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This study characterizes the current firearm-related anticipatory guidance practices of pediatricians-in-training and the factors affecting those practices. In this study of Pediatric residents in the Mid-Atlantic region, surveys were distributed to 189 trainees at three hospitals. Eighty-one responses were collected between June 2017 and March 2018. The survey gathered information about the residents' values related to firearms, firearm-specific counseling practices, barriers to providing counseling, and educational needs related to firearms. The residents surveyed overwhelmingly agreed (96%) that physicians have a responsibility to counsel patients on the risks posed by firearms. However, most (63%) never provide firearm-related counseling or do so in only 1-5% of well-child visits. Their unfamiliarity with safe storage devices contributes to a lack of comfort providing counseling. For pediatricians to provide potentially lifesaving counseling on firearm safety, they must be well-versed in the subject and feel comfortable and confident in doing so. Educational interventions addressing physician self-efficacy are necessary to accomplish this. There is an urgent need to develop a comprehensive firearm safety education program for physicians and trainees to improve firearm counseling. [ABSTRACT FROM AUTHOR]

A series of prominent mass shootings in the United States (US) has prompted renewed interest in revising gun policy. One proposal that has gained political traction is raising the minimum age for purchase and possession of guns to 21. While some commentators have suggested that the public mood may be shifting on gun policy, proposals to raise the minimum age have nevertheless provoked controversy. In this manuscript, we examine the ethical acceptability of raising the minimum age of purchase and possession of guns to 21. First, we examine the nature of the rights claim at issue. Second, we examine liberty-based objections to minimum age laws, and offer counter-arguments to these claims. Then, we examine the nature of the harm to be prevented via minimum age laws. We conclude that gun ownership is an important right, but one that nevertheless is ethical to regulate. We argue that liberty-based objections to minimum age laws are not as strong as critics of these laws claim. While we acknowledge the data limitations on assessing their likely success in reducing gun-related harms, we argue that minimum age laws are an ethically permissible policy strategy. We conclude with several recommendations for further research and policy responses to addressing the toll of gun-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Gun-related deaths and gun purchases were at record highs in 2020. In light of the COVID-19 pandemic, public protests against police violence, and a tense political environment, which may influence policy preferences, we aimed to understand the current state of support for gun policies in the U.S. We fielded a national public opinion survey in January 2019 and January 2021 using an online panel to measure support for 34 gun policies among U.S. adults. We compared support over time, by gun ownership status, and by political party affiliation. Most respondents supported 33 of the 34 gun regulations studied. Support for seven restrictive policies declined from 2019 to 2021, driven by reduced support among non-gun owners. Support declined for three permissive policies: allowing legal gun carriers to bring guns onto college campuses or K-12 schools and stand your ground laws. Public support for gun-related policies decreased from 2019 to 2021, driven by decreased support among Republicans and non-gun owners. • We fielded national surveys measuring support for gun policies in 2019 and 2021. • Most US adults supported 33 of 34 gun regulations assessed. • Support for 7 restrictive gun policies decreased from 2019 to 2021. • Decreases in support for gun policies driven by non-gun owners and Republicans. [ABSTRACT FROM AUTHOR]

Objective In 2013, more than 40,000 individuals died from suicide in the United States. Restricting access to lethal means has the potential to prevent suicide, as suicidal thoughts are often transient. Permit-to-purchase (PTP) laws for handguns could potentially reduce suicides by making it more difficult for persons at risk of suicide to purchase a handgun. Methods We used a quasi-experimental research design with annual, state-level suicide data to evaluate changes to PTP laws in Connecticut and Missouri. Data were analyzed for 1981–2012. We used synthetic control modeling as the primary method to estimate policy effects. This methodology provided better prediction of pre-PTP-law-change trends in the two states with PTP law changes than econometric models and is thus likely to provide more accurate estimates of policy effects. Results The synthetic control model estimated a 15.4% reduction in firearm suicide rates associated with Connecticut's PTP law. Missouri's PTP law repeal was associated with a 16.1% increase in firearm suicide rates. Evidence that PTP laws were associated with non-firearm suicide rates was mixed in Connecticut and negative in Missouri. Conclusion The findings are consistent with prior research linking firearm availability to increased risk of suicide and lower suicide risks associated with PTP handgun laws. [ABSTRACT FROM AUTHOR]

