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PubMed1993

Firearm-related mortality in Oklahoma, 1985-1989.

To determine the extent of firearms as a cause of mortality, Oklahoma vital statistic records were analyzed. The annual mortality rate in Oklahoma between 1985 and 1989 was 20% higher than the U.S. rate. Firearms were the second leading cause of injury deaths; firearms were the leading cause of injury deaths among blacks and the leading cause of all deaths among blacks 15 to 29 years of age. Ninety-two percent of the firearm-related deaths were intentional; firearms accounted for 70% of suicides and 59% of homicides. The male death rate from firearms was 4.5 times the female death rate. Suicide rates were highest among white males 65 years and older; homicide rates peaked among black males 25 to 34 years of age. Residents of eastern Oklahoma had the highest rates. The magnitude and preventability of firearm-related deaths and injuries demand attention and collaboration from Oklahoma health care providers; public health, mental health, and education officials; and criminal justice professionals.

Adolescent↗
PubMed1996

Epidemiology of firearm mortality and injury estimates: state of Connecticut, 1988-1993.

STUDY OBJECTIVES: To retrospectively determine the 6-year cumulative incidence rate of firearm mortality and estimate nonfatal firearm injuries in Connecticut. METHODS: Retrospective analysis of data originating from the Connecticut State Medical Examiner's Office and records from the Trauma Registry of one urban hospital. RESULTS: From January 1988 through December 1993, 1,625 Connecticut residents died from firearm-related injuries. The cumulative incidence rate was 49.4 deaths per 100,000 population during the 6-year study period. Rates peaked among 20- to 24-year-olds at 18.1 deaths per 100,000. Males outnumbered females more than eightfold. The ratio of nonfatal firearm injuries to firearm deaths was 7:1 for those shot by another, self-inflicted injuries were fatal in half of all cases. CONCLUSION: Analysis of firearm mortality data indicated that males in younger age categories were disproportionately affected. These rates combined with nonfatal injury projections demonstrate that firearms represent a significant public health threat to the population of Connecticut, reaching epidemic proportions among specific subpopulations. These results are consistent with those obtained from national studies.

Adolescent↗
PubMed1998

Change in substance P in a firearm wound and its significance.

The present study was designed to detect the change of substance P (SP) in firearm wounds and its relationship with wound healing. Twenty two rabbits were randomly divided into two groups, one with firearm wounds created by steel balls shooting rabbits' thighs and another with stab wounds created by knife. The experimental design did not include direct injury to femora major peripheral nerve trunks or blood vessels. SP content in wound tissue of both groups was measured with radioimmunoassay (RIA). Histologic examination was performed on the wound and the saphenous and sciatic nerves away from the wound-track edges. It was found that both types of injuries caused an increase of SP content in the wound compared with normal tissue. At three to 10 days after injury, SP content was lower in firearm wounds than that in stab wounds. Pathomorphologic observation showed the indirect injuries to the saphenous and sciatic nerves in the rabbits with firearm wounds were more severe than those with stab wounds. Meanwhile, wound healing in the firearm wounds was poor compared with that in the stab wounds. The results suggest that the change in SP in firearm wounds differs from that in cold weapon wounds as a result of the presence of indirect injuries to major peripheral nerve trunks created by laceration shock wave and cavity effects, and SP in vivo may participate in wound healing as a growth factor. Therefore, the improvement of neuropeptide metabolism in firearm wound may be an important measure for accelerating wound healing.

Animals↗
PubMed1986

Protection or peril? An analysis of firearm-related deaths in the home.

To study the epidemiology of deaths involving firearms kept in the home, we reviewed all the gunshot deaths that occurred in King County, Washington (population 1,270,000), from 1978 through 1983. The medical examiner's case files were supplemented by police records or interviews with investigating officers or both, to obtain specific information about the circumstances, the scene of the incident, the type of firearm involved, and the relationship of the suspect to the victim. A total of 743 firearm-related deaths occurred during this six-year period, 398 of which (54 percent) occurred in the residence where the firearm was kept. Only 2 of these 398 deaths (0.5 percent) involved an intruder shot during attempted entry. Seven persons (1.8 percent) were killed in self-defense. For every case of self-protection homicide involving a firearm kept in the home, there were 1.3 accidental deaths, 4.6 criminal homicides, and 37 suicides involving firearms. Hand-guns were used in 70.5 percent of these deaths. The advisability of keeping firearms in the home for protection must be questioned.

Accidents, Home↗
PubMedDate not supplied

Reducing firearm injuries: the role of local public health departments.

