FIREARM VIOLENCE The physician’s perspective on the impact of firearm violence in our society.

Generously supported by: The John D. and Catherine T. MacArthur Foundation (for the 2003 and 1995 edition) and The Joyce Foundation The Chicago Community Trust (for the original 1995 edition)

FEAR OF VIOLENCE

CELEBRATING VIOLENCE We Celebrate Violence We Glamorize Violence We Promote Violence

REALITY OF VIOLENCE Source: Cook County Medical Examiner

VIOLENCE AS ENTERTAINMENT

REALITY OF VIOLENCE

EPIDEMIOLOGY

Source: National Center for Health Statistics, 2002 FIREARMS AS A PUBLIC HEALTH EPIDEMIC Number of U.S. Deaths Due to Firearms Each Year

FIREARM RELATED DEATHS IN THE UNITED STATES, 2000 (Total: 28,663) Source: National Center for Health Statistics, 2002

FIREARM AND MOTOR VEHICLE RELATED INJURY DEATHS Source: National Center for Health Statistics, 2002 Deaths

Source: National Center for Health Statistics, 2002 Firearm deaths of teenagers exceed the total from all natural causes of death combined.

Source: Annest JL, Mercy JA, Gibson DR, Ryan GW. National Estimates of Nonfatal Firearm-related Injuries. JAMA 1995 For every child killed by a gun, four are injured.

Source: National Center for Health Statistics, 2002 Age in Years U.S. FIREARM DEATH RATES BY AGE: HOMICIDE, SUICIDE AND UNINTENTIONAL, 2000 (Rate per 100,000 population)

U.S. FIREARM DEATH RATES BY AGE, RACE AND GENDER, 2000 (Rate per 100,000 population) Source: National Center for Health Statistics, 2002 Age in Years

FIREARM RELATED INJURIES Source: CDC. Data sources: for deaths, 2000 National Vital Statistics System, NCHC; for nonfatal injuries, 2000 National Electronic Injury Surveillance Systems, CPSC. Note: excludes 595 observed/unknown. Treated and Released 26,450 Hospitalized or Transferred 31,053 Deaths 28,663 Ratio:

Firearm injuries are all too common in the pediatric and adolescent population in the United States.

Source: National Center for Health Statistics, 2002 Gun violence is the Number 2 cause of death for young Americans between the ages of 10 and 19.

Source: National Center for Health Statistics, 2002 Gun violence is the number one cause of death for young African Americans between the ages of 10 and 19.

Source: National Center for Health Statistics, 2002 U.S. CHILD FIREARM FATALITIES 0-19 YEARS OF AGE 1986 – 2000

Deaths from polio (1952) 3,145 (all ages) Deaths from Firearms (2000) 3,042 (ages 0-19) Source: National Center for Health Statistics, 2002 COMPARING U.S. EPIDEMICS

Every day in America, eight children die from gun violence.

More than 30% of homes with children contain a gun. Source: Smith, T National Gun Policy Survey of The National Opinion Research Center: Research Findings.

FIREARM STORAGE PRACTICES AMONG PARENTS 28% keep a gun hidden and unlocked 54% of parents would be very concerned about their child’s safety if they knew there was a gun in the home of their child’s friend However, 73% believe that it is “not at all likely” that their child would find and handle a gun without permission Source: Center to Prevent Handgun Violence, 1998

IN STUDY OF BOYS 8 – 12 YEARS: Source: Jackman GA, et al., Seeing Is Believing: What Do Boys Do When They Find a Real Gun?, Pediatrics, Found the hidden gun72% Handled the gun76% Pulled the trigger 48%

SAFETY PRECAUTIONS OF PARENTS OF YOUNG CHILDREN Source: Coyne-Beasley, Tamera, The Association of Handgun Ownership and Storage Practices with Safety Consciousness, Archives of Pediatric and Adolescent Medicine, Aug 2002 Use Smoke Detector99% Kept Poisons Out of Reach92% Store Guns Locked73% Cap Electrical Outlets72%

Nearly 40 % American teens know someone who has been shot. Source: Source: Teen Research Unlimited, Teen Gun Survey. Commissioned by Uhlich Children’s Advantage Network, 2003.

