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PubMed1994

Homicide in New York City. Cocaine use and firearms.

OBJECTIVE: To determine differences between racial/ethnic groups in overall rates of death by homicide, proportion of firearm homicides, and the use of cocaine prior to death. DESIGN: Descriptive epidemiologic survey of a complete 2-year sample of homicides. SETTING: New York City, NY (population 7,322,564). SUBJECTS: All residents (N = 4298) of New York City who were victims of homicide during 1990 and 1991. MAIN OUTCOME MEASURES: Using medical examiner data, age- and gender-specific rates of homicide were calculated for African Americans, Latinos, and whites. Separate logistic regression analyses were conducted to examine the association between demographic variables and both recent cocaine use and firearm-related homicides. RESULTS: Young African-American and Latino men were more likely to be victims of homicide than all other demographic groups. Approximately three fourths of all homicides involved firearms. In the subset of homicide victims dying within 48 hours (n = 3890), 31.0% were positive for cocaine metabolites. African Americans (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2 to 2.1), Latinos (OR, 1.4; 95% CI, 1.1 to 1.9), and victims 25 through 34 years of age (OR, 2.9; 95% CI, 2.5 to 3.5) and 35 through 44 years of age (OR, 2.7; 95% CI, 2.2 to 3.4) were more likely to be positive for cocaine metabolites than other groups. Young males and females were equally likely to have used cocaine before death. Victims 15 through 24 years of age were more likely than other age groups to be killed by a firearm. African Americans (OR, 1.7; 95% CI, 1.3 to 2.3), Latinos (OR, 1.5; 95% CI, 1.2 to 2.0), and Asians (OR, 2.2; 95% CI, 1.4 to 3.6) were more likely than whites to be killed by a firearm. Men (OR, 4.8; 95% CI, 4.0 to 5.9) were more likely than women to be killed by a firearm. There was no association between having used cocaine before death and being killed by a firearm. CONCLUSIONS: The high rates of death by homicide among young African Americans and Latinos may be due to the increased involvement with both cocaine use and firearms. New efforts must be made to decrease cocaine use and firearm availability.

Adolescent↗
PubMed2003

Hospitalization for firearm-related injuries in the United States, 1997.

BACKGROUND: Firearm-related injuries are a serious public health problem in the United States. Despite the magnitude of this problem, prior national estimates of nonfatal, firearm-related morbidity have been limited to an emergency department-based surveillance system. The objective of this study was to assess and report the information available on firearm-related injuries in an existing national database, derived from hospital discharge data. METHODS: Cross-sectional analysis of the 1997 Nationwide Inpatient Sample (NIS), a stratified probability sample of 1012 nonfederal community hospitals from 22 states. The database was queried using E codes to identify firearm-related injuries. The SUDAAN software program was used to convert raw counts into weighted counts that represent national estimates and 95% confidence intervals (CIs). RESULTS: An estimated 35,810 (95% CI, 32,615-38,947) cases nationwide were identified, of which 86% were male. Assault was the leading cause of firearm-related hospitalization, followed by unintentional injury. The mean length of stay (LOS) for patients with a firearm-related assault was 6 days. Seven percent of all firearm cases died during the hospitalization. The total estimated hospital charges for firearm-related injuries in the United States in 1997 was over $802 million, and 29% of the patients admitted for this condition were uninsured. CONCLUSIONS: Firearm-related injuries rank highest among all conditions in the number of uninsured hospital stays, and the average LOS is much longer compared to other medical conditions. National estimates derived from the NIS are consistent with previous estimates, and NIS provides additional information not available from other data sources.

Adolescent↗
PubMed1998

Oklahoma Firearm-Related Injury Surveillance.

CONTEXT: The magnitude of firearm-related deaths is known, but few studies have evaluated the magnitude and epidemiology of nonfatal firearm-related injuries. The circumstances resulting in fatal versus nonfatal injury are likely very different. No single data source provides complete details on nonfatal shootings. OBJECTIVE: To establish a surveillance system to define the epidemiology of fatal and nonfatal firearm-related injuries. DESIGN: Data were collected on fatal and nonfatal firearm-related injuries that occurred in 1995. SETTING: State of Oklahoma. PARTICIPANTS: Medical Examiner, Vital Statistics, hospital emergency and medical records departments, police departments, newspaper clipping service. MAIN OUTCOME MEASURES: Incidence rate of firearm-related injuries; case-fatality rate; demographic, medical, and epidemiologic data; sensitivity of each reporting source; completeness of reporting. RESULTS: The incidence rate of firearm-related injuries was 45.5 per 100,000 population. The case fatality rate was 35%. Injury rates were highest among adolescents, young adults, males, and African Americans. The Medical Examiner and Vital Statistics reported 87% and 98% of fatal cases, respectively. Passive surveillance of hospital emergency departments identified 72% of patients seeking hospital treatment. Among inpatients, 81% were identified by medical records departments. Newspaper clippings were obtained for 31% of cases. Information on the victim-perpetrator relationship and the type of firearm was available for 79% and 80% of cases, respectively. CONCLUSIONS: Statewide surveillance of firearm-related injuries using multiple data sources is possible and provides a picture of the overall firearm-related injury problem. Strategies to enhance computer linkages of medical and police data should be pursued to maximize the sensitivity of reporting and minimize the costs of surveillance.

