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gun violence

Etiology: - substance use is a risk factor for adolescent firearm homicide [7] - gun violence may be propagated through networks of people by social interaction [7] - exposure to gun use in movies, television, & other forms of media may influence how children interact with guns whenthey find them [8] - watching gun use associated with significantly more gun holding & trigger pulls [8] Epidemiology: - Surgeon general declares firearm violence a public health crisis in US [39] - firearm deaths now leading cause of death from trauma is U.S. exceeding deaths from motor vehicle accidents [33] - firearm fatality rates in the United States reached a 28-year high in 2021 [35] - 50,000 deaths in United States from gun violence in 2023 [40] - in 2013, more than 33,000 people in the United States died from gunshot injuries [3] - in the United States, the National Rifle Association (NRA), the legislators it has funded, & a certain breed of gun owners have stood in the way of research to determine what policies might help [3] - very few existing state-specific firearm laws are associated with reduced firearm mortality [4] - of 25 state firearm laws, 9 associated with reduced firearm mortality, 9 were associated with increased firearm mortality, & 7 had an inconclusive association - 3 state laws most strongly associated with reduced overall firearm mortality included: - universal background checks for firearm purchase (RR=0.39) - ammunition background checks (RR=0.18) - identification requirement for firearms (RR=0.16) [4] - Australia has had no mass fatal shootings since it banned semi-automatic weapons in 1996 [6] - the ban included guns already owned by citizens & mandated government buyback of all prohibited firearms [6] - from 1979-1996 in Australia, there were 13 mass fatal shootings, with 104 deaths, none afterwards [6] - total firearm deaths in Australia also declined after the ban, from 3.6 per 100,000 population to 1.2 per 100,000 - non-firearm suicides & homicides also declined, thus the reduction in total firearm deaths could not be directly attributed to the semi-automatic weapons ban [6] - 37,000 deaths from firearms in U.S. in 2016, 2/3 being suicides [27] - 6 countries accounted for half the global firearm deaths in 2016, Brazil, U.S., Mexico, Colombia, Venezuela, & Guatemala [27] - death rate from gun violence was 12.0 per 100,000 population in 1st quarter of 2017, higher prior year (11.4 per 100,000) [16] - firearm homicide in 2020 at highest in 25 years [34] - young adult males from zip codes with the most violence in Chicago & Philadelphia in 2020-2021 had a higher risk of firearm-related death than US military personnel who served during the wars in Afghanistan & Iraq [36] - from 2014 to 2020, mortality from firearm homicides increased by 7% annually [38] - from 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, & homicide due to firearms & all other injuries [38] - gun violence in the US is the leading cause of death among children & teenagers - cost to the economy was around $557 billion in 2022 [41] Management: - SaFETy score predicts risk for firearm violence in youth with substance abuse - evidence-based laws compliant with the 2nd amendment work [26] - prohibit dangerous individuals from purchasing firearms - enforce prohibited purchase laws - safe storage, smart guns, & child protection - ban hazardous weapons - permissive right-to-carry laws significantly increase violent crime, including homicides - crime detection [26] - stricter state gun laws are associated with safer schools [30] Notes: - research on gun violence has been underfunded compared with research on other major cause of death [7] - with background checks for firearm purchases, firearm- related mortality would decline from 10.35 per 100,000 to 4.46; with ammunition background checks to 1.99; with firearm identification* to 1.81 - 22% of current U.S. gun owners who acquired a firearm in 2014-2015 did so without a background check [21] - unregulated gun shows (i.e. in Nevada) may increase gun violence in neighboring states (i.e. in California) [15] - large increases in handgun purchases may occur after mass shootings (40-50%) [20,24] - exposure to violence increases likelihood of carrying a firearm [22] - Supreme Court allows for firearms regulation within the context of the second ammendment [25] - assessment of Mass Attacks in Public Spaces [37] * microstamping or ballistic fingerprinting given as examples of firearm identification - general engagement guidelines for physicians [14] - educate yourself & regularly contact their elected officials about this public health threat - meet with your institution's leaders to find ways to work with the government at all levels - ask patients about guns in the home - not be silent Clinical trials: - of 43 pairs of children who found a planted (disabled) handgun, 22 (51%) handled it, & 14 (33%) alerted researchers to its presence [8] - children who watched gun scenes held the handgun longer (53.1 vs 11.1 seconds) & pulled the trigger more times (2.80 vs 0.01) - children watching gun scenes played more aggressively, shot at their play partners & people passing by outdoors [8]

Related

firearm (gun, rifle, handgun)

General

assault (violence)

References

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