OBJECTIVE: The purpose of this study was to gather data regarding local public health departments' involvement in activities to prevent firearm-related morbidity and mortality. METHODS: A questionnaire was sent to local public health departments serving cities with populations > or =60,000 to assess their perceptions of the magnitude of the firearm injury problem in their jurisdictions and the activities in which they were engaged to reduce firearm-related injuries. RESULTS: Almost half (49.7%) of respondents said that their departments had not seriously thought about being involved in activities to reduce firearm-related injuries, and fewer than one in five (17.8%) reported that their departments were involved in such activities. Respondents identified three barriers to involvement in activities to reduce firearm injuries: limited financial resources (62.7% of respondents), lack of expertise (50.8%), and not enough time (47%). CONCLUSIONS: Despite the extent of firearm injuries in the US, systematic collection of local data on firearm morbidity and mortality to help guide policy development is lacking.

Female↗
PubMed1999

Child and adolescent injury and death from urban firearm assaults: association with age, race, and poverty.

OBJECTIVE: To describe rates and trends in the incidence of non-fatal and fatal firearm assault among children (16 years old or younger) over an 11 year period in Chicago, Illinois and to identify the socioeconomic characteristics of community areas where assaults are common. METHODS: The Chicago Police Department (CPD) records from 1986 through 1996 were reviewed for children assaulted with a firearm. United States census data for 1990 for Chicago were used to calculate incidence rates; census data were also used for community area (defined by census tract) socioeconomic descriptions. RESULTS: The CPD recorded 11,163 pediatric firearm assaults during the study period: 10,571 non-fatal and 592 (5%) fatal. From 1986 through 1996 non-fatal assaults more than doubled, with the highest rates in 1994; fatal assaults tripled, with rates peaking in 1993-94. Significant increases in non-fatal firearm assaults occurred among black and Hispanic males and females. In 1994, compared with white males, the relative risk of non-fatal assault was 7.0 (95% confidence interval (CI) 5.3 to 9.1) for black males and 3.3 (95% CI 2.5 to 4.4) for Hispanic males; the relative risk was 1.5 (95% CI 1.1 to 2.1) for black females. A handgun was the firearm used in most assaults (88% of non-fatal and 84% of fatal). Within community areas, the correlation between non-fatal and fatal assault incidence was strong (r=0.80, p<0.001). The proportion of families with income below the 1989 poverty level ($12,674) and the per cent black race in the community area together accounted for 70% of the variance in assault rates. CONCLUSIONS: From 1986 to 1994 there were significant increases in both non-fatal and fatal firearm assaults, usually by handguns; thereafter, rates declined. Urban children who were victims of non-fatal firearm assault appear to come from the same population as those who suffer fatal assaults. Black and Hispanic youth living in poverty were at particular risk.

Adolescent↗
PubMed2002

Risk factors associated with non-fatal adolescent firearm injuries.

STUDY OBJECTIVES: To identify behavioral, environmental, and sociodemographic risk factors associated with non-fatal firearm injuries among inner city adolescents in the United States. DESIGN: A case-control study in which patients with firearm injury serve as cases and those with medical conditions serve as controls. SETTING: A level I trauma center in a metropolitan area serving a predominately lower socioeconomic status population. PARTICIPANTS: Cases were 45 consecutive patients 11-18 years presenting to the emergency department with non-fatal firearm injury; controls were 50 age and gender matched patients presenting with acute medical problems. OUTCOME MEASURE: Odds ratios (OR) and associated 95% confidence interval (CI) as estimates of the magnitude of association between risk factors and non-fatal firearm injury. RESULTS: After adjusting for age, gender and socioeconomic status, multivariate analysis identified four risk factors independently associated with firearm injury: living with less than two parents (OR 3.8, 95% CI 1.2 to 12.2), skipping class (OR 7.1, 95% CI 1.7 to 28.9), previous arrest (OR 6.2, 95% CI 1.9 to 20.7), and being African-American (OR 4.2; 95%CI 1.4 to 14.9). CONCLUSION: Risk factors for adolescents sustaining a non-fatal firearm injury are sociodemographic and environmental, not just behavioral. Thus interventions that foster protective and supportive environments may help prevent firearm injuries.

Adolescent↗
PubMed2004

Urban-rural shifts in intentional firearm death: different causes, same results.

OBJECTIVES: We analyzed urban-rural differences in intentional firearm death. METHODS: We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban-rural variable. RESULTS: The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide. CONCLUSIONS: Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.