PROTECT CHILDREN NOT GUNS

HOMICIDE

GUN HOMICIDE RATES IN TEN DEVELOPED NATIONS (1999/2000*) Source: Alpers, Phillip. Update: Closing Illegal Markets, The Educational Fund to Stop Gun Violence, July *Most recent year available. Rate per 100,000 population

Source: World Health Organization, 2002 National Center for Health Statistics, 2002 * Most recent year available INTERNATIONAL HOMICIDE RATES MALE, AGE ( *) Rate per 100,000

INTERNATIONAL HOMICIDE RATES MALE, AGE ( *) Source: World Health Organization, 2002 National Center for Health Statistics, 2002 * Most recent year available Rate per 100,000

INTERNATIONAL HOMICIDE RATES MALE, AGE ( *) Source: World Health Organization, 2002 National Center for Health Statistics, 2002 * Most recent year available Rate per 100,000

INTERNATIONAL HOMICIDE RATES MALE, AGE ( *) Source: World Health Organization, 2002 National Center for Health Statistics, 2002 * Most recent year available Rate per 100,000

INTERNATIONAL HOMICIDE RATES MALE, AGE ( *) Source: World Health Organization, 2002 National Center for Health Statistics, 2002 * Most recent year available Rate per 100,000

INTERNATIONAL HOMICIDE RATES MALE, AGE ( *) Source: World Health Organization, 2002 National Center for Health Statistics, 2002 * Most recent year available Rate per 100,000

INTERNATIONAL HOMICIDE RATES MALE, AGE ( *) Source: World Health Organization, 2002 National Center for Health Statistics, 2002 * Most recent year available Rate per 100,000

1 Unintentional Injury 2 HOMICIDE 3 SUICIDE 4 Malignant Neoplasms Age 15 –24 LEADING CAUSES OF DEATH, YOUNG AMERICANS 2000 Source: CDC, National Center for Injury Prevention and Control, Unintentional Injury 2 Malignant Neoplasms 3 SUICIDE 4 HOMICIDE Age 10 –14

LEADING CAUSES OF DEATH, YOUNG AFRICAN AMERICAN MALES, 2000 Source: CDC, National Center for Injury Prevention and Control, HOMICIDE 2 Unintentional Injury 3 SUICIDE 4 Heart Disease Age 10 –14 1 HOMICIDE 2 Unintentional Injury 3 HIV 4 Heart Disease Age 15 –24

YEARS OF POTENTIAL LIFE LOST AT AGE 65 U.S. AFRICAN AMERICAN MALES, 2000 Source: CDC, National Center for Injury Prevention and Control, 2002

FIREARM & NON-FIREARM HOMICIDES, BY YEAR, FOR AFRICAN-AMERICAN MALES (12-24 YEARS OF AGE) Source: CDC, National Center for Injury Prevention and Control, 2002

PERCENT OF U.S. HOMICIDES DUE TO FIREARMS, 2000 Source: CDC, National Center for Injury Prevention and Control, 2002

HOMICIDE CHARACTERISTICS

RELATIONSHIP OF MURDER OFFENDER AND VICTIM, 2000 Source: U.S. Department of Justice, 2002

White VictimsBlack Victims RACE RELATIONSHIP OF MURDER OFFENDER AND VICTIM, 2000 Source: U.S. Department of Justice, 2002

HOMICIDE CIRCUMSTANCES, 2000 Source: U.S. Department of Justice, 2002  Romantic Triangle  Brawl  Argument

HOMICIDE TRENDS IN THE U.S., ALL AGES HOMICIDE CIRCUMSTANCES Source: FBI, Supplementary Homicide Reports, Deaths Year

WEAPONS USED IN HOMICIDES, 2000 (TOTAL: 12,943) Source: Bureau of Justice, 2002

RISKS OF HOMICIDE Summary Usually killed by someone known to victim Usually killed by someone of the same race Usually killed during an argument or fight Usually killed in an environment of drugs or alcohol Usually killed with a handgun

SUICIDE

Source: CDC, National Center for Injury Prevention and Control, 2002 SUICIDE is the third leading cause of death for young adults in the United States.

Source: Joe S, Kaplan M, Psychiatric Services, 2002 Suicide rates increased 14% among African American young men from 1979 to 1997.

Source: CDC, National Center for Health Statistics, 2002 Most suicides (over 57%) are committed with a firearm.

