Research and Publications

Summaries of Key Recent Research Articles from JHCGPR Faculty

HIDDEN HOMICIDE TRENDS IN THE U.S., 1999-2004
Hu G, Webster DW, Baker SP.  
Journal of Urban Health 2008;85:597-606.

Prior to 1999, dramatic fluctuations in homicide rates were driven by changes in the rates of firearm homicide among men aged 15-24. Since 2000, the overall homicide rate has appeared stable. We analyzed recent trends in homicide rates by weapon, age, race, gender, state, and urbanization to determine whether the risk of victimization increased substantially during 1999-2005 for subgroups. The analysis of death certificate data revealed no trend in the overall homicide rate nationally between 1999 and 2005. Yet there were large increases in firearm homicide rates among black men aged 25-44 and among white men aged 25-34. Between 1999 and 2005, for ages 25-44 combined, the increase for black men was 31% compared with 12% for white men. The firearm homicide rate increased the most in large central metropolitan areas (+32%) and large fringe metropolitan areas (+30%) for men aged 25-44. We conclude that the recent, unrecognized increases in firearm homicide among men aged 25-44, especially men in large metropolitan areas, merit the attention of policymakers.

RESTRAINING ORDERS AMONG VICTIMS OF INTIMATE PARTNER HOMICIDE
Vittes KA, Sorenson SB
Injury Prevention; 2008; 14:191-195.

This study examines the restraining order history of IPH victims by
characteristics of the victim, assailant, and homicide. State-wide databases containing information about restraining orders and homicides were linked, and bivariate and multivariate statistics were calculated to identify differences between IPH victims who had and had not been issued a restraining order. About 11% of 231 women killed by male intimates had been issued a restraining order. About one-fifth of the female IPH victims who had a restraining order were killed within 2 days of the order being issued; about one-third were killed within a month. Nearly half of those with a restraining order had been protected by multiple orders. Victims killed in a shared residence (versus elsewhere) had lower odds of having a restraining order, whereas victims from rural (versus urban) counties, married (versus dating) victims, and Latino (versus non-Latino) victim-offender dyads had higher odds of having a restraining order. The type of weapon used was not associated with whether the victim had been under the protection of a restraining order. We conclude that further research is needed to determine whether restraining orders protect against IPH and, if they do, on how to increase their utilization.

MENTAL HEALTH AND FIREARMS IN COMMUNITY-BASED SURVEYS: IMPLICATIONS FOR SUICIDE PREVENTION
Sorenson SB, Vittes KA
Evaluation Review; 2008; 32:239-256

Suicide rates are higher among those who own a handgun and among those who live in a household with a handgun. This article examines the association between gun ownership and mental health, another risk factor for suicide. Data from the General Social Survey are analyzed to compare 4 categories of mental health among gun owners, persons who do not own but live in a household with a gun, and those who do not own a gun. After taking into account a few basic demographic characteristics associated with both variables, there appears to be no association between mental health and gun ownership. Nor is there any association between mental health and living in a household with a firearm. Findings suggest that the high risk of suicide among those who own or live in a household with a gun is not related to poor mental health. Implications for prevention are discussed.

KEEPING GUNS OUT OF THE HANDS OF ABUSERS: HANDGUN PURCHASES AND RESTRAINING ORDERS
Vittes KA, Sorenson SB
American Journal of Public Health; 2008; 98:828-831

Persons under certain domestic violence restraining orders are prohibited by federal law from purchasing and possessing a firearm. We used administrative data from California to link 794,426 restraining orders with 1,388,724 handgun purchase applications. We found that restrained persons were not a less law-abiding group in general, but they appeared to be repeatedly or serially abusive to intimate partners, and their handgun purchase rates were highest after their restraining orders expired.

POLICIES TO PREVENT FIREARM TRAFFICKING
Vernick JS, Webster DW
Injury Prevention 2007;13:78-79.

Problem firearm dealers, straw purchasers, and gun traffickers are an important source of firearms for criminals.  This article summarizes a number of policies that can reduce illegal gun trafficking.  These policies include: 1) improved licensing and oversight of gun dealers; 2) requiring background checks for all gun purchases; 3) outlawing firearms, such as so-called “junk guns,” that are especially attractive to criminals; 4) mandatory reporting of lost and stolen firearms; and 5) comprehensive tracing of all firearms recovered by the police.

