Rates of firearm injury and mortality are far higher in the United States compared to other high-income nations. Patterns of firearm injury have complex causal pathways; different social contexts may be differentially affected by firearm legislation. In the context of the diversity of social, political, and legal approaches at the state level, we suggest the application of the social ecological model as a conceptual public health framework to guide future policy interventions in the U.S.
Get full access to this article
View all access options for this article.
References
1.
A.B.Daviset al., “The Role of Epidemiology in Firearm Violence Prevention: A Policy Brief,”International Journal of Epidemiology47, no. 4 (2018): 1015-1019.
2.
Centers for Disease Control and Prevention, “Web-Based Injury Statistics Query and Reporting System (WISQARS),”National Center for Injury Prevention and Control (2018), available at <https://www.cdc.gov/injury/wisqars> (last visited October 8, 2020) [hereinafter cited as WISQARS].
3.
M.Siegel and E.F.Rothman, “Firearm Ownership and Suicide Rates among Us Men and Women, 1981–2013,”American Journal of Public Health106, no. 7 (2016): 1316-1322.
4.
Id. (Anglemyer et al.).
5.
See Siegel and Rothman, supra note 3.
6.
M.Miller, S.J.Lippmann, D.Azrael, and D.Hemenway, “Household Firearm Ownership and Rates of Suicide across the 50 United States,”Journal of Trauma and Acute Care Surgery62, no. 4 (2007).
7.
G.J.Wintemute, “The Epidemiology of Firearm Violence in the Twenty-First Century United States,”Annual Review of Public Health36, no. 1 (2015): 5-19.
8.
Id.; C.A.Riddellet al., “Comparison of Rates of Firearm and Nonfirearm Homicide and Suicide in Black and White Non-Hispanic Men, by U.S. State,”Annals of Internal Medicine168, no. 10 (2018): 712-20.
9.
D.Azraelet al., “The Stock and Flow of U.S. Firearms: Results from the 2015 National Firearms Survey,”RSF: The Russell Sage Foundation Journal of the Social Sciences3, no. 5 (2017): 38-57.
10.
C.C.Branaset al., “Urban–Rural Shifts in Intentional Firearm Death: Different Causes, Same Results,”American Journal of Public Health94, no. 10 (2004): 1750-1755.
11.
S.Fazel and B.Runeson, “Suicide, ”New England Journal of Medicine382, no. 3 (2020): 266-274.
12.
E.A.Deisenhammeret al., “The Duration of the Suicidal Process: How Much Time Is Left for Intervention Between Consideration and Accomplishment of a Suicide Attempt?”Journal of Clinical Psychiatry70, no. 1 (2009): 19-24.
13.
C.W.Barber and M.J.Miller, “Reducing a Suicidal Person's Access to Lethal Means of Suicide: A Research Agenda,”American Journal of Preventive Medicine47, no. 3 (2014): S264-S272.
14.
D.M.Stoneet al., “Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015,”Morbidity and Mortality Weekly Report67 (2018): 617-624.
15.
See WISQARS, supra note 2.
16.
See Wintemute, supra note 7.
17.
See Riddell, supra note 8.
18.
See Branas, supra note 10.
19.
D.Kim, “Social Determinants of Health in Relation to Fire-arm-Related Homicides in the United States: A Nationwide Multilevel Cross-Sectional Study,”PLoS Medicine16, no. 12 (2019).
20.
Z.D.Baileyet al., “Structural Racism and Health Inequities in the USA: Evidence and Interventions,”The Lancet389, no. 10077 (2017): 1453-63.
21.
F.Edwards, H.Lee, and M.Esposito, “Risk of Being Killed by Police Use of Force in the United States by Age, Race–Ethnicity, and Sex,”Proceedings of the National Academy of Sciences116, no. 34 (2019): 16793-98.
22.
E.Miller and B.McCaw, “Intimate Partner Violence,”New England Journal of Medicine380, no. 9 (2019): 850-857.
23.
J.C.Campbellet al., “Risk Factors for Femicide in Abusive Relationships: Results from a Multisite Case Control Study,”American Journal of Public Health93, no. 7 (2003): 1089.
24.
R.M.Cunningham, M.A.Walton, and P.M.Carter, “The Major Causes of Death in Children and Adolescents in the United States,”New England Journal of Medicine379, no. 25 (2018): 2468-2475.
25.
K.A.Fowleret al., “Childhood Firearm Injuries in the United States,”Pediatrics140, no. 1 (2017): e20163486.
26.
Baralet al., “Modified Social Ecological Model: A Tool to Guide the Assessment of the Risks and Risk Contexts of HIV Epidemics,”BMC Public Health13, no. 1 (2013): 482.
27.
C.A.Kolff, V.P.Scott, and M.S.Stockwell, “The Use of Technology to Promote Vaccination: A Social Ecological Model Based Framework,”Human Vaccines & Immunotherapeutics14, no. 7 (2018): 1636-1646.
28.
E.G.Kruget al., “The World Report on Violence and Health,”The Lancet360, no. 9339 (2002): 1083-1088.
B.P.Kaskie, C.Leung, and M.S.Kaplan, “Deploying an Ecological Model to Stem the Rising Tide of Firearm Suicide in Older Age,”Journal of Aging & Social Policy28, no. 4 (2016): 233-245.
J.Gau and R.Brunson, “Procedural Injustice, Lost Legitimacy, and Self-Help,”Journal of Contemporary Criminal Justice31 (2015): 132-50.
36.
J.Hirsch and K.Cukrowicz, “Suicide in Rural Areas: An Updated Review of the Literature,”Journal of Rural Mental Health38, no. 2 (2014).