SUICIDE METHODS IN U.S. BY GENDER, 1998 Percentage of All Suicides Source: Romero, M and Wintemute, G. The Epidemiology of Firearm Suicide in the United States, Journal of Urban Health: Bulletin of the New York Academy of Medicine, 2002 Totals Firearm 7,424 Hanging/Suffocation 5,726 Poisoning 5,072 Other 881 Fall 621 Cutting/Piercing 476 Drowning 375

Source: Kellerman AL and Waeckerle JF. Preventing Firearm Injuries. Ann Emergency Medicine, July % of firearm suicide attempts result in death.

SUICIDE RATES, 2000: HIGH RISK GROUPS Source: CDC, Center for Health Statistics, 2002

Source: Kellerman AL, Rivara FP, Somes G, et al., NEJM 1992 Guns Kept in the Home: Increase risk of suicide 5 times

SUICIDE RISK AND GUN OWNERSHIP Source: Kellerman AL, Rivara FP, Somes G, et al., NEJM 1992 No Increased Risk Odds Ratio No Increased Risk

In 1 st year after gun purchase, suicide is leading cause of death. Source: Wintemute GJ, Parham CA, Beaumont JJ, Wright M, and Drake C. Mortality among recent purchasers of handguns. New England Journal of Medicine 1999, 341: , November 18, 1999.

In 1 st week after handgun purchase, suicide risk increases 57 times. Source: Wintemute GJ, Parham CA, Beaumont JJ, Wright M, and Drake C. Mortality among recent purchasers of handguns. NEJM, 1999.

37% of American teens can get a gun if they want one. Source: Teen Research Unlimited, Teen Gun Survey. Commissioned by Uhlich Children’s Advantage Network, 2003.

Source: Kellerman AL, Rivara FP, Somes G, et al., NEJM 1992 In homes with firearms, a gun was the method chosen in 86% of the suicide cases. In homes where firearms were not usually kept, only 6% of the cases killed themselves with a gun.

Source: Smith, T National Gun Policy Survey of The National Opinion Research Center: Research Findings. About 25% of American adults and 40% of American households own 192 million firearms.

American Citizens Own: 65 Million Handguns 70 Million Rifles 49 Million Shotguns 8 Million Other Long Guns Source: Smith, T National Gun Policy Survey of The National Opinion Research Center: Research Findings.

HOMES WITH GUNS Homicide of Household Member – 3 times more likely Risk of Suicide – 5 times more likely Source: Kellerman AL et al. Gun ownership as a risk factor for homicide in the home. NEJM, 1993, and Suicide in the home in relation to gun ownership, NEJM, 1992.

A gun in the home increases a woman’s risk of intimate partner homicide 7 times. Source: Bailey, JE, et al., Archives of Internal Medicine, 1997

ARE GUNS PROTECTIVE? Gun Deaths

21% of law enforcement officers killed with a handgun were shot with their own weapon. Source: Wintemute GJ. American Journal of Public Health, 1994.

Potential for Morbidity or Lethality

Kinetic Energy

Caliber

Assault Weapons The term “assault weapon” refers to an entire category of military-style firearms that have the ability to hold a large capacity magazine, generate a rapid rate of fire, and operate in semi-automatic mode.

Semiautomatic Weapons

Armor Piercing Bullet

PERCENTAGE U.S. SPINAL CORD INJURIES CAUSED BY VIOLENCE Source: Spinal Cord Injury Information Network, 2003.

Source: CDC, Safe USA Fact Sheet: What You Should Know About Spinal Cord Injury Young Americans between 16 and 30 years of age account for over 50% of the spinal cord injuries from violence.

TRAUMATIC BRAIN INJURIES Source: CDC, Safe USA Fact Sheet: What You Should Know about Spinal Cord Injury

Annual U.S. Cost of Spinal Cord Injury due to Violence: $ 1.81 Billion Source: DeVivo MJ. Causes and costs of spinal cord injury in the United States. Spinal Cord, 1997.

