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Firearm Injury Interventions
Ownership and Licensing/Safe Storage
Background
In this section, we review the impact of
legislation designed to decrease access to guns, especially handguns. Legislation
may intend to decrease access to all segments of the population for certain types
of guns, or to decrease access to certain segments of the population, such as children
through safe storage laws.
Evaluation of these laws is difficult, since
there are no randomized controlled trials of such legislation. Some of the studies
are ecological studies, in which entire communities are compared. These studies
are potentially flawed by the fact that other differences, in addition to gun legislation,
certainly exist between such communities, and many other factors can affect firearm
death rates. In addition, one is attempting to analyze effects on individuals by
looking at entire populations.
Other evaluations have relied on sophisticated
and complicated statistical techniques to determine changes in rates of events over
time. There are also other factors which change over time, which most of these analyses
do not take into consideration. The interpretation of these results is also not
intuitive for many.
Review of legislation to
restrict firearm ownership and access:
Author | Kleck et al., 1993 |
Study design and target population | City level cross-sectional study of 170 US cities over
100,000 population in 1980. |
Intervention | 19 major categories of firearms restriction at both
state and city-level. |
Outcomes | Total rates and gun specific rates per 100,000 for
homicide, suicide, aggravated assault and robbery in 1979-81, and gun prevalence
rates. |
Results | (1) Gun control restrictions have no net effect
on gun prevalence levels
(2) Gun control restrictions generally
have no net effect on violence rates.
102 assessments of effects of different
gun laws on different types of violence, 7 indicated good support, 11 partial
support for hypothesis of gun control efficacy. |
Study quality and conclusions | Major assumption that higher violent crime rates could
increase gun prevalence and higher gun prevalence would increase violence rates.
Limitations: no information available on how
strictly gun permit and licensing laws administered.
Supportive findings: Mandatory penalty
laws reduce robbery; local dealer licensing requirements reduced aggravated
assault, robbery and suicide; gun owner licensing or purchase permits; bans
on possession of guns by criminals and mentally ill, stronger controls on
illegal carrying. |
Author | Loftin et al., 1991 |
Study design and target population | Before/After study design. Entire population of Washington,
DC, 1968-1987. Comparison population, adjacent metropolitan areas in Virginia
and Maryland. |
Intervention | Firearms Control Regulations Act effective February,
1977 required registration of handguns and long guns as well as safe storage |
Outcomes | Firearm and non-firearm rates of suicide and homicide. |
Results | Reduction in firearm homicides (3.3 per month, 25%,
p=0.001) and suicide (0.6 per month, 23%, p=0.005) with no reduction of non-firearm
homicide and suicide. No significant change in non-firearm homicide or suicide. |
Study quality and conclusions | Restrictive handgun licensing was associated with significant
decline in firearm homicides and suicides. No decline in these rates in adjacent
areas of Maryland and Virginia which had no registration requirements. The authors
were unable to measure non-fatal firearm injuries. |
Author | Mundt, 1990, with comments by Hung, 1993 and Lester et al., 1994 |
Study design and target population | Ecological study design comparing Canada to the United
States. Evaluated the period 1974-1987. |
Intervention | 1977 Criminal Law Amendment Act in Canada which required
a firearms acquisition certificate for purchase, increased registration requirements,
prohibited automatic weapons, sawed -off shot guns and rifles and increased
penalties for firearm related crime. Major provisions effective in 1979. |
Outcomes | Rates per 100,000 for violent crime, suicide, accidental
death divided in to gun and non-gun categories. Major outcomes compared Canadian
rates to U.S. rates |
Results | All data are presented as yearly rates for each outcome
in Canada and U.S. Found a greater decrease in firearm robbery rates in Canada;
accidental gun deaths decreased in both countries. No change in homicide and
suicide rates. |
Study quality and conclusions | The author concludes that there was no impact of legislation
on the rate of violent crime or gun-related violent crime in Canada. Study uses
total U.S. rates to adjust for secular trends in various outcomes.
Study design is very weak and doesn’t
adequately adjust for differences between the two countries (proportion of
gun ownership, changes in gun laws, large differences in crime rates). Evaluating
the entire country could mask regional changes.
Critique by Hung (ref) reports steeper
decreases in firearm crimes and deaths in Canada indicate law successful.
Critique by Lester used linear regression
to evaluate suicide rates from 1978-85 and reports decrease in firearm suicides
(p=.04) and decrease in proportion of suicides due to firearms (p=.03).
More rigorous time series analysis
adjusting for confounding variables is necessary to determine law’s effects.
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Author | Sloan et al., 1990 |
Study design and target population | Ecological study comparing firearm suicide rates in
King County, WA and Vancouver Metropolitan Area, B.C. 1985-1987 |
Intervention | Strict regulations govern the purchase, ownership,
and carrying of firearms in Vancouver. Concealed weapons are not permitted in
Vancouver, a restricted weapons permit is required for handgun purchase, and
self defense is not a valid reason for handgun purchase.
King County allows legal purchase of handguns for self-defense
and concealed weapon permits are easily obtainable.