37.
D. K.Humphreys, A.Gasparrini, and D.J.Wiebe, “Evaluating the Impact of Florida's ‘Stand Your Ground’ Self-Defense Law on Homicide and Suicide by Firearm: An Interrupted Time Series Study,”JAMA Internal Medicine177, no. 1 (2017): 44-50.
38.
B.Ukert, D. J.Wiebe, and D. K.Humphreys, “Regional Differences in the Impact of the ‘Stand Your Ground’ Law in Florida,”Preventive Medicine115 (2018): 68-75.
39.
M. DegliEspostiet al., “Increasing Adolescent Firearm Homicides and Racial Disparities Following Florida's ‘Stand Your Ground’ Self-Defence Law,”Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention26, no. 2 (2020): 187-90.
40.
Id.
41.
N.Ackermannet al., “Race, Law, and Health: Examination of ‘Stand Your Ground’ and Defendant Convictions in Florida,”Social Science & Medicine142 (2015): 194-201.
42.
L.Ren, Y.Zhang, J. S.Zhao, “The Deterrent Effect of the Castle Doctrine Law on Burglary in Texas: A Tale of Outcomes in Houston and Dallas,”Crime & Delinquency61, no. 8 (2015): 1127-51.
43.
M.B.Chamlin, “An Assessment of the Intended and Unintended Consequences of Arizona's Self-Defense, Home Protection Act,”Journal of Crime and Justice37, no. 3 (2014): 327-338.
44.
A.Castillo-Carnigliaet al., “California's Comprehensive Background Check and Misdemeanor Violence Prohibition Policies and Firearm Mortality,”Annals of Epidemiology30 (2019): 50-56.
45.
A.Knopovet al., “The Impact of State Firearm Laws on Homicide Rates among Black and White Populations in the United States, 1991-2016,”Health & Social Work44, no. 4 (2019): 232-240.
46.
C.Chenget al., “Does Strengthening Self-Defense Law Deter Crime or Escalate Violence? Evidence from Expansions to Castle Doctrine,”The Journal of Human Resources48, no. 3 (2013): 821-854.
47.
C.Loftin, “Assaultive Violence as a Contagious Social Process,”Bulletin of the New York Academy of Medicine62, no. 5 (1986): 550-555.
L.K.Leeet al., “Firearm Laws and Firearm Homicides: A Systematic Review,”JAMA Internal Medicine177, no. 1 (2017): 106-19.
52.
M.Miller, L.Hepburn, and D.Azrael, “Firearm Acquisition without Background Checks: Results of a National Survey,”Annals of Internal Medicine166, no. 4 (2017): 233-39.
53.
See Knopov, supra note 45.
54.
Id.; M.K.Goyalet al., “State Gun Laws and Pediatric Firearm-Related Mortality,”Pediatrics144, no. 2 (2019): e20183283; Kalesan, supra note 44.
55.
Crifasi, supra note 44; A.Castillo-Carnigliaet al., “California's Comprehensive Background Check and Misdemeanor Violence Prohibition Policies and Firearm Mortality,”Annals of Epidemiology30 (2019): 50-56.
S.A.Sumner, P.M.Layde, and C.E.Guse, “Firearm Death Rates and Association with Level of Firearm Purchase Background Check,”American Journal of Preventive Medicine35, no. 1 (2008): 1-6.
58.
Id.
59.
D.W.Websteret al., “Association between Youth-Focused Firearm Laws and Youth Suicides,”JAMA292, no. 5 (2004): 594-601.
60.
Id. (Hamilton et al.).
61.
See Cummings, supra note 59.
62.
See Webster, supra note 59.
63.
See Hepburn, supra note 59.
64.
H.A.Azadet al., “Child Access Prevention Firearm Laws and Firearm Fatalities Among Children Aged 0 to 14 Years, 1991-2016,”JAMA Pediatrics174, no. 5 (2020): 463-469.
65.
See DeSimone, supra note 59.
66.
J.Leeet al., “Guns and States: Pediatric Firearm Injury,”Journal of Trauma & Acute Care Surgery75, no. 1 (2013): 50-53.
67.
A.Rowhani-Rahbaret al., “Extreme Risk Protection Orders in Washington: A Statewide Descriptive Study,”Annals of Internal Medicine (2020), available at <https://doi.org/10.7326/M20-0594> (last visited October 8, 2020).
68.
Id.
69.
J.W.Swansonet al., “Implementation and Effectiveness of Connecticut's Risk-Based Gun Removal Law: Does It Prevent Suicides,”Law and Contemporary Problems80 (2017): 179.
70.
A.J.Kivisto and P.L.Phalen, “Effects of Risk-Based Firearm Seizure Laws in Connecticut and Indiana on Suicide Rates, 1981–2015,”Psychiatric Services69, no. 8 (2018): 855-862.
71.
R.Pallinet al., “Assessment of Extreme Risk Protection Order Use in California from 2016 to 2019,”JAMA Network Open3, no. 6 (2020): e207735-e207735.
72.
See Rowhani-Rahbar, supra note 67.
73.
S.E.Benjamin-Neelon and E.R.Grossman, “State Regulations Governing Firearms in Early Care and Education Settings in the US,”JAMA Network Open3, no. 4 (2020): e203321.
74.
See Allchin, supra note 31.
75.
E.E.McGintyet al., “Using Research Evidence to Reframe the Policy Debate around Mental Illness and Guns: Process and Recommendations,”American Journal of Public Health104, no. 11 (2014): e22-e26.