Background/Purpose: Approximately 1 in 4 injury deaths in children and adolescents ages 0-19 is a result of firearm injury. We examined trends in firearm injury deaths by intent (unintentional, suicide, homicide/legal intervention, and undetermined) among children and adolescents in the U.S. We also estimated the annual economic costs of firearm injury in this population. Methods: We used the National Center for Health Statistics, Multiple Cause of Death data from 2010-2019 to examine trends in firearm injury deaths. Joinpoint regression analysis estimated the average annual rate changes in firearm injuries. For economic analysis, we used the 2018 fatal incidence data from the National Center for Health Statistics, Multiple Cause of Death data and 2018 nonfatal incidence from the Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project datasets. Our costs included medical and mental healthcare, police and criminal justice costs, injury-related work loss and perpetrator work loss, and quality of life loss using the established injury cost model. Results: Firearm injury deaths increased from 3.3 per 100,000 in 2010 to 4.2 in 2019 among U.S. children and adolescents. Rates increased by 16% on average per year for homicide/legal intervention-related firearm injury deaths and by 59% on average per year for suicide-related firearm injury deaths. We estimated $34 billion cost to society annually for firearm injuries in children and adolescents. Conclusions: Our trends and cost estimates allow us to assess the magnitude of firearm injuries in children and adolescents and support economic analyses of firearm prevention programs.

Background/Purpose: The Centers for Disease Control and Prevention (CDC) publishes estimates of the distribution of nonfatal firearm injury intent (NF-FII) using data from the National Electronic Injury Surveillance System (NEISS). Over the past two decades, the proportion of undetermined NF-FII in NEISS has declined from 15% in the mid-1990s to nearly zero in recent years, raising questions about why undetermined cases have nearly disappeared and what effect eliminating undetermined attribution may have had on the accuracy of intent adjudication. In this analysis, we recover population level estimates of annual NF-FII in NEISS, 1997-2016, under the assumption that effectively eliminating undetermined as an intent coding option adulterated intent attribution in later years.

Methods: Machine learning was used to support the presence of misclassification of NF-FII in later years using an assumed correct distribution from earlier years. “Unintentional” and “Unknown” NF-FII were decoupled and NF-FII were imputed by fully conditional specification; national estimates were then recovered from combining multiply imputed datasets.

Results/Outcomes: There is evidence of a shift in the 2016 population distribution of NF-FII when comparing estimates using the original NEISS data with the multiply imputed data (respectively)- Unintentional: 20%(95% CI [14%, 27%]) vs. 13%([8.7%,17%]), Undetermined: 0.2%([0%, 0.6%]) vs. 22%([18%, 26%]), Assault: 75%([65%, 82%]) vs. 60%([53%, 67%]), Self-inflicted: 3.9 ([2.3%, 6.5%]) vs. 3.8%([2.4%, 5.2%]), and Legal Intervention: 1.4%([0.7%, 2.7%]) vs. 1.1%([0.0%, 2.2%]).

Conclusions: Recent National estimates of NF-FII may be misclassified. With a better understanding of the distribution of NF-FII we may better allocate resources to reduce overall non-fatal firearm injuries.

Background/Purpose: Increasing school-based violence is a persistent public health issue. In accordance with New Jersey (NJ) state law, the NJ Safe Schools Program reviews safety and health plans regarding environmental health and safety regulations for secondary school career-technical-vocational (CTE) in hazardous occupations. The goal is to reduce injury and illness and increase safety practices among school staff and students.

Methods: A statewide online survey for secondary school teachers, expanding survey piloted 1-8/2019, was implemented between 10-11/2019 through PsychData (State College, PA). The survey consisted of twenty-eight items assessing hazard concerns, presence of guns and weapons on/off campus, confidence in student emergency preparedness, perceived effectiveness of preparedness practices, and potential initiatives and gun control measures. Completed data by 128 of 139 participants represented 19 of 21 counties and 88 school districts across NJ. Data were used to assess perceptions of threats and violence at schools and perceived effectiveness of safety initiatives. Data collected were de-identified, managed in Excel, and analyzed in SPSS.

Results/Outcomes: Results suggested school shootings are the primary concern for teachers and revealed teachers selected preparedness training and student access to mental health care services as potentially most effective for improving school safety. Analyses about potential associations between teacher/administrator personal and school perceptions of safety threats and implementing various emergency preparedness measures will be presented.

Conclusions: Data from this study will assist in identifying hazards of greatest concern, teacher reactions to existing preparedness practices, and school-based services needed. Recommendations for school-wide safety practices based upon findings will be presented.