Handgun ownership in Canada was about
1/4 that of US. |
Outcomes | Rates of suicide from all causes and from firearms |
Results | Risk of suicide did not differ in King County compared
to Vancouver (RR=0.97, 0.87-1.09). The rate of suicide by firearms was higher
in King County (RR= 2.34, 1.90-2.88) related to a 5.7 fold increased rate of
suicide by handguns (RR=5.7, 4.08-7.93). The difference in the rate of suicide
by firearms was offset by a 1.5 fold higher rate of suicide by other means in
the Vancouver area. Young adults 15-24 years had a higher rate of suicide in
King County (RR=1.38, 1.02-1.96) due to a RR= 9.56 (3.62-25.25) risk of suicide
by handguns. |
Study quality and conclusions | Restricting access to handguns may be associated with
a decreased rate of suicide for certain segments of the population.
The two cities were similar in size, geography,
unemployment rates, education and income.
It was not possible to adjust for some
important confounders such as illegal drug-related activity, illicit gun sales,
and SES of the victims.
The study also has the limitations
of all ecological studies. |
Author | Sloan et al., 1988 |
Study design and target population | Ecological study comparing firearm homicide rates in
Seattle, WA and Vancouver, B.C. 1980-1986 |
Intervention | Strict regulations govern the purchase, ownership,
and carrying of firearms in Vancouver. Concealed weapons are not permitted in
Vancouver, a restricted weapons permit is required for handgun purchase, and
self defense is not a valid reason for handgun purchase.
Seattle allows legal purchase of handguns for self-defense
and concealed weapon permits are easily obtainable.
Handgun ownership in Canada was about
1/4 that of US. |
Outcomes | Rates of homicide (all causes), firearm homicide, simple
assault, robbery, burglary |
Results | Relative risk of homicide, adjusted for age and sex,
was significantly higher in Seattle (RR=1.63, 1.28-2.08). Firearm homicide rate
was 5 fold higher in Seattle. (RR=5.08, 3.54-7.27).
Firearm assault rate was 7 times higher in
Seattle (RR=7.7, 6.7-8.7) while the simple & aggravated assault rates,
respectively, were only slightly higher in Seattle (RR=1.18, 1.15-1.20) and
(RR=1.16, 1.12-1.19).
Robbery , burglary and non-gun homicide
rates were equal. |
Study quality and conclusions | Restricting access to handguns may reduce homicide
rate in a community. The two cities were similar in size, geography, unemployment
rates, education and income.
It was not possible to adjust for some important confounders
such as illegal drug-related activity, illicit gun sales, and SES of the victims.
The study also has the limitations
of all ecological studies. |
Author | Jung et al., 1988 |
Study design and target population | Before/After study design to evaluate gun control legislation
in East St. Louis, IL (1981) and Evanston, IL(1982) Control city Rock Island,
IL. |
Intervention | Law increased penalties for carrying firearms on street
(East St. Louis); ban on possession of all handguns in Evanston. |
Outcomes | Firearm assaults and firearm robberies. Data source
Uniform Crime Report (UCR) Used time series analysis adjusting for seasonality. |
Results | Temporary reduction in firearm assaults in E. St. Louis
and Evanston BEFORE the law took effect (p=0.05) followed by significant increase
after the later went into effect in E. St Louis and no change in Evanston .
Firearm robberies showed the same pattern in E. St.
Louis but no change in Evanston. |
Study quality and conclusions | No lasting effect of legislation. Pre-intervention
decrease in Evanston and E. St. Louis possibly due to extensive media campaign.
Control city, Rock Island IL showed no change during either period. There was
no increase in assaults using knives or other weapons in any of the 3 cities. |
Author | Lester et al., 1986 |
Study design and target population | Cross-sectional study involving entire population of
the United States in 1960 and 1970 |
Intervention | Handgun control statutes rated on a Guttman scale of
strictness |
Outcomes | Death rates for homicides, suicides and accidents.
Source: Vital Health and Statistics |
Results | States with stricter handgun control statutes had lower
firearm suicide rates and lower overall suicide rates. No relation between strictness
of laws and homicide rates. |
Study quality and conclusions | Study poorly designed and analyzed. Authors conclusions
can not be based on the data presented. Correlation coefficients are not the
appropriate statistical measure. Regression coefficients would illustrate the
quantitative relationship. Other problems-no adjustment for any type of confounding
or secular trends; variations and changes in laws. Not known when laws enacted.
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Author | Lester et al., 1982 |
Study design and target population | Ecological study involving entire population of the
United States |
Intervention | Handgun control laws in 1968; rated on 8 characteristics
and ranked on Guttman scale of strictness (from 1-7) Factor analysis used to
define 3 principal components of gun laws: restrictions on seller, restrictions
on buyer and restrictions on carrying guns. |
Outcomes | Homicide and suicide rates by various methods including
firearms. Data from Vital Statistics of the United States (1960-1970) |
Results | Lower firearm suicide rates in states with stricter
handgun laws (in 1960 r= -0.46 and r= -0.52 in 1970) but an increase in suicide
rate by other means r=0.34 and r=0.43 for 1960 and 1970. No statistically significant
change in firearm homicide. |
Study quality and conclusions | Strict handgun control laws appeared to reduce firearm
suicide rates, but had no effect on firearm homicide rates.
No adjustment for age of SES of population; no information
available on enforcement or number of guns available prior to legislation. |
Summary of firearm ownership
and licensing/safe storage
The evaluation of the impact of these laws
is based on ecological analyses or time series analyses. As is the case with mandatory
sentencing legislation evaluations, there are methodological problems inherent in
these types of analyses. The conclusions which can be made form the available are
unclear, since the results of the studies are contradictory.
Recommendations on ownership
and licensing/safe storage
Recommendations on future
research
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