Homicide↗
PubMed1991

Firearm victims--who were they?

OBJECTIVE: To determine the characteristics of victims killed by firearms, whether they died by suicide, homicide or accident, and the types of firearms involved. DESIGN: A retrospective and descriptive study. SETTING AND SUBJECTS: Coronial autopsy data were obtained from the Brisbane Laboratory of Pathology and Microbiology. All 587 firearm deaths during the period 1980-1989 were included. MAIN OUTCOME MEASURES: The proportions of deaths by suicide, homicide, accident or undetermined cause. In cases of homicide, we sought to define the relationship of the perpetrator to the victim. RESULTS: The types of death were suicide 76%, homicide 18%, accidents 3% and undetermined 3%. Most homicides were of a domestic nature as opposed to crime. Small calibre rifles were the most common weapon; handguns were rarely used. CONCLUSIONS: Recent debate regarding firearm legislation has failed to recognise the predominance of interpersonal and psychological issues in the causation of firearm deaths. Crime is a motive for only a minority. Medical practitioners may reduce firearm deaths both by organisational representation and individual efforts in clinical practice. In particular, attention should be given to the identification of individuals or families at risk, the detection and treatment of psychological disorder and advice regarding firearm disposal.

Accidents↗
PubMedDate not supplied

Homicidal deaths by firearms in Peshawar: an autopsy study.

BACKGROUND: Medico legal autopsies can be valuable sources of information about the distribution of causes of reported deaths, particularly in homicidal cases. The present study provides information regarding the homicidal deaths due to firearm injuries in the district of Peshawar, NWFP, Pakistan. METHODOLOGY: This descriptive study was conducted over the period of the year 2004. Data were collected from the autopsy records of the Department of Forensic Medicine, Khyber Medical College Peshawar and included all reported unnatural deaths from urban and rural areas of district Peshawar on whom autopsies were conducted in the department. RESULTS: Homicidal deaths constituted 77.7% (492/633) of all autopsies for the year 2004. Of 492 homicidal deaths, a vast majority of 452 (91.87%) were caused by firearm injuries. Among these, the male to female ratio was 5.5:1. The most common firearm weapon (418/452, 92.5%) were high velocity rifled weapons (Kalashnikov, rifles, pistols), followed by low velocity rifled weapons (18/452, 3.98%) and shotguns (16/452, 3.54%). A total of 956 injuries were found in various body areas, giving an average of over two injuries per person. The head, face and neck sustained the highest injuries (257, 26.9%), followed by the chest (248, 25.9%) and abdomen (149, 15.6%); the extremities, buttocks and genitalia together sustained 302 (31.6%) injuries. CONCLUSION: The vast majority of reported homicides in Peshawar are caused by firearm injuries, which bring up issues related to possession of firearms and changes in cultural attitudes towards use of firearms, if a decrease in firearm-related homicides is desired.

Adolescent↗
PubMed1995

Hospitalization charges, costs, and income for firearm-related injuries at a university trauma center.

OBJECTIVE: To quantify the actual cost of inpatient medical care for firearm-related injuries at a university trauma center. DESIGN: Retrospective case series of all hospital admissions for firearm-related injuries for the 3 years 1990 through 1992. Total inpatient financial data were examined by means of a recently instituted cost-accounting methodology. SETTING: Level I trauma center at a university hospital that provides trauma care and tertiary care to 3.7 million residents of 23 counties. PATIENTS: A total of 787 consecutive patients were admitted to the hospital with firearm-related injuries. Information from the trauma registry and hospital finance records were linked for 750 (95%) of these patients. MAIN OUTCOME MEASURES: Total inpatient hospital charges, costs, revenues, and net income according to payer source. RESULTS: Men aged 15 to 44 years accounted for 77% of patients with firearm-related injuries. The overall mean and median hospital charges per admission were $52,271 and $28,033, respectively, whereas the overall mean and median hospital costs per admission were $13,794 and $7964, respectively. The net income per patient ranged from an average loss of $6980 for each patient having no insurance to an average profit of $28,557 for each patient with a health maintenance organization contract. The losses sustained on nonsponsored and Medicaid patients were more than offset by net income from patients having private health insurance, Medicare, or other insurance coverage such that there was an average profit of $5809 per admission for a firearm-related injury. CONCLUSIONS: Treatment of firearm-related injuries produces net income for this university trauma center by virtue of the cost shifting built into its pricing structure. If data from this institution are extrapolated to the nation, then the actual cost of providing medical care for firearm-related injuries in the United States in 1995 is projected to be $4.0 billion. The majority of this cost will be paid indirectly by private health insurance.

