Gun control and suicide: the impact of state firearm regulations in the United States, 1995-2004

Objective

To empirically assess the impact of firearm regulation on male suicides.

Method

A negative binomial regression model was applied by using a panel of state level data for the years 1995-2004. The model was used to identify the association between several firearm regulations and male suicide rates.

Results

Our empirical analysis suggest that firearms regulations which function to reduce overall gun availability have a significant deterrent effect on male suicide, while regulations that seek to prohibit high risk individuals from owning firearms have a lesser effect.

Conclusions

Restricting access to lethal means has been identified as an effective approach to suicide prevention, and firearms regulations are one way to reduce gun availability. The analysis suggests that gun control measures such as permit and licensing requirements have a negative effect on suicide rates among males. Since there is considerable heterogeneity among states with regard to gun control, these results suggest that there are opportunities for many states to reduce suicide by expanding their firearms regulations.     

Firearm availability and suicide, homicide, and unintentional firearm deaths among women

Context In the United States, more than 45,000 women died from gun violence over the last decade. Objective To determine whether measures of firearm availability are related to rates of suicide, homicide, and unintentional firearm deaths among women in the United States. Design Pooled cross-sectional time series data on suicide, homicide, and unintentional firearm deaths (1988–1997) were used to estimate the association between the rate of violent death among women and four proxies of firearm availability. Two proxies came from survey reports of household firearm ownership rates; two were derived from mortality statistics. Setting United States, 1988–1997. Results The increased rate of suicide and homicide in states with high gun levels was accounted for primarily by significantly elevated firearm suicide and firearm homicide rates. Unintentional firearm death rates were also increased in states with more guns. At the regional level, qualitatively similar results were obtained. Conclusion Between 1988 and 1997, the suicide, homicide, and unintentional firearm death rates among women were disproportionately higher in states where guns were more prevalent. The elevated rates of violent death in states with more guns was not entirely explained by a state’s poverty or urbanization and was driven primarily by lethal firearm violence, not by lethal nonfirearm violence.     

State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003

Two of every three American homicide victims are killed with firearms, yet little is known about the role played by household firearms in homicide victimization. The present study is the first to examine the cross sectional association between household firearm ownership and homicide victimization across the 50 US states, by age and gender, using nationally representative state-level survey-based estimates of household firearm ownership. Household firearm prevalence for each of the 50 states was obtained from the 2001 Behavioral Risk Factor Surveillance System. Homicide mortality data for each state were aggregated over the three-year study period, 2001-2003. Analyses controlled for state-level rates of aggravated assault, robbery, unemployment, urbanization, per capita alcohol consumption, and a resource deprivation index (a construct that includes median family income, the percentage of families living beneath the poverty line, the Gini index of family income inequality, the percentage of the population that is black and the percentage of families headed by a single female parent). Multivariate analyses found that states with higher rates of household firearm ownership had significantly higher homicide victimization rates of men, women and children. The association between firearm prevalence and homicide victimization in our study was driven by gun-related homicide victimization rates; non-gun-related victimization rates were not significantly associated with rates of firearm ownership. Although causal inference is not warranted on the basis of the present study alone, our findings suggest that the household may be an important source of firearms used to kill men, women and children in the United States.     

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.     

Use of alcohol before suicide in the United States

PurposeFew studies have compared acute use of alcohol in suicide decedents with that in a nonsuicide group. This study provides the first national analysis of acute use of alcohol before suicide compared with an estimate of acute use of alcohol in a living sample.MethodsPooled 2003–2011 National Violent Death Reporting System data were used to estimate the prevalence of postmortem blood alcohol content positivity (blood alcohol content >0.0 g/dL) and intoxication (blood alcohol content ≥0.08 g/dL). Population estimates of comparable use of alcohol (within the past 48 hours) were based on the National Epidemiologic Survey on Alcohol and Related Conditions.ResultsCompared with the living sample, male and female suicide decedents showed, respectively, a 1.83-fold (95% confidence interval [CI], 1.73–1.93) and 2.40-fold (95% CI, 2.24–2.57) increased risk of alcohol ingestion before their death after age, race/ethnicity, and chronic alcohol problems were controlled. Furthermore, male and female decedents exhibited, respectively, a 6.18-fold (95% CI, 5.57–6.86) and a 10.04-fold (95% CI, 8.67–11.64) increased risk of being intoxicated before their death after confounders were considered.ConclusionsThe findings underscore the crucial need to include among the essential components of suicide prevention policies programs that minimize the use of alcohol, particularly drinking to intoxication.     