This study sought to examine public support for gun carrying-related policies from 2019 to 2021, a period encompassing the COVID-19 pandemic and increasing calls for racial and social justice. We conducted the National Survey of Gun Policy in January 2019 and 2021. The surveys were fielded using the NORC AmeriSpeak panel. Respondents indicated support for six policies regulating civilian gun carrying. Analyses, conducted in 2021, incorporated survey weights for nationally representative estimates. There were significant declines in support from 2019 to 2021 for two policies that would expand where civilians can lawfully carry guns: allowing concealed carry when on K-12 school grounds (23% in 2021 vs 31% in 2019) and college/university campuses (27% vs 36%). Support was also significantly lower for requiring concealed carry applicants to pass a test demonstrating safe and lawful use (74% in 2021 vs 81% in 2019). For the two new policies in the 2021 survey, more than half of respondents overall supported prohibiting open carry at demonstrations/rallies (54%) and prohibiting the carry of guns into government buildings (69%). There was lower support among gun owners (39% and 57%, respectively). Since 2019, there has been a decline in support for expanding locations for civilian gun carrying. Support remains high among U.S. adults, including the two-thirds of gun owners, for requiring concealed carry applicants to demonstrate competence in safe and lawful gun use. Our findings in support of a more regulated approach to concealed carry are in direct contrast to state-level shifts eliminating concealed gun carrying regulations. [ABSTRACT FROM AUTHOR]

We sought to examine support for gun polices by race and ethnicity, and among gun owning subgroups. We combined two waves of the National Survey of Gun Policy (January 2017 and 2019 [N = 3804]). We used chi-square tests to assess whether support for gun policies differed by race or ethnicity overall and among subgroups of gun owners. Most U.S. adults supported 17 of 21 gun-related policies. Among gun owners, Blacks supported six policies at higher levels than whites, including minimum age requirements for gun ownership and assault weapon and ammunition-related restrictions. Hispanic gun owners supported safe storage requirements at higher levels than white gun owners. While support differed by race and ethnicity for some policies, majorities of U.S. adults supported nearly all gun policies examine regardless of race. One notable exception, carrying a concealed gun on K-12 school grounds did not reach majority support among any subgroup. While tailored messaging may be appropriate in certain circumstances, it is important to highlight the similarities in support for evidence-based gun polices across racial and ethnic groups. [ABSTRACT FROM AUTHOR]

After the school shooting at Marjory Stoneman Douglas High School in Parkland, Florida in 2018, there was an increase in gun violence prevention-related advocacy. While much of this recent political activity and engagement was led by young adults, little is known about support for specific gun policies within this age group. This study uses data from two nationally representative surveys fielded in 2017 and 2019 to compare public support for gun policies: (1) between young adults age 18-29 years and adults age 30 and older, and (2) between young adults in 2017 and young adults in 2019, before and after the Parkland shooting. Relative to adults age 30 and older, young adults had lower support for 16 of 20 gun violence prevention policies examined. Public support was largely unchanged between 2017 and 2019 among survey respondents ages 18-29; however, support for requiring a safety test for concealed carry decreased significantly among young adults between 2017 and 2019. Despite owning fewer guns and finding gun violence prevention important generally, young adults appear to have lower support for policies that regulate guns compared to older adults. [ABSTRACT FROM AUTHOR]

Inequitable experiences of community gun violence and victimization by police use of force led to nationwide calls to "reimagine public safety" in 2020. In January 2021, we examined public support among U.S. adults for 7 policy approaches to reforming policing and investing in community gun violence prevention. Using a nationally representative sample (N = 2778), with oversampling for Black Americans, Hispanic Americans, and gun owners, we assessed support overall and by racial, ethnic, and gun owner subgroups. Overall, we found majority support for funding and implementing police and mental health co-responder models (66% and 76%, respectively), diversion from incarceration for people with symptoms of mental illness (72%), stronger laws to assure police accountability (72%), and funding for community-based and hospital-based gun violence prevention programs (69% and 60%, respectively). Support for redirecting funding from the police to social services was more variable (44% overall; White: 35%, Black: 60%, Hispanic: 43%). For all survey items, support was strongest among Black Americans. Gun owners overall reported lower support for public safety reforms and investments than respondents who did not own guns, but this distinction was found to be driven by White gun owners. The views of Black gun owners were indistinguishable from Black non-owners and were similar to White non-owners on most issues. These findings suggest that broad public support exists for innovative violence reduction strategies and public safety reforms. • Most US adults support policing reforms and investments in gun violence prevention. • Support for public safety advances span racial, ethnic, and gun-owner subgroups. • Public safety reform can prioritize policies endorsed by groups affected by violence. [ABSTRACT FROM AUTHOR]