Adolescent↗
PubMed2001

"Love our kids, lock your guns": a community-based firearm safety counseling and gun lock distribution program.

BACKGROUND: Safer storage practices may reduce injury rates by limiting youth access to firearms. OBJECTIVE: To determine if a firearm safety counseling and gun lock distribution program improved storage practices. DESIGN: Community-based before-after trial. SETTING: Urban county in central North Carolina. PARTICIPANTS: One hundred twelve adult gun owners recruited through a mass media advertising campaign. INTERVENTION: In the parking lot of a shopping mall, participants completed a survey, and were then provided with tailored counseling, gun safety information, a gun lock, and instructions to use it. MAIN OUTCOME MEASURES: Firearm storage practices, assessed by survey and personal interview (baseline) and telephone interview (6-month follow-up). RESULTS: Most participants were white (62%), men (63%), had children (58%), and owned a gun for protection (74%). At follow-up, of the 82 participants, 63 (77%) (up from 39 [48%]) reported storing their gun(s) in a locked compartment (P =.004), 59 (72%) (up from 0) reported using gun locks (P =.001), 61 (74%) (up from 57 [69%]) reported storing their ammunition locked in a separate location, 59 (72%) (up from 52 [63%]) reported storing their gun(s) unloaded, and 6 (7%) (down from 15 [18%]) reported storing firearms unlocked and loaded. Participants with children were more likely at baseline to store weapons unlocked and loaded (38 [59%] vs 19 [41%]; P =.02) but were more likely after counseling to lock their weapons (29 [58%] vs 14 [44%]) and remove guns from the home (5 [10%] vs 0 [0%]). CONCLUSIONS: This program prompted reporting of safer firearm storage practices, particularly among parents. Longer follow-up, verification of self-reports and correct use, testing of gun locks, and monitoring firearm injury rates after distribution programs are needed to establish the public health potential of this approach.

Adult↗
PubMed2002

Pediatric residents' attitudes and behaviors related to counseling adolescents and their parents about firearm safety.

BACKGROUND: Firearms continue to be a major cause of mortality in adolescence. Although the American Academy of Pediatrics strongly encourages pediatricians to counsel adolescents and their parents on firearm safety, few residency programs educate their trainees in this area. More in-depth information is needed to design effective educational interventions. OBJECTIVES: To determine the attitudes, beliefs, and practices of pediatric residents regarding firearm safety counseling and to compare their counseling practices for adolescents and parents of adolescents during health maintenance visits. DESIGN: Cross-sectional survey. PARTICIPANTS: Pediatric residents from 9 programs in the mid-Atlantic region. RESULTS: Of the 322 respondents (76% response rate), few believed that it is not a pediatrician's responsibility to counsel, that their patients are not at risk for firearm injury, and that children are safer with a gun in the home. However, only 50% reported routine counseling, and more than 20% reported almost never counseling adolescents and their parents on firearm safety. Barriers included inadequate training (38%), insufficient time (26%), and a lack of preceptor expectation (13%). The strongest predictors for counseling adolescents included the belief that gun-related media coverage influences counseling practice, level of training, and personal experience with guns in the home. The strongest predictors for counseling parents of adolescents were the belief in the media's influence on counseling practice, perceived counseling effectiveness, and discomfort with firearm safety counseling. CONCLUSIONS: To increase counseling practices, clinical preceptors should aim to strengthen residents' comfort in counseling and to develop specific ways to enhance their perceived effectiveness in counseling parents.

Accident Prevention↗
PubMed1995

Firearm injury prevention counseling by pediatricians and family physicians. Practices and beliefs.

OBJECTIVES: To ascertain and compare beliefs, attitudes, and counseling practices of primary care physicians of children and adolescents regarding firearm injury prevention counseling. DESIGN: Cross-sectional survey. SETTING: State of Washington. SUBJECTS: All active members of the state chapters of the American Academy of Pediatrics and American Academy of Family Physicians. A total of 979 pediatricians and family physicians (53%) responded to the survey after two mailings. MAIN OUTCOME MEASURES: Attitudes, beliefs, and current practices with regard to firearm safety counseling among families of child and adolescent patients. RESULTS: Only 25% of pediatricians and 12% of family physicians currently counsel more than 5% of their patients. Pediatricians were more likely than family physicians (70% vs 46%, P < .001, chi 2 test) to believe that physicians have a responsibility to counsel families about firearm safety. Pediatricians recommended removing guns from the home more frequently than family physicians (32% vs 19%, P < .001, chi 2 test), but most physicians of both specialties perceived that parents are rarely receptive to this advice. However, 97% of physicians from both specialties agreed that firearms should be stored locked separately from ammunition, and a substantial majority believed that parents would be receptive to this advice. Compared with physicians who owned guns (32%), non-owners were 15 times more likely (odds ratio, 15; 95% confidence interval, 10 to 23) to agree that families with children should not keep firearms in the home. CONCLUSIONS: Few primary care physicians who see children and adolescents currently counsel families about firearm safety, although many agree that they have such a responsibility. At least half of these physicians would potentially benefit from an intervention to improve their knowledge of and counseling skills on this topic.

