Firearm Retailers and Suicide: Results from a Survey Assessing Willingness to Engage in Prevention Efforts

A Half-Century Analysis of Firearm-Related Mortality Trends in the United States: A Retrospective Study Utilizing National Data (1968-2022)

Background: Firearm-related deaths are a substantial public health crisis in America, with studies reporting an increasing rate in the past decade. Effective public health interventions rely on comprehensive information about risk and protective factors.

AIM

This study aims to provide a comprehensive examination of trends in firearm-related deaths over the past 55 years, shedding light on the changing landscape and identifying key risk and protective factors associated with firearm-related deaths in the United States.

METHODS

This retrospective study utilizes data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (WISQARS) for 1968-2022 to determine trends in firearm-related deaths. A multivariate logistic regression model was employed to identify independent predictors of firearm-related suicides, homicides, and unintentional deaths, exploring intersectionality by introducing interaction terms between race/ethnicity and level of education.

RESULTS

Firearm-related deaths showed a fluctuating but upward trend from 12.0/100,000 persons in 1968 to 14.5/100,000 in 2022, with firearm-related suicides consistently accounting for a significant proportion of firearm-related deaths, from 45.7% in 1968 to 56.1% in 2022, with a peak of 63% in 2013. From the multivariate regression analysis, individuals aged 10-19 years had the highest risk of firearm-related suicides (OR = 3.04, 95% CI = 2.92-3.16) and homicides (OR = 2.87, 95% CI = 2.77-2.97). In addition, White people with higher education (OR = 1.42, 95% CI = 1.40-1.45) had the highest risk of firearm-related suicides, while Black people with lower educational attainment (OR = 6.68, 95% CI = 6.50-6.87) had the highest risk of firearm-related homicides.  Conclusion: Our findings underscore the urgent need for targeted, evidence-driven public health interventions and policies. Primary suicide prevention strategies focusing on means restriction and reshaping perceptions around firearm ownership emerge as critical components. Comprehensive, multidimensional approaches that engage firearm owners and communities and address structural factors are imperative to curbing the multifaceted challenges associated with firearm-related