearm-related violent crimes, and any violent crimes. Results: Of the study population (N=79 678), 91.0% were males and 68.9% were white individuals; the median age was 34 (range, 21-49) years. The analytic sample for multivariable models included 78 878 purchasers after exclusions. Compared with purchasers who had no prior criminal history, those with prior DUI convictions and no other criminal history were at increased risk of arrest for a Crime Index-listed violent crime (adjusted hazard ratio [AHR], 2.6; 95% CI, 1.7-4.1), a firearm-related violent crime (AHR, 2.8; 95% CI, 1.3-6.4), and any violent crime (AHR, 3.3; 95% CI, 2.4-4.5). Among purchasers with a history of arrests or convictions for crimes other than DUI, associations specifically with DUI conviction remained. Conclusions and Relevance: This study's findings suggest that prior DUI convictions may be associated with the risk of subsequent violence, including firearm-related violence, among legal purchasers of handguns. Although the magnitude was diminished, the risk associated with DUI conviction remained elevated even among those with a history of arrests or convictions for crimes of other types.

Alcohol-Related Crimes And Risk Of Arrest For Intimate Partner Violence Among California Handgun Purchasers.

Intimate partner violence is a major public health problem in the US. Both firearms and alcohol have been documented to contribute to the risk and severity of this violence. Yet there has been little research examining the nexus of the two risk factors. This study sought to determine whether alcohol-related problems, as indicated by a history of conviction for offenses such as driving under the influence (DUI), were associated with risk for future intimate partner violence among authorized purchasers of handguns in California. Using a longitudinal cohort design, we found that purchasers with prior DUI convictions (and no other criminal history) had close to three times the risk of subsequent arrest for an intimate partner violence offense than did those with no criminal history at the time of the index firearm purchase. The regulation of firearm ownership among people with alcohol use problems may represent an important opportunity to reduce intimate partner violence and the escalation of firearm-related harm.

Firearms, alcohol and crime: convictions for driving under the influence (DUI) and other alcohol-related crimes and risk for future criminal activity among authorised purchasers of handguns.

Firearm violence frequently involves alcohol, but there are no studies of misuse of alcohol and risk for future violence among firearm owners. We examined the association between prior convictions for alcohol-related crimes, chiefly driving under the influence (DUI), and risk of subsequent arrest among 4066 individuals who purchased handguns in California in 1977. During follow-up through 1991, 32.8% of those with prior alcohol-related convictions and 5.7% of those with no prior criminal history were arrested for a violent or firearm-related crime; 15.9% and 2.7%, respectively, were arrested for murder, rape, robbery or aggravated assault. Prior alcohol-related convictions were associated with a fourfold to fivefold increase in risk of incident arrest for a violent or firearm-related crime, a relative increase greater than that seen for age, sex or prior violence. Prior convictions for alcohol-related crime may be an important predictor of risk for future criminal activity among purchasers of firearms.

Evaluation of California's Armed and Prohibited Persons System: study protocol for a cluster-randomised trial.

BACKGROUND AND OBJECTIVE: Too little is known about the effectiveness of efforts to prevent firearm violence. Our objective is to evaluate California's Armed and Prohibited Persons System (APPS), a law enforcement intervention that seeks to recover firearms from individuals who purchased them legally but subsequently became prohibited from having access to firearms. Prohibitions usually arise from events suggesting an increased risk for future violence. DESIGN AND STUDY POPULATION: This group-randomised trial involves approximately 20 000 APPS-eligible individuals in 1041 communities. Randomisation was performed at the community level, to early or later intervention (Group 1 and Group 2, respectively) with stratification by region, population and violent crime rate. METHODS: APPS is being implemented by the California Department of Justice. The principal outcome measure is the incidence of arrest for a firearm-related or violent crime. Primary analysis will be on an intention-to-treat basis, comparing individuals in Group 1 and Group 2 communities. Analyses will focus on time to event, using proportional hazards regression with adjustment for the clustered nature of the data and incorporating individual- and community-level characteristics. Secondary analyses will examine the effect of the intervention on an as treated basis, effects on subgroups, and effects on community-wide measures such as crime rates. DISCUSSION: APPS may have a significant impact on risk for future violence among members of its target population. The findings of this study will likely be generalisable and have clear implications for violence prevention policy and practice. TRIAL REGISTRATION NUMBER: NCT02318732.

Firearms and the incidence of arrest among respondents to domestic violence restraining orders.