THE ETHICS OF RESTRICTIVE LICENSING FOR HANDGUNS: COMPARING THE UNITED STATES AND CANADIAN APPROACHES TO HANDGUN REGULATION 
Vernick JS, Hodge JG, Webster DW 
Journal of Law, Medicine, and Ethics 2007;35:668-678.

The United States and Canada regulate firearms, particularly handguns, quite differently. With only a few state and local exceptions, the U.S. approach emphasizes the ability of most individuals to purchase, possess, and carry handguns. By comparison, Canada has a form of restrictive licensing for handguns that places a premium on community safety. This article first reviews the potential individual and community level harms and benefits associated with these differing firearm policies. Using this information, the article explores the ethical dimensions of the U.S. and Canadian approaches through three major themes of autonomy, prevention of harms, and social justice. The article concludes that the Canadian approach is consistent with respect for the autonomy of persons, fosters the prevention of harms, and more appropriately furthers social justice.

AVAILABILITY OF LITIGATION AS A TOOL FOR FIREARM INJURY PREVENTION: COMPARING GUNS, VACCINES, AND MOTOR VEHICLES
Vernick JS, Rutkow L, Salmon D. 
American Journal of Public Health, 2007;97:1991-1997.

The Protection of Lawful Commerce in Arms Act (PLCAA), enacted in 2005, grants the firearm industry broad immunity from liability. The PLCAA not only prevents most people from receiving compensation for their firearm-related injuries, it erodes litigation's ability to serve its public health role of providing manufacturers with a financial incentive to make their products safer. When the viability of the vaccine industry was threatened in the 1980s, Congress provided limited protection from liability and also established the Vaccine Injury Compensation Program. The liability of nearly all other products, for example motor vehicles, is governed by traditional common law principles. The absence of both litigation and product safety rules for firearms is a potentially dangerous combination for the public's health.

In early 2006, 2 separate but virtually identical bills were introduced in the Virginia and West Virginia legislatures that would have profoundly affected the relationship between a physician and his or her patients. Each bill would have prohibited a physician from asking a patient if he or she owned firearms for the purpose of counseling that patient about ways to reduce risks associated with firearms. The Virginia bill was initially approved by its state House of Delegates by a vote of 88 to 11. It was ultimately defeated in a Virginia Senate committee. Although neither bill became law this year, this type of bill is likely to reappear in future legislative sessions. The Virginia and West Virginia bills were contrary to the best-practices recommendations of medical societies. Anticipatory guidance regarding firearms can indeed reduce risks to patients. Yet, the bills would have preferred the judgment of legislators over physicians regarding this aspect of the practice of medicine.  The Virginia and West Virginia bills would have treated risks associated with firearms differently from other hazards and interfered with a physician's ability to protect his or her patients. The Virginia bill was defeated, in part, through the efforts of physicians to educate legislators. However, physicians must remain prepared to respond to similar state legislative initiatives in the future.

REGULATING FIREARMS DEALERS IN THE UNITED STATES: AN ANALYSIS OF STATE LAW AND OPPORTUNITIES FOR IMPROVEMENT
Vernick JS, Webster DW, Bulzacchelli MT
Journal of Law, Medicine, and Ethics 2006;34:765-775.

Licensed firearm dealers are an important source of guns for criminals and gun traffickers.  Federal law makes it difficult for ATF to inspect and revoke the licenses of problem gun dealers.  State licensing systems, however, are a greatly under-explored opportunity for firearm dealer oversight.  We identify and categorize these state systems to identify opportunities for interventions to prevent problem dealers from supplying guns to criminals, juveniles, or gun traffickers.  Just seventeen states license gun dealers.  Twenty-three states permit routine inspection of gun dealers but only two mandate that those inspections occur on a regular basis.  Twenty-six states impose record-keeping requirements for gun sales.  Only thirteen states require some form of store security measures to minimize firearm theft.  We conclude with recommendations for a comprehensive system of state licensing and oversight of gun dealers.


EFFECTS OF POLICE STINGS OF GUN DEALERS ON THE SUPPLY OF NEW GUNS TO CRIMINALS
Webster DW, Zeoli AM, Bulzacchelli MT, Vernick JS
Injury Prevention 2006;12:225-230.