Inequitable experiences of community gun violence and victimization by police use of force led to nationwide calls to "reimagine public safety" in 2020. In January 2021, we examined public support among U.S. adults for 7 policy approaches to reforming policing and investing in community gun violence prevention. Using a nationally representative sample (N = 2778), with oversampling for Black Americans, Hispanic Americans, and gun owners, we assessed support overall and by racial, ethnic, and gun owner subgroups. Overall, we found majority support for funding and implementing police and mental health co-responder models (66% and 76%, respectively), diversion from incarceration for people with symptoms of mental illness (72%), stronger laws to assure police accountability (72%), and funding for community-based and hospital-based gun violence prevention programs (69% and 60%, respectively). Support for redirecting funding from the police to social services was more variable (44% overall; White: 35%, Black: 60%, Hispanic: 43%). For all survey items, support was strongest among Black Americans. Gun owners overall reported lower support for public safety reforms and investments than respondents who did not own guns, but this distinction was found to be driven by White gun owners. The views of Black gun owners were indistinguishable from Black non-owners and were similar to White non-owners on most issues. These findings suggest that broad public support exists for innovative violence reduction strategies and public safety reforms. [ABSTRACT FROM AUTHOR]

We measured the association between vacant housing demolitions and changes in crime and emergency department (ED) visits in Baltimore, MD. We included 646 block groups in Baltimore, 224 of which experienced at least one demolition from 2012 to 2019. The exposure was the number of demolitions completed in a block group during the previous quarter. Crime (all, property, and violent) and ED visits (all, adults, children, and for specific causes) were examined as the change in the rate per 1000 people from the previous quarter to the current quarter and analyzed using multivariable mixed effects regression models. Demolitions were associated with a small decrease in total ED visits (difference = -0.068 per 1000 people from the previous quarter to the current quarter, 95% CI -0.119, -0.018) but no significant change in crime. For each demolition, the rate of total child ED visits was 0.452 lower compared to the previous quarter (95% CI -0.777, -0.127). Demolitions were associated with small decreases in adult injury-related ED visits in the short term. [ABSTRACT FROM AUTHOR]

Place and race are two important predictors of fatal police shootings. We used Mapping Police Violence Data and the Washington Post Fatal Force Data to determine whether a county's deprivation status within communities influences the association between the number of fatal police shootings, and how the number of fatal police shootings differs by race and ethnicity. We categorized counties based on the Social Vulnerability Index (SVI) to three categories: low-, medium-, and high-SVI. The analytical sample included 3136 US counties between 2015 and 2020; during this time, 5525 individuals were fatally shot by police. Our findings show that place strongly impacts the number of fatal police shootings. Among all fatal shootings, 713 occurred in low-SVI counties, 1660 in middle-SVI, and 3152 in high-SVI counties. Race played a significant role; fatal shooting deaths increased by 2.3 times among White individuals, 9.6 times among Black individuals, and 15 times among Hispanic individuals between low- and high-SVI counties. The results of negative binomial regressions show a strong association between fatal police shootings and the counties' characteristics. In comparison with low-SVI counties, residents in counties with moderate and high-SVI are more likely to be fatally shot by police by 4.9 and 5.8 percentage points. In addressing violence and fatal police shootings, the vulnerability of counties and the population's racial composition play significant roles and need specific attention in addressing systemic racial disparities in the criminal justice system. • Neighborhood strongly impacts the number of fatal police shootings. • Race and place play a significant role in fatal police shootings. • Compared to low-socially vulnerable, Whites fatally shot 2.3 times more in high-SVI areas by police. • Compared to low-socially vulnerable, Blacks fatally shot 9.6 times more in high-SVI areas by police. • Compared to low-socially vulnerable, Hispanics fatally shot 15 times more in high-SVI areas by police. [ABSTRACT FROM AUTHOR]

Place and race are two important predictors of fatal police shootings. We used Mapping Police Violence Data and the Washington Post Fatal Force Data to determine whether a county's deprivation status within communities influences the association between the number of fatal police shootings, and how the number of fatal police shootings differs by race and ethnicity. We categorized counties based on the Social Vulnerability Index (SVI) to three categories: low-, medium-, and high-SVI. The analytical sample included 3136 US counties between 2015 and 2020; during this time, 5525 individuals were fatally shot by police. Our findings show that place strongly impacts the number of fatal police shootings. Among all fatal shootings, 713 occurred in low-SVI counties, 1660 in middle-SVI, and 3152 in high-SVI counties. Race played a significant role; fatal shooting deaths increased by 2.3 times among White individuals, 9.6 times among Black individuals, and 15 times among Hispanic individuals between low- and high-SVI counties. The results of negative binomial regressions show a strong association between fatal police shootings and the counties' characteristics. In comparison with low-SVI counties, residents in counties with moderate and high-SVI are more likely to be fatally shot by police by 4.9 and 5.8 percentage points. In addressing violence and fatal police shootings, the vulnerability of counties and the population's racial composition play significant roles and need specific attention in addressing systemic racial disparities in the criminal justice system. [ABSTRACT FROM AUTHOR]