Adolescent↗
PubMed1998

Firearm-related deaths in the United States and 35 other high- and upper-middle-income countries.

BACKGROUND: The Forty-Ninth World Health Assembly recently declared violence a worldwide public health problem. Improved understanding of cross-national differences is useful for identifying risk factors and may facilitate prevention efforts. Few cross-national studies, however, have explored firearm-related deaths. We compared the incidence of firearm-related deaths among 36 countries. METHODS: Health officials in high-income (HI) and upper-middle-income countries (UMI) with populations greater than one million were asked to provide data using ICD-9 codes on firearm-related homicides, suicides, unintentional deaths and deaths of undetermined intent, as well as homicides and suicides for all methods combined. Thirty-six (78%) of the 46 countries provided complete data. We compared age-adjusted rates per 100,000 for each country and pooled rates by income group and geographical location. RESULTS: During the one-year study period, 88,649 firearm deaths were reported. Overall firearm mortality rates are five to six times higher in HI and UMI countries in the Americas (12.72) than in Europe (2.17), or Oceania (2.57) and 95 times higher than in Asia (0.13). The rate of firearm deaths in the United States (14.24 per 100,000) exceeds that of its economic counterparts (1.76) eightfold and that of UMI countries (9.69) by a factor of 1.5. Suicide and homicide contribute equally to total firearm deaths in the US, but most firearm deaths are suicides (71%) in HI countries and homicides (72%) in UMI countries. CONCLUSIONS: Firearm death rates vary markedly throughout the industrialized world. Further research to identify risk factors associated with these variations may help improve prevention efforts.

Adolescent↗
PubMed2006

Trends in hospitalization for firearm-related injury in Finland from 1990 to 2003.

BACKGROUND: The firearm-related mortality in Finland is one of the highest in Europe. The study objective was to describe the incidence trends and nature of firearm-related injury hospitalizations in Finland between 1990 and 2003. METHODS: We included all firearm-related injury hospitalizations between 1990 and 2003. The data were obtained from the Finnish National Hospital Discharge Register. Only events with traumatic physical injuries were included. RESULTS: The overall incidence of firearm-related injury hospitalization was 5.1 (95% confidence interval [CI]: 34.5-5.7) per 100,000 person-years in 1990 and 2.6 (95% CI: 2.1-3.0) in 2003. The absolute numbers were 254 and 133, respectively. Unintentional injuries accounted for 44% of injuries during the study period. Hospitalization incidence resulting from intentional firearm-related injuries (self-inflicted and assault) remained unaltered over the study period. Men's injury incidence was 10.0 times (95% CI: 8.8-11.4) that of women's. Young men aged 15 to 34 years displayed the highest incidence figures. The most common types of the firearm-related injuries were open wounds (52%) and fractures (17%). Anatomically they involved the head and the neck (35%), the lower limb (28%), and the trunk (19%). CONCLUSIONS: Although the total incidence of firearm-related injuries decreased in Finland during the 14-year study period, the incidence of intentional firearm-related injuries remained at the same level. Finding information on the risk factors of firearm-related injuries and the reasons for the steady level of intentional injuries are the next steps toward preventive measures.

Adolescent↗
PubMedDate not supplied

Firearm-related death and injury among children and adolescents.