深圳市居民自杀流行病学研究

目的 了解深圳市人群自杀流行特征及模式,为自杀干预提供依据.方法 采用描述性流行病学方法,对2006-2009年深圳市伤害监测系统自杀病例进行分析.结果 2006-2009年深圳市伤害监测系统共报告自杀病例1 634例,占伤害总数的0.75%.自杀病例户籍主要为外省(67.68%);文化程度以初中居多(46.74%);职业主要为商业、服务业、生产运输业和办事人员,分别占39.35%、15.30%、9.12%;女性多于男性(男女性别比为0.48∶1),年龄以25～30岁居多(26.72%);自杀高峰出现在春季及一天中的21～24时,自杀方式以中毒为主(53.68%),50.79%的病人需住院治疗.结论 深圳市自杀干预重点人群为外来劳务工,主要干预措施为提高生活质量,加强心理教育和危险品管理等.     

The role of firearm and alcohol availability in firearm suicide: A population-based weighted case-control study

Firearm availability has been linked to firearm self-harm, but the joint relationship with alcohol availability, while supported by theory, has not been examined. This study sought to quantify the separate and joint relations of community firearm and alcohol availability with individual-level risk of (fatal and nonfatal) firearm self-harm. We conducted a case-control study of California residents, 2005–2015, using statewide mortality, hospital, firearm transfer, and alcohol license data. We estimated monthly marginal risk differences per 100,000 in the overall population and in white men aged 50+ under various hypothetical changes to firearm and alcohol availability and assessed additive interactions using case-control-weighted g-computation. In the overall population, non-pawn shop firearm dealer density was associated with firearm self-harm (RD: 0.02, 95% CI: 0.003, 0.04) but pawn shop firearm dealer and alcohol outlet densities were not. Secondary analyses revealed a relationship between firearm sales density and firearm self-harm (RD: 0.07, 95% CI: 0.04, 0.10). There were no additive interactions between measures of firearm and alcohol availability. Among older white men, generally the same exposures were related to self-harm as in the overall population, but point estimates were substantially larger. Findings suggest community-level approaches to reducing firearm sales may help mitigate suicide risk.     

Sociodemographic and geographic patterns of firearm suicide in the United States, 1989-1993

This study identified the sociodemographic and geographic patterns of using firearms to commit suicide in the United States. Data from the Mortality Detail Files (1989-1993) were analyzed using logistic regression. The adjusted odds of using firearms increased with age among men and decreased among women. Widowed men and married women had the highest odds of using firearms. The odds were highest among those without college education, in nonmetropolitan areas and in the East South Central and West South Central geographic divisions. The likelihood of using firearms to commit suicide varies significantly across sociodemographic and geographic subgroups of the US population and parallels patterns of gun ownership. The results of this study suggest that regional cultural factors play an important role in accounting for the differential rates in suicidal behavior involving firearms.     

The supply and demand for guns to juveniles: Oakland’s gun tracing project

In response to Oakland, California’s high level of gun violence affecting young people, the East Oakland Partnership to Reduce Juvenile Gun Violence, a citywide collaboration, was formed in 1997. In 1999, the Partnership established the Oakland Gun Tracing Project to develop evidence-based policy recommendations aimed at reducing the supply of and demand for gun acquisition among urban youth. The advocacy project involved gathering, analyzing, and using police record and gun sale/registration data to inform policy and practice. Such data were collected for all gun crimes committed in Oakland, California between 1998 and 1999 in which a juvenile was either the suspect or the victim. The 213 cases involved 263 juveniles of which 170 were suspects/perpetrators and 93 were victims. Suspects as well as victims were predominantly male and African American. The 213 cases involved 132 recovered guns. Only 55% of the cases were traced to a federally licensed dealer. Three-quarters of the guns were purchased near Oakland, California. Successful traces, defined as the ability to identify federally licensed dealers and initial purchasers, were completed on only 52 of the 132 guns, demonstrating systemic tracing difficulties. Data gathered for the project was used to advocate for numerous policy changes. Recommended policy strategies include initiating a comprechensive gun tracing program so police can track all secondary sales, new laws requiring federal handgun registration which would track ownership changes, required reporting of stolen firearms, and providing effective intervention services to all juveniles the first time they enter the criminal justice system. Preliminary findings were reported in a presentation at the American Public Health Association Annual Meeting in Atlanta, Georgia, October 2001.     

Decreasing the Supply of and Demand for Guns: Oakland’s Youth Advocacy Project

This paper is a case study of how Youth ALIVE!, a nonprofit public health organization, blended direct service and policy goals to reduce youth gun violence at a time when guns became the number one killer of children in California. Youth ALIVE! trained young people living in California communities with the highest rates of gun violence to become peer educators and leaders to reduce both the supply of, and demand for, guns. The youth presented health and criminal justice data in the context of their own experiences living in communities endangered by gun violence to help build public policy solutions, contributing to the subsequent drop in gun homicides. Youth ALIVE’s vibrant grassroots model provides a real-life tableau of research and direct services working together to yield realistic policy solutions to a lethal public health problem. The youths’ successes demonstrate how nonprofit direct service organizations are uniquely positioned to advocate for policy and regulatory changes that can be beneficial to both program participants and society. Direct service organizations’ daily exposure to real-life client needs provides valuable insights for developing viable policies—plus highly motivated advocates. When backed by scientific findings on the causes of the problem, this synergy of youth participant engagement in civil society can promote good policy and build healthy communities.     