BACKGROUND: Persons subject to domestic violence restraining orders (DVROs), known as respondents, are generally prohibited from possessing firearms. Efforts to enforce that prohibition have not been evaluated. The study objective was to determine whether associations exist between risk of incident arrest among DVRO respondents and 1) respondents' access to firearms, and 2) law enforcement recovery of firearms from respondents with access to them. METHODS: This was an observational study of 2,972 DVRO respondents in San Mateo County, California, 525 of whom were linked to firearms by standardized screening procedures. Enrollment occurred from May 2007 to June 2010 and follow-up through September 2010. Follow-up began when DVROs were served (or when issued if no date of service was available); median duration was 689 days. Principal exposures were access to firearms and, for subjects with access to firearms whose DVROs were served, contact by law enforcement personnel to recover those firearms. Main outcome measures were 1) incidence of arrest; 2) relative risk for arrest, adjusted for age, sex, prior criminal history, and duration of follow-up, assessed using logistic regression. RESULTS: Respondents linked to firearms were older than others and were more likely to have a history of prior arrest (49.7 % and 37.3 %, p < 0.0001). The incidence of arrest was 20.6 % for respondents linked to firearms and 21.1 % for others (p = 0.78). In multivariate models, access to firearms was associated with a modest, generally not statistically significant, decrease in risk for incident arrest. Among respondents who were linked to firearms and whose restraining orders were served, no statistically significant association existed between firearm recovery and risk for incident arrest. CONCLUSIONS: In this small study of DVRO respondents, findings are inconclusive for an association between access to firearms or firearm recovery and risk of incident arrest. Controlled trials on larger populations are indicated.

Epidemiology and clinical aspects of stray bullet shootings in the United States.

BACKGROUND: Stray bullet shootings contribute to a sense of risk in affected communities but have rarely been studied. We describe the epidemiology and clinical aspects of stray bullet shootings in the United States. METHODS: We defined a case as a shooting event involving death or injury to a person and meeting criteria for a stray bullet mechanism of injury. From March 1, 2008, to February 28, 2009, we conducted real-time surveillance using two automated Internet news searches for the term "stray bullet." Secondary searches were performed to identify new cases and additional news reports. RESULTS: We reviewed 1,996 non duplicate news reports for 501 shooting events, of which 284 (56.7%) met our case criteria. There were 317 persons injured by stray bullets, of whom 65 (20.5%) died. Most cases (59.2%) involved interpersonal violence. When compared with persons killed or injured in firearm-related assaults or unintentional shootings generally in the United States in 2007, those killed or injured by stray bullets were more likely to be female (44.8% and 10.7%, respectively; odds ratio, 7.4; 95% confidence interval, 5.9-9.3) and outside the age range 15 years to 34 years (55.5% and 27.0%, respectively; odds ratio, 5.6; 95% confidence interval, 4.3-7.3). Most stray bullet victims (81.4%) were apparently unaware of the events leading to the gunfire that caused their injuries. Shooters were predominantly male (95.9%); 62.0% were aged 15 years to 34 years. Eighteen deaths (27.7%) occurred at the scene of the shooting and 55 (84.6%) on the day of the shooting. The case-fatality ratio for stray bullet shootings was somewhat higher than that for firearm-related assaults or unintentional shootings in the United States in 2007. CONCLUSION: Stray bullet shootings are epidemiologically distinct from other firearm-related injury events. It is likely that not all stray bullet shootings were identified, there may have been differential reporting related to severity of outcome, and missing data were common. LEVEL OF EVIDENCE: Epidemiological study, level III.

Felonious or violent criminal activity that prohibits gun ownership among prior purchasers of handguns: incidence and risk factors.

BACKGROUND: Federal law prohibits firearm possession by felons and certain others. Little is known about criminal activity resulting in new ineligibility to possess firearms among persons who have previously purchased them. METHODS: Cohort study of handgun purchasers ages 21 to 49 in California in 1991, 2,761 with a non-prohibiting criminal history at the time of purchase and 4,495 with no prior criminal record, followed for up to 5 years. The primary outcome measures were the incidence and relative risk of conviction for a felony or violent misdemeanor resulting in ineligibility to possess firearms under (a) California law or (b) federal law. Secondary measures were the incidence and relative risk of conviction for murder, forcible rape, robbery, or aggravated assault; and of arrest for any crime. RESULTS: A new conviction for a felony or violent misdemeanor leading to ineligibility to possess firearms under federal law was identified for 0.9% of subjects with no prior criminal history and 4.5% of those with 1 or more prior convictions (hazard ratio, 5.1; 95% confidence interval, 3.3-7.7). Risk was related inversely to age and directly to the extent of the prior criminal history; incidence rates varied by a factor of 200 or more among subgroups based on these characteristics. CONCLUSIONS: Among legal purchasers of handguns, the incidence of new felonious and violent criminal activity resulting in ineligibility to possess firearms is low for those with no prior criminal history but is substantially higher for those with a prior criminal record and is affected by demographic characteristics.