As the articles in this journal issue show, gun violence affects children and youth in many ways: psychologically, emotionally, financially, and legally. But first and foremost, gun violence affects children's physical safety. Therefore, this issue opens with an overview of the physical toll that firearms exact upon children and youth, reviewing the incidence of firearm-related injury and death among Americans under age 20. This article analyzes trends and current status in firearm death and injury, based on nationwide data collected by the federal government. Several key findings emerge from the data: Firearm death rates among children and youth in the United States have declined dramatically since 1993, but remain high compared with historical rates in this country and rates in other developed nations. A majority of these deaths are homicides. Certain groups of children and youth, especially adolescents, boys, minority youth, and those residing outside the Northeast, are particularly at risk for firearm death. The problem is most acute among black teenage males. Firearm injuries are much more likely to result in death than are other injuries for which children and youth visit emergency departments--a reflection of the extreme lethality of firearms. Given these findings, the authors call for a concerted effort to reduce youth firearm deaths to levels comparable to those of other industrialized nations, using a wide variety of approaches that span the public health, criminal justice, and educational spheres. They also recommend improved data systems to track firearm injury and death, so that researchers can better analyze these incidents and evaluate intervention strategies.

Accidents↗
PubMed1987

The epidemiology of firearm deaths among residents of California.

Firearms are a leading cause of death in the United States, yet the effort to understand their aggregate impact on the public's health has only just begun. There were 26,442 firearm deaths among California residents during the years 1977 through 1983. During this period firearms were the eighth leading cause of death for California as a whole, sixth for male Californians and first for black males aged 15 to 34 years and black females aged 15 to 24 years. A plurality of firearm deaths were suicides; unintentional deaths contributed only 3% of the total. Black men aged 25 to 34 years had the single highest firearm mortality rate; 80% of firearm deaths in that group were homicides. Men 75 years old and older had the highest firearm mortality rate when all races were considered together, however, and 93% of firearm deaths in that group were suicides. The discussion focuses on our current understanding of firearms as a medical and public health problem and suggests directions for future research and intervention.

Adolescent↗
PubMed2006

Police chiefs' perceptions of the regulation of firearms.

BACKGROUND: This national study assessed police chiefs' support for various types of firearm control measures, perceptions regarding firearms as a public health problem, and the likelihood of initiating firearm control advocacy activities. METHODS: A 29-item survey instrument was developed to assess respondents' likelihood of firearm policy support, interest, exposure, involvement with firearm control advocacy, and demographic and background characteristics. The survey was sent out in spring 2005 using a three-wave mailing to a national random sample of 600 police chiefs in cities with populations greater than 25,000 in 2002 and 2003. RESULTS: The majority of responding police chiefs supported 11 out of 14 proposed firearm control policies. Most police chiefs (62%) believed that the government should do everything it can to keep handguns out of the hands of criminals, even if it makes it more difficult for law-abiding citizens to purchase handguns. Police chiefs were not likely to participate in the majority of firearm control advocacy activities. The advocacy activities that police chiefs were most likely to participate in were meeting with state legislators (52%) and writing a letter to a legislator in relation to gun control (44%). CONCLUSIONS: Police chiefs support several potentially important firearm control policies. This suggests the need to evaluate interventions aimed at increasing their role in shaping policy on this important public health issue.

Attitude↗
PubMed1998

Firearm suicides and homicides in the United States: regional variations and patterns of gun ownership.

Among industrialized countries, the United States has the highest rates of firearm suicide and homicide, as well as the highest rate of gun ownership. The present study compares the differential impact of gun availability on firearm suicides and homicides in the U.S. Using data from the NCHS Mortality Detail Files (1989-1991), the 1990 U.S. census population estimates, and the General Social Surveys (1989-1991) for nine geographic divisions, we computed rates of firearm and non-firearm suicides and homicides as well as rates of gun ownership for four gender-race groups. We tested the strength of the associations between gun availability and firearm suicide and homicide rates by computing the Spearman correlation coefficients. To help elucidate the role of method substitution, we conducted similar analyses on non-firearm suicide and homicide. The results show that gun ownership has a stronger impact on firearm suicides than homicides. These findings held up after stratifying by gender and race. The study suggests that reducing the aggregate level of gun availability may decrease the risk of firearm-related deaths.

Black or African American↗
PubMed2003

High school students' attitudes about firearms policies.

PURPOSE: To examine high school students' attitudes about firearm policies and to compare their attitudes with those of adults. METHODS: The Hamilton Youth and Guns Poll is the first national survey of high school students about their attitudes concerning firearm policies. Questions were asked of 1005 sophomores, juniors, and seniors about their actual (i.e., direct) exposure (e.g., presence of a gun in the home) and about their social (i.e., indirect) exposure (e.g., whether the student could get a gun) to firearms and related violence. Population weights were applied, and multivariate logistic regression was used to examine the relationship between demographic and exposure variables and opinions about firearm policies. RESULTS: Most high school students supported more restrictive firearm policies. Opinions varied little by demographic variables with the exception of gender. Females were significantly more supportive of most firearm policies. Actual exposure was a more consistent predictor than social exposure. Students living in a home with a gun, particularly a handgun, were less likely to support most restrictive gun policies. CONCLUSIONS: Most high school students in the United States favor stringent policies governing firearms. Adolescents' attitudes about firearm policies parallel those of adults.