In the U.S., death by suicide is a leading cause of death and was the 2nd leading cause of death for ages 15-to-34 in 2018. Though incomplete, much of the scientific literature has found associations between cannabis use and death by suicide. Several states and the District of Columbia have legalized cannabis for general adult use. We sought to evaluate whether cannabis legalization has impacted suicide rates in Washington State and Colorado, two early adopters. We used a quasi-experimental research design with annual, state-level deaths by suicide to evaluate the legalization of cannabis in Washington State and Colorado. We used synthetic control models to construct policy counterfactuals as our primary method of estimating the effect of legalization, stratified by age, gender, and race/ethnicity. Overall death by suicide rates were not impacted in either state. However, when stratified by age categories, deaths by suicide increased 17.9% among 15-24-year-olds in Washington State, or an additional 2.13 deaths per 100,000 population (p-value ≤0.001). Other age groups did not show similar associations. An ad hoc analysis revealed, when divided into legal and illegal consumption age, 15-20-year olds had an increase in death by suicides of 21.2% (p-value = 0.026) and 21-24-year olds had an increase in death by suicides of 18.6% (p-value ≤0.001) in Washington State. The effect of legalized cannabis on deaths by suicide appears to be heterogeneous. Deaths by suicide among 15-24-year-olds saw significant increases post-implementation in Washington State but not in Colorado. [ABSTRACT FROM AUTHOR]

Federal law places no regulations on unlicensed, private firearm sellers. However, a majority of the firearms used in crime come from these unregulated markets. This study aims to characterize the demographics of gun owners who engage in private sales, determine how often these individuals engage in selling behaviors, and ascertain whether sellers' attitudes are associated with their reported behaviors in the private market. A nationally representative web-based survey of 1444 gun owners, fielded in Spring 2016, were asked about their participation in the private market. The 238 respondents who participated in the private market were asked about their behavior on their last sale and the extent to which they felt it was the responsibility of sellers to ensure purchasers were legally able to own a firearm. Less than half of private gun sellers agreed that it is the seller's responsibility to ensure purchasers are eligible to buy guns (46%). Among private sellers, only 44% checked purchasers for eligibility and 32% denied a sale due to concerns about whether the firearm would be used safely. Sellers who agreed it was their responsibility to ensure purchasers were eligible to buy a gun had 4.52 (95% CI:1.78 to 11.5) times greater odds of reporting checking for a permit or conduct a background check on their last sale. it. These findings suggest a need for strategies to increase gun sellers' perceptions of responsibility for ensuring only eligible purchasers purchase guns, potentially including communication campaigns or educational programs. [ABSTRACT FROM AUTHOR]

Firearms are a leading cause of death and injury in the United States, and this trend has continued during the COVID-19 pandemic. We sought to identify whether states designated gun retailers as essential businesses in their stay-at-home orders and characterize other references that could affect firearm acquisition during the COVID-19 pandemic. In this cross-sectional policy review, we assessed stay-at-home orders issued in March or April 2020. Orders were reviewed in their entirety, and any reference to firearms, firearm retailers, shooting ranges, or other relevant elements was documented. Forty-three states and the District of Columbia issued stay-at-home orders. Most considered federal firearm licensees to be among essential businesses or made provisions for them to remain open during widespread business closures. Others referenced the US Department of Homeland Security's Cybersecurity and Infrastructure Security Agency (CISA) advisory memorandum on essential critical infrastructure workers which named workers supporting firearm manufacturing and retail among essential workers. Therefore, stay-at-home orders issued in most states included provisions for firearms retailers to remain open, at least in some capacity. Only four states and the District of Columbia did not include federal firearms licensees among essential businesses or include provisions for them to be open. Meanwhile, an all-time high in firearm background checks indicates firearm sales have markedly increased. Given the associations between firearm access and injury risk, the effects of continued firearm access facilitated by these orders should be the focus of future research. [ABSTRACT FROM AUTHOR]