Background/Purpose. Gun Shop Projects (GSPs) are community-driven suicide prevention partnerships between the firearms community and local public or community health agencies, with the goal of using trusted messengers in the firearms community to educate owners and employees of firearm businesses on the increased risk of suicide for firearm owners. While GSPs are being implemented in 21 states in the U.S., studies evaluating GSP implementation and impact are limited, with only three sources of publicly reported evaluative data. This study assessed the mechanisms by which GSP may impact suicide in Colorado communities.

Methods. We administered a cross-sectional survey to all owners or managers of firearm businesses who participated in Colorado’s GSP between 2015 and 2020 (n=209). We included measures to understand GSP implementation, business characteristics, behavioral changes and its antecedents, and individuals’ firearm background and demographics. Multiple linear regression was used to assess the unique contributions of GSP implementation on expected behavioral changes and corresponding antecedents.

Results/Outcomes. Our findings suggest how GSP implementation may contribute to changing firearm business owners/managers’ perceptions about their role in preventing suicide among customers and the broader community. Owners reported their willingness to educate others about temporary safe storage, facilitate temporary safe storage, and deny sales of a firearm to a customer believed to be in crisis.

Conclusions. These findings confirm the importance of conducting process and outcome evaluations to assess the impact of GSPs on suicides involving firearms, and the mechanisms by which GSPs may have population-level effects on suicide in local communities.

Background: Firearm injuries result from community violence, and pediatric deaths related to firearms are a public health crisis. It is one of the leading preventable mechanisms of death and non-fatal injury among children and adolescents. The objective of this study is to describe pediatric deaths attributed to firearm-related injuries in Harris County, Texas between 2008-2017.

Methods: Using data collected by the Harris County Child Fatality Review Team, all firearm-related child fatalities in Harris County, Texas were evaluated and identified using descriptive and analytical statistics.

Results: Firearm-related deaths among children 0-17 between 2008-2017 in Harris County accounted for 13.8% of all non-natural child fatalities. Of those, 69% of firearm-related fatalities among children were due to homicide, 30% due to suicide, and 1% unintentional. As children age, firearm-related deaths become more common and more intentional; firearms account for only 3.6% of all deaths in children 1-4 years, yet 13.9% in children 5-12 years, and 39.9% of deaths in children 13-17 years old. Firearms account for the most common method of suicide (45.0%) and homicide (46.0%) among children in Harris County. The firearm homicide mortality rate is significantly higher in 16- and 17-year-olds than other ages. Black children, adolescents, and males were found to be at highest risk of firearm-related deaths among children.

Conclusion: Firearms are a leading mechanism of death among children. Child fatalities due to firearms can be reduced by policies and practices which decrease child access to firearms through safe storage and through programs that address community violence and resiliency.

Background

One option for reducing risk of suicide is temporary, voluntary firearm storage out of the home. In Washington and Colorado, we sought to recruit potential storage suppliers (law enforcement organizations [LEO], firearm retailers/ranges) and organizations interested in firearm safety to understand how, why, and where voluntary storage is offered and used.

Methods

Prospective interview participants were recruited in each state from stakeholder groups (LEOs, retailers, administrators/policymakers) and national or regional firearm or public health organizations. Recruitment used direct emails and telephone calls within each stakeholder. The recruitment plan was reevaluated when 50% reduction in recruitment was experienced.

Results

After initial recruitment success (October-November 2020; 44% participation among stakeholders contacted), recruitment plateaued in late November - December (22%). This drop was likely multifactorial, including impacts from the Presidential election, COVID-19 surge, and holiday season. The language from the initial recruitment materials may also have hindered success; it was amended to emphasize the study goal of suicide prevention through voluntary storage. These strategies brought our recruitment rate up to 37% in January-February 2021.

The stakeholder group with the highest refusal rate from both states was LEOs (CO-63%; WA-80%). The next highest refusal rate was retailers/ranges, each state reporting 69%. Firearm and public health organizations both had the lowest refusal rate, regardless of state (CO-27%; WA -37%).

Conclusion

Culturally competent language is important for recruiting LEOs and firearm retailers into public health research studies. Strategies to address barriers are relevant for public health to collaborate with the firearms community to prevent suicide.

Objective: Cure Violence (CV) is an effective intervention to reduce gun violence; however, the mechanisms that make CV effective have not been thoroughly explored. This study focused on the role of CV peer mentoring to disengage high-risk individuals from antisocial-peer networks and from participating in retaliatory shootings in the aftermath of gun-shot victimization (GSV).

Methods: The authors conducted qualitative interviews with 30 GSVs with prior gun charges and 12 CV peer-mentors. Interpretative Phenomenological Analysis was used to examine (1) how CV peer-mentors used their own narratives to promote attitudinal and behavioral changes, and (2) how GSVs used CV peers to form new ideas and attitudes that promoted crime desistance and disengagement from anti-social peers.