Factors affecting a recently purchased handgun's risk for use in crime under circumstances that suggest gun trafficking.

While many handguns are used in crime each year in the USA, most are not. We conducted this study to identify factors present at the time of a handgun's most recent retail sale that were associated with its subsequent use in crime under circumstances suggesting that the handgun had been trafficked--purchased with the intent of diverting it to criminal use. Handguns acquired in multiple-gun purchases were of particular interest. Using data for 180,321 handguns purchased from federally licensed retailers in California in 1996, we studied attributes of the handguns, the retailers selling them, the purchasers, and the sales transactions. Our outcome measure was a handgun's recovery by a police agency, followed by a gun ownership trace, conducted by the Bureau of Alcohol, Tobacco, Firearms and Explosives, that determined (a) that the recovery had occurred within 3 years of the handgun's most recent purchase from a licensed retailer and (b) that the person who possessed the gun when it was recovered by police was not its most recent purchaser. Altogether, 722 handguns were recovered and had trace results that met the additional criteria. Handguns acquired in multiple-gun, same-day transactions were more likely to be traced than were single-purchase handguns (odds ratio [OR] 1.33, 95% confidence intervals [CI] 1.08 to 1.63). This was not the case for multiple-purchase handguns defined more broadly as multiple handguns purchased by one individual over any 30-day period as used in "one-gun-a-month" laws. Bivariate regressions indicated increased risk of a handgun being traced when it sold new for $150 or less (OR 4.28, 95% CI 3.59 to 5.11) or had been purchased by a woman (OR 2.02, 95% CI 1.62 to 2.52). Handguns sold by retailers who also had a relatively high proportion (>or=2%) of purchases denied because the prospective purchasers were prohibited from owning firearms were more likely to be traced than were those sold by other retailers (OR 4.09, 95% CI 3.39 to 4.94). These findings persisted in multivariate analyses. Our findings suggest specific strategies for intervention to prevent gun violence.

Gun suicide by young people in California: descriptive epidemiology and gun ownership.

We studied the 336 firearm suicides occurring in California in 1997-1999 to persons under age 21. The gun used was most often owned by the victim or a family member living in the victim's household. Prevention efforts should focus on gun ownership and accessibility.

The life cycle of crime guns: a description based on guns recovered from young people in California.

STUDY OBJECTIVE: We describe the life cycle of crime guns recovered from young people-the movement of those guns from manufacture to criminal use-and identify associations between the characteristics of those guns and their possessors, purchasers, sellers, and places of origin. METHODS: This is a cross-sectional study of data from gun ownership tracing records compiled by the Bureau of Alcohol, Tobacco, Firearms and Explosives for 2,121 crime guns recovered in California from persons younger than 25 years and traced in 1999. Purchaser and seller data for handguns were updated when possible by linking to California handgun sales records. RESULTS: The 2,121 traced guns were recovered from 1,717 young people. Guns recovered from persons aged 21 to 24 years were most frequently also purchased by persons aged 21 to 24 years; those recovered from persons younger than 18 years were most often purchased by persons aged 45 years or older. Small-caliber handguns made up 41.0% of handguns recovered from persons younger than 18 years but 25.2% of handguns recovered from persons aged 21 to 24 years. The median time from sale to recovery (commonly called time to crime) for all guns was 6.4 years (interquartile range 2.7 to 12.4 years). A time to crime of less than 3 years, suggesting deliberate gun trafficking, was observed for 17.3% of guns recovered from persons younger than 18 years but 34.6% of guns recovered from persons aged 21 to 24 years. Ten retailers who sold 10 or more traced guns accounted for 13.1% of all guns traced to a retailer. Handguns whose purchaser and possessor were the same person were more likely than others to be large-caliber semiautomatic pistols (29.3% and 11.7%, respectively); their median time to crime was 0.2 years (69 days). CONCLUSION: Analysis of crime-gun ownership traces reveals patterns that may help refine gun violence prevention efforts and render them more effective.