This study assessed the effects of undercover police stings and lawsuits against gun dealers suspected of facilitating illegal gun sales in 3 U.S. cities (Chicago, Detroit, and Gary) on the flow of new firearms to criminals.  The intervention was associated with an abrupt 46% reduction in the flow of new guns to criminals in Chicago, and a more gradual reduction in new crime guns in Detroit.  There was no statistically significant change associated with the stings in Gary, and no change in comparison cities that was coincident with the stings in Chicago and Detroit.  Given the important role that gun stores play in diverting guns into the illegal market, further efforts of this type are warranted and should be evaluated.


EFFECTS OF A GUN DEALER'S CHANGE IN SALES PRACTICES ON THE SUPPLY OF GUNS TO CRIMINALS
Webster DW, Vernick JS, Bulzacchelli MT
Journal of Urban Health 2006;83:778-787.

Prior to May 1999, a single gun store sold more than half of the guns recovered from criminals in Milwaukee shortly following retail sale.  Following news reports that this gun dealer had sold more guns subsequently used in crimes than any other dealer in the country, the store announced that it would no longer sell small, inexpensive handguns commonly used in crime.  This study examined trends in crime gun traces in Milwaukee and three comparison cities in the Midwest and estimated that this store's new policy was associated with a 73% decline in the number of its guns linked to crime within a year of retail sale.  The store's new policies were also associated with a 44% decrease in the total number of newly trafficked guns recovered from criminals in Milwaukee.


SEPARATING BATTERERS AND GUNS: A REVIEW AND ANALYSIS OF LAWS IN 50 STATES
Frattaroli S, Vernick JS
Evaluation Review 2006;30(3):296-312.

Firearms play an important role in lethal domestic violence incidents.  We review laws regarding two policies to separate batterers from firearms: laws authorizing police to remove firearms when responding to a domestic violence complaint ("police gun removal laws"), and laws authorizing courts to order guns removed from batterers through a protective order ("court-ordered removal laws").  As of April 2004, 18 states had police gun removal laws; 16 states had court-ordered removal laws.  We examine relevant characteristics of the laws and recommend that these laws be mandatory, apply to all guns and ammunition possessed by an abuser, and include clear procedures to enhance implementation.


UNDERSTANDING AND INFORMING POLICY IMPLEMENTATION: A CASE STUDY OF THE DOMESTIC VIOLENCE PROVISIONS OF THE MARYLAND GUN ACT
Frattaroli S, Teret SP
Evaluation Review 2006;30(3):347-60.

The Maryland Gun Violence Act, enacted into law in 1996, explicitly authorized courts to order batterers to surrender their firearms through civil protective orders.  It also vested law enforcement with the explicit authority to remove guns when responding to a domestic violence complaint.  In order to assess how these laws were implemented, we designed a case study and collected data from in-depth, key informant interviews, court observations, and relevant documents.  We present findings from this study and recommend how to increase the likelihood that policies designed to separate batterers and guns are implemented in a way that will result in greater protections for victims of domestic violence.


USING LOCAL PUBLIC HEALTH POWERS AS A TOOL FOR GUN VIOLENCE PREVENTION: THE BALTIMORE YOUTH AMMUNITION INITIATIVE
Lewin NL, Vernick JS, Beilenson PL, Mair JS, Lindamood LM, Teret SP, Webster DW
American Journal of Public Health 2005;95:762-765.

In 2002, the Baltimore City Health Department and the Johns Hopkins Center for Gun Policy and Research launched the Youth Ammunition Initiative.  The initiative was a response to the discovery that some of the city's youth were illegally purchasing firearm ammunition from local businesses.  The health commissioner's legal authority to identify and abate public health risks as well as state firearms laws were examined.  Due to the ongoing epidemic of youth gun violence in Baltimore that qualified as a public health emergency, the health commissioner decided to use his powers to remedy the problem of illegal ammunition sales to underage youth.  Undercover stings of local businesses were conducted and a local hardware store was cited for illegal ammunition sales.  The store was ordered closed and abatement options were presented to the proprietor.


EFFECTS OF YOUTH-FOCUSED FIREARM LAWS ON YOUTH SUICIDES
Webster DW, Vernick JS, Zeoli AM, Manganello JA
Journal of the American Medical Association 2004;292:594-601.

State-specific trends in suicides among youths ages 14-17 were analyzed to assess the effects of laws restricting firearm access to underage youth.  Child access prevention (CAP) laws were associated with an 11% decrease in the risk of firearm suicides and an 8% decrease in suicide by any means among 14 to 17 year olds.  The law had no significant effect on suicides by other methods.  Laws establishing a minimum age for handgun purchase and possession were not associated with statistically significant reductions in suicide rates among youth.