Federal Gun Control Laws National Firearms Act of 1943 Federal Firearms Act of 1938 Gun Control Act of 1968 Brady Bill 1994

A Right to Bear Arms? “…the right of the people to keep and bear arms shall not be infringed.” Second Amendment The Constitution of the United States

A Right to Bear Arms? “A well–regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.” Second Amendment The Constitution of the United States

Examples of Federal Protection Agencies National Highway Traffic Safety Administration Environmental Protection Agency Food and Drug Administration Consumer Product Safety Commission Bureau of Alcohol, Tobacco, and Firearms Source: Sugaman J, Rand K. Ceasefire, Violence Policy Center, 1994

Public Health and Individual Rights Smoke-free Environments Mandatory Seat Belts Motorcycle Helmets Childhood Immunizations Firearms

SURGEON GENERAL’S WARNING: Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, and Low Birth Weight. Public Health Approach to Injury Prevention Handguns Fatal

TRAUMA IS NO ACCIDENT

The Public Health Approach: Multidisciplinary Scientific Method Directed to Prevention Individual Behaviors and Attitudes Disease or Injury Social and Physical Environments

- AIDS Tested Methods: - Use condoms - Do not share needles - Multiple sex partners increase risk - Firearm Injuries Under Study: - Lock all guns - Store ammunition separately - Guns in home increase risk PUBLIC HEALTH ISSUES Health Problem Examples of Attitude and Behavior Changes

PUBLIC HEALTH ISSUES Tested Methods: - Improvement in sanitation, nutrition, housing - Attention to overcrowded areas Under Study: - Creation of youth activity programs - Developing suicide prevention networks - Common sense gun laws Health Problem Examples of Social Environment Modifications - Tuberculosis - Firearm Injuries

PUBLIC HEALTH ISSUES Health Problem Examples of Physical Environment Modifications - Shoulder harness - Airbags - Roadway construction and lighting - Integrated trigger locks - Chamber load indicators - Magazine disconnect devices - Motor vehicle crashes - Firearm Injuries

Primary Prevention Prevent injury or disease before it happens PUBLIC HEALTH ISSUES Primary PreventionFirearms - Vaccines - Smoking education - Diet and exercise Under Study: - Conflict resolution training - Prevent access (locks, background checks) - Develop alternative means of protection.

PUBLIC HEALTH ISSUES Secondary Prevention Minimizing the effects of disease or injury in progress - Treating hypertension - Registration of guns - Smoking cessation - Bulletproof vests - Reducing air pollution - Less destructive firearm power and ammunition Secondary PreventionFirearms

PUBLIC HEALTH ISSUES Tertiary Prevention Responding after the injury or disease has occurred Tertiary PreventionFirearms - Treating lung cancer - Coronary artery bypass - Chelation therapy for lead poisoning - Trauma network - Spinal cord injury rehabilitation - Counseling programs for victims

PRESCRIPTION TO REDUCE GUN VIOLENCE

Handguns, like cigarettes, can be deglamorized.

Rx: Public Messages Source: Chicago Project for Violence

“Which one is more regulated?” Source: Consumer Federation of America

Child proofing Chamber load indicators Less destructive ammunition Personalized handguns Rx: PRODUCT LIABILITY OPPORTUNITIES FOR SAFETY Ballistic fingerprinting Truth in advertising Control distribution Regulate manufacturers

Rx: Physician and Medical Student Advocacy

Rx: ADDRESS SOCIAL INEQUALITIES AND CONDITIONS THAT FUEL VIOLENCE

Rx: Reduced Gun Access to Suicidal Patients

Rx: Identify High Risks

PREVENTIVE MEDICINE TOPICS REMEMBERED BY PATIENTS (%) One study showed that young men recalled their doctor’s discussion of guns more than any other preventive medicine issue. Source: May JP, Martin KL, Journal of General Internal Medicine Counseling Topic % patients

64% of teens are willing to discuss guns with their physicians Source: Kahn DJ, Kazimi MM, Mulvihill MN, Attitudes of New York City High School Students Regarding Firearm Violence, Pediatrics. May 2001

64% of adults made safe gun storage changes after counseling. 12% got rid of their guns altogether. Source: Albright TL, Burger SK. Improving Firearm Storage Habits: Impact of Brief Office Counseling by Family Physicians, Journal of the American Board of Family Practice. 2003

COUNSELING PATIENTS ABOUT GUNS

Talk to your patients about guns and violence.

Threats to children’s health require urgent and comprehensive action.

Adults must make environments safe, so kids can be safe.

WHAT WILL YOU DO?

Thank You