The epidemiology of pacemaker implantation in the United States.

Data on pacemaker implantation were obtained from the Medical Device Implant Supplement to the 1988 National Health Interview Survey, a nationally representative, population-based survey of 47,485 households (122,310 persons). The survey yielded an estimate of 456,482 noninstitutionalized adults with pacemakers (prevalence, 2.6 per 1,000). Prevalence rose significantly with age, from 0.4 per 1,000 among persons ages 18-64 to 26 per 1,000 among those ages 75 or older. Age-adjusted prevalence in males was 1.5 times that in females, and in whites 1.6 times that in nonwhites, although these differences were of borderline statistical significance. Prevalence did not vary significantly by region of residence, educational level, or income, but was significantly increased (more than threefold) in those reporting any activity limitation compared with those with no limitation. Fifteen percent of pacemakers in use were replacements; about one-fifth of these had been replaced more than twice. Sixty percent of previous pacemakers had been in place for at least 5 years. These data provide the first nationwide, population-based estimates of the epidemiology of pacemaker implantation, focusing particularly on the demographics of U.S. pacemaker recipients.     

Drugs and firearm deaths in New York City, 1990–1998

Firearm deaths remain among the leading causes of mortality in the United States. Changing law enforcement activities, incarceration, drug use, and socioeconomic conditions may have played roles in the declining rates of firearm deaths during the 1990s. Using records from the Office of the Chief Medical Examiner, we analyzed the role of drugs in firearm deaths in New York City between 1990 and 1998. Positive drug toxicology was present in over half of all firearm death victims during this time. Cocaine, cannabis, opiates, and alcohol accounted for almost all of these deaths with drug-positive toxicology. There were decreases in cocaine- and alcohol-positive toxicology for firearm deaths in New York City starting in the early 1990s; there was a more gradual decrease in heroin-positive toxicology for firearm deaths. Cannabis-positive toxicology for firearm deaths increased in the early part of the 1990s and then decreased starting in the mid-1990s. Although the disparities between minority and white firearm death rates narrowed during this time, minorities remained about three times more likely to be victims of fatal firearm violence than whites in 1998. The highest firearm death rates were among African American and Latino male decedents, with a larger proportion of Latinos testing cocaine or opiate positive, while a larger proportion of African Americans tested cannabis positive. These results suggest a complex role of drugs in firearm-related deaths.     

The epidemiology of appendicitis and appendectomy in the United States

To describe the epidemiology of appendicitis and appendectomy in the United States, the authors analyzed National Hospital Discharge Survey data for the years 1979-1984. Approximately 250,000 cases of appendicitis occurred annually in the United States during this period, accounting for an estimated 1 million hospital days per year. The highest incidence of primary positive appendectomy (appendicitis) was found in persons aged 10-19 years (23.3 per 10,000 population per year); males had higher rates of appendicitis than females for all age groups (overall rate ratio, 1.4:1). Racial, geographic, and seasonal differences were also noted. Appendicitis rates were 1.5 times higher for whites than for nonwhites, highest (15.4 per 10,000 population per year) in the west north central region, and 11.3% higher in the summer than in the winter months. The highest rate of incidental appendectomy was found in women aged 35-44 years (43.8 per 10,000 population per year), 12.1 times higher than the rate for men of the same age. Between 1970 and 1984, the incidence of appendicitis decreased by 14.6%; reasons for this decline are unknown. A life table model suggests that the lifetime risk of appendicitis is 8.6% for males and 6.7% for females; the lifetime risk of appendectomy is 12.0% for males and 23.1% for females. Overall, an estimated 36 incidental procedures are performed to prevent one case of appendicitis; for the elderly, the preventive value of an incidental procedure is considerably lower.     

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.     

Characteristics of automatic or semiautomatic firearm ownership in the United States.

OBJECTIVES: This study examined ownership patterns of automatic/ semiautomatic firearms in the United States. METHODS: Data were derived from a national random-digit-dialing telephone survey of 800 gun owners. RESULTS: Sixty percent of gun owners reported owning an automatic or semiautomatic firearm. In comparison with other gun owners, owners of automatics or semiautomatics were more likely to be male, live in the South, own a gun for protection, and have a gun for work. They were also more likely to report binge drinking. CONCLUSIONS: Owners of automatic or semiautomatic firearms differ from other gun owners in several respects, including frequency of binge drinking.     

Firearms and suicide in the United States.

Regional United States suicide rates in the mid 1970s were associated with the household prevalence of all guns and of pistols. The term "regional" applies to the nine Census divisions of the four US census regions. A literature review suggests that the relation may be etiologic, and that more definitive studies and pilot programs are needed. Arming may be an etiologic factor common both to individual and to national self-destructive behaviors.