Results: A number of themes were found, but most salient were caring, redemption, and empowerment. Peer-mentors indicate that they draw on their past “street life” experiences and “redeemed” lives to provide genuine care and promote attitudinal shifts in GSVs. Likewise, feeling “inspired” by “ex-gang bangers” and wanting to do well in the eyes of CV peer-mentors, were described as empowering and motivating components to leave “street life” and desist from retaliatory shootings amongst GSVs.

Implications: The themes that emerged suggest peer mentors have a unique advantage over non-peer or non-credible messengers when committed to anti-violence work. These advantages likely could be leveraged to extend the types of support that peer mentors offer. Additionally, the findings have implications for bringing programming that use peer mentors to scale.

Background/purpose:

Suicide is the 10th most frequent cause of death in the US with 48,344 deaths in 2018, of which 24,432 were firearm suicides. Men are more likely to complete suicide using firearms, accounting for 61% of firearm fatalities. Men are not likely to substitute different suicide means if firearms are not available.Addressing firearm access will reduce overall suicide rates. This is a compelling argument for the development of suicide prevention programs that target firearm owners.

Methods:

As part of a larger mixed-methods study aimed at understanding attitudes and risk of diverse groups of firearms owners, we engaged a CBPR informed approach to conduct 45 qualitative interviews with firearm owners. Qualitative interviews aimed to expand understanding of firearm owners’ perceptions of suicide prevention and risk. Firearm owners were trained as Community Research Associates who informed study development, conducted interviews, and participated in analyses and dissemination activities

Results/Outcomes:

Perspectives of firearm owners related to suicide and prevention emerged. Perspectives included the firearm owner not blaming the firearm when there is a suicide, believing that suicide is not preventable, seeing the importance of engaging the firearm community in suicide prevention efforts, and believing in the need to reduce stigma of mental illness as it relates to preventing suicide..

Conclusions:

To effectively address and prevent the most lethal method of suicide, it is important to understand the perspectives of firearm owners. One must first understand the perspectives and beliefs of firearm users and then develop appropriate suicide prevention strategies.

BACKGROUND/PURPOSE: In the wake of police violence and amplified calls for a justice revolution, U.S. gun sales spiked in 2020, with anecdotes suggesting greater diversity among recent purchasers. The purpose of this study was to analyze similarities or differences in violence prevention policy support by race and gun owner subgroups.

METHODS: In January 2021 we fielded a nationally representative survey of support for violence prevention policies and policing reforms, as well as perceptions of safety and discrimination, with oversampling of gun owners, Black Americans, and Hispanic Americans.

RESULTS/OUTCOMES: Across all subgroups, support was high for the adoption of policing models that connect people with symptomatic mental illness to non-punitive health services. In other policy areas, differences emerged, particularly among Black compared to white gun owners. Notably, just 60% of Black gun owners agree that owning a gun makes them safer (compared to 79% of white gun owners (p=.001) and 46% of Americans overall), and 90% of Black gun owners favor stronger laws to hold police accountable for unjustified use of violence (compared to 60% of white gun owners (p<.001) and 72% of Americans overall).

CONCLUSIONS: Safety is a basic human need and a common motivator of gun ownership. Despite strong agreement about certain protective solutions, a substantial portion of the population perceives safety as being inadequately met by law enforcement or by personal gun ownership. Safety is foundational to all public health. To address health disparities, public safety systems must adapt to overcome enduring legacies of discrimination and unequal protection.

Background

Colorado’s Extreme Risk Protection Order (ERPO) law (effective January 1, 2020) allows petitioners to submit evidence that a respondent poses significant risk to themselves or others. If the court grants a temporary (2-week) ERPO and/or full (one year) ERPO is granted, the respondent must surrender firearms and concealed carry licenses and may not possess any during the specified period. In the controversial law’s passage and implementation, 57% (37/64) of Colorado counties declared themselves “Second Amendment sanctuaries (2AS);” examples included sheriffs stating they would not submit petitions or enforce ERPOs. These proclamations are not binding and their impact on ERPO utilization is unclear.

Methods

We requested public records from Colorado county courts for all ERPO petitions filed from January 1 to December 31, 2020. Data were abstracted and compared by county 2AS status.

Results

In 2020, there where 109 petitions filed. In 2AS counties, 9 (24%) had at least one petition filed, versus 13 (48%) of non-2AS counties. In 2AS counties, 39% of petitions resulted in TERPOs (12/31), versus 63% across non-2AS counties (49/78). Petitions filed by law enforcement accounted for a smaller proportion in 2AS counties (35%, versus 53% in non-2AS) but were still more likely to be granted (73%) versus those filed by family/household members (5%).

Conclusion

During the first year of ERPOs in Colorado, both 2AS and non-2AS counties had TERPOs/ERPOs granted. After more petitions are available, future studies should examine whether differences in LEO filing or petition approval are statistically significant.