Adolescent↗
PubMed2000

Adolescent suicide and household access to firearms in Colorado: results of a case-control study.

PURPOSE: To determine whether, compared with age- and sex-matched controls who did not commit suicide, adolescents who committed suicide by firearms were more likely to have had household access to firearms (after adjusting for significant risk factors for adolescent suicide). METHODS: A case-control study design was used; case subjects were Colorado adolescents who committed suicide between 1991 and 1993; controls were sex- and age-matched adolescents who were randomly selected from the same school the subjects had attended. Interviews were conducted with the parent or guardian of cases and controls. RESULTS: Of the 36 case subjects in this study, 67% committed suicide using a gun obtained from their home. Adolescent suicide victims who committed suicide by firearms were significantly more likely to have a firearm in their home (72%) than age- and sex-matched community controls (50%), after adjusting for significant risk factors. Conduct disorder and previous mental health treatment were also found to be independent risk factors for adolescent firearm suicide. CONCLUSIONS: Two types of public health interventions to prevent adolescent firearm suicides are likely to be successful: (a) limiting household access to firearms, and (b) identifying adolescents at high risk of firearm suicide.

Adolescent↗
PubMed2002

Congressional voting behavior on firearm control legislation: 1993-2000.

Firearm morbidity and mortality place an enormous burden on the health care enterprise and society at large. Recent research has shown strong public support for strategies to regulate firearms yet effective federal legislation to control the types of firearms sold, conditions of sale and purchase, limitation in transportation and storage, and responsibility for use of personally owned firearms has been limited. Thus the purpose of this study was to evaluate the relationship between Congressional voting on firearm control legislation and the following: political affiliation, military service, geographic location of representation, education level, sex, and gun rights and gun control contributions. This was accomplished using a retrospective assessment of Congressional voting records from the 103rd-106th Congresses (1993-2000) regarding firearm control legislation. The study found that $6,270,553 was donated to members of Congress, $5,394,049 to members of the House and $876,504 to members of the Senate by groups concerned with firearm legislation. In the House, males (Odds Ratio [OR], 3.87), Republicans (OR, 13), those from the South (OR, 5), and those who received gun rights funds (OR, 13 to 203, depending on level of donations) were more likely to vote pro gun rights. In the Senate, support for gun rights occurred more often for those from the West (OR, 3.56), Republicans (OR, 130.50), or those who had received gun rights donations (OR, 28.00). This study has found a strong and consistent relationship between a Congressional member's position on firearm legislation and the amount of money received, political affiliation, and geographic location of representation.

Conflict of Interest↗
PubMed1997

Training in firearm safety counseling in family practice residency programs.

The purpose of this study was to establish a national baseline regarding the prevalence of training of family practice residents regarding firearm safety counseling. A national survey of the residency directors at the 420 accredited family practice residency programs in the coterminous United States was used to assess the prevalence of training in firearm safety counseling, perceived effectiveness of such training, and perceived barriers to such counseling in residency programs. Program directors were sent a two-page questionnaire on firearm safety counseling activity in their programs and 71% responded. Few residencies (16%) had formal training in firearm safety counseling. The most common perceived barriers were no trained personnel (31%), too many other important issues (31%), not enough time (30%), and lack of educational resources (28%). Patient education materials (57%), video training programs (49%), and a curriculum guide (46%) were identified as resources that would be most helpful in implementing a firearm safety counseling program. The results showed that formal training in firearm safety counseling is virtually absent from family practice residency training programs. This finding is not surprising given that less than 14% of the directors perceived firearm safety counseling would be effective in reducing firearm-related injuries or deaths and that research on effectiveness of such counseling is very limited.

Analysis of Variance↗
PubMed2002

Household firearm ownership and suicide rates in the United States.

BACKGROUND: In the United States, more people kill themselves with firearms than with all other methods combined. A central question regarding the relation between firearms and suicide is whether the ready availability of firearms increases the suicide rate, rather than merely increasing the proportion of suicides from guns. METHODS: We used publicly available data for the nine regions and 50 states in the United States over a 10-year period (1988-1997) to examine the association between levels of household firearm ownership and rates of suicide, firearm suicide, and non-firearm suicide by age groups and gender. RESULTS: In both regional and state-level analyses, for the U.S. population as a whole, for both males and females, and for virtually every age group, a robust association exists between levels of household firearm ownership and suicide rates. CONCLUSIONS: Where firearm ownership levels are higher, a disproportionately large number of people die from suicide.