Accident Prevention↗
PubMed2004

Indian homemade firearm--a technical review.

A wide variety of homemade (country made) firearms are involved in crime cases in India. These firearms are made up of very cheap material and are not safe for firing. Moreover, the country made firearms are different in their design, loading and locking mechanism, cocking and firing arrangements. In this paper we have studied the characteristic features of 300 country made firearms received for examination in the Central Forensic Science Laboratory (CFSL), Chandigarh during last two decades. The characteristic features of these firearms are so unique that the fired crime bullets or cartridges can easily be matched with the test. It is hoped that such information will be useful for firearm experts in case of interpretation.

Equipment Design↗
PubMed1991

Accidental firearm fatalities among New Mexico children.

STUDY HYPOTHESIS: Risk factors associated with unintentional gunshot fatalities among children include gender and race of the decedent, type of firearm used, and whether loaded guns are stored within the home. STUDY POPULATION: All New Mexico children 0 to 14 years old unintentionally killed by a firearm between 1984 and 1988. METHODS: The New Mexico Office of the Medical Investigator master mortality file was reviewed retrospectively to identify all unintentional firearm fatalities occurring in New Mexico children during a five-year period. Medical investigator, autopsy, and police reports were analyzed to identify epidemiologic factors associated with these deaths. Chi-square and Fisher's exact tests were used to analyze the data. RESULTS: Twenty-five unintentional firearm fatalities were identified. These deaths occurred most frequently among children playing with loaded firearms found within the home. A disproportionate number involved handguns. CONCLUSIONS: The study results provide a basis for preventive strategies that limit accessibility or decrease lethality of loaded firearms within the home.

Accident Prevention↗
PubMed1998

Trends in firearm-related injuries in Washington State, 1989-1995.

STUDY OBJECTIVES: To describe the incidence and outcome of firearm-related injuries and to describe trends over time. DESIGN: Information about firearm-related injuries in Washington state was extracted from computerized death certificate and hospital discharge files for the period 1989 through 1995. Cases seen only in emergency departments were estimated using initial results from a statewide firearm injury surveillance system. RESULTS: An estimated 9,995 persons were shot during the 7-year period (incidence 28.0/100,000 person-years); 2,944 persons (29%) required ED care only, 2,864 persons (29%) were hospitalized and survived, and 4,187 persons (42%) died. Survival was lowest for suicide attempts (11%), intermediate for assaults (68%), and greatest for unintentional shootings (96%). Most deaths (91%) occurred before hospital admission. From 1989 to 1995, the incidence of firearm-related injuries showed little change: an increase of 4.5%. However, suicidal shootings among persons younger than 35 years increased by 31.3%, and the incidence of firearm-related assaults rose by 53.7% among persons of all ages. Survival among all persons who were shot and among hospitalized shooting victims showed little change over time. CONCLUSION: Firearm-related suicides among the young and assault-related shootings among all persons increased. The estimated proportion of shooting victims who survived did not change over time.

Adolescent↗
PubMed1997

Firearm suicide among older women in the U.S.

Contrary to the common view that older women (65+) in the United States use suicide methods that have relatively low potential for death, firearms have become the most common suicide method in this group. The present study examines the association between demographic and geographic factors and the use of firearms vs other suicide methods. Data were derived from the National Center for Health Statistics (NCHS) Mortality Detail Files (1989-1991). Results from a logistic regression analysis indicate that among white women 65 and over who died by suicide in 1989-1991, the risk of using firearms varied significantly across demographic and geographic subcategories of the population. The following characteristics among women were significantly more likely to be associated with the use of firearms as a suicide method: ages 65-74, married, of lower educational attainment, in nonmetropolitan areas, and in the South. Research is needed to assess the effects of limiting firearms on the growing proportion of firearm-related suicides among older women.

Age Factors↗