Adolescent↗
PubMed1987

Firearms as a cause of death in the United States, 1920-1982.

We present the epidemiologic history of firearms in the United States. Firearms are among the nation's ten leading causes of death. Nearly one million firearm deaths occurred in the half-century 1933-1982. Suicide is the leading type of firearm death. Teenagers, young adults, and males 75 years old and older are currently at highest risk. An individual's risk of suffering a firearm death has generally risen with age. Increased firearm availability is associated with increased rates of firearm homicide and suicide. Strategies to prevent firearm deaths and injuries should be formulated in light of these findings, and heightened efforts to design, implement, and evaluate preventive measures are urgently needed.

Adolescent↗
PubMed1999

Firearm ownership among female physicians in the United States.

BACKGROUND: Physicians have been called upon to counsel patients about firearm safety, but the personal prevalence of firearm ownership among physicians is poorly established. METHODS: We examined responses to the question "Do you keep a gun/firearm in your home?" from the Women Physicians' Health Study, a nationally representative survey of US female physicians (n = 4,501). RESULTS: Among female physicians, 16.5% reported having a firearm in their homes. Those who were older, married, practicing in a rural region, and residing in the South Central or Mountain states were more likely to report having a firearm in the home. Emergency medicine specialists, Protestants, physicians reporting a history of depression, and those on call more than six times per month were also more likely to report keeping a firearm in their home. Female physicians residing on the East Coast, Hindus, and Jews were least likely to report keeping a firearm in the home. CONCLUSIONS: In the United States, the proportion of female physicians who report having a firearm in the home was about half that reported by other women and one third that reported by men. This observation may have important implications for encouraging female physicians to counsel their patients about firearm ownership and storage.

Adult↗
PubMed1994

Firearm injuries in children and adolescents: epidemiology and preventive approaches.

Firearm injury, now a leading cause of death in childhood and adolescence, had jointed the ranks of pediatric conditions that threaten child health and development. This paper reviews articles on epidemiology (of firearm injuries and the firearms themselves) and prevention. Epidemiology of injuries: 5356 Americans under 20 years of age died of firearm injuries in 1991; most of these were homicides, and most involved 15 to 19 years olds. The same year, firearm deaths exceeded motor vehicle deaths in seven states and the District of Columbia. Case-control studies showed that handguns in the home raised the risk of homicide threefold, and that handguns raised the risk of suicide ninefold; for suicide, the risk was greatest (13-fold) in those without psychiatric problems. In Iowa, handguns were used disproportionately often in suicides (as compared with other firearms). Hospitalized pediatric shooting victims often had social as well as medical problems. Epidemiology of firearms: gun ownership was higher among incarcerated youths than in community controls (83% vs 22%), but the patterns of gun acquisition were similar: mainly handguns for self-protection, most often from a friend or family member, or "off the street," cost under $100 per gun. Among 5000 families attending pediatric offices, 32% owned handguns or rifles; 13% of handguns and 1% of rifles were stored unlocked and loaded. In a school survey, three-fourths of first and second graders who knew there was a gun at home knew where it was. Gun sales are very loosely under the jurisdiction of the Bureau of Alcohol, Tobacco, and Firearms; no regulations affect gun design, and oversight of commerce is extremely lax.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Young guns: an empirical study of persons who use a firearm in a suicide or a homicide.

OBJECTIVES: The purpose of this investigation was to identify population groups at highest risk of using a firearm in a fatal incident. SETTING: Los Angeles County (California, USA). METHODS: Data were gathered from vital statistics reports and law enforcement records on the characteristics of suicide victims (n = 4799) and homicide suspects (n = 5369) from 1990 through 1994. Logistic regression was used to identify characteristics of the actor/perpetrator that were associated with firearm use. RESULTS: Persons less than 21 years old and males were more likely to use a firearm to kill themselves or someone else. Even when their other demographic attributes and characteristics of the incident itself were taken into consideration, persons under the age of 18 were substantially more likely than those 21 or more years old to use a firearm in the commission of a homicide (adjusted odds ratio = 2.59). Asians were less likely than white people to use a firearm in the commission of a suicide, whereas black people, Hispanics, and Asians were more likely than whites to use a firearm in the commission of a homicide. CONCLUSIONS: The US enacts and enforces some policies differentially by age. These data support the idea that such an approach may be warranted when addressing fatalities associated with the use of a firearm. Of particular interest, given minimum age requirements for firearm purchases, is the source of the weapons themselves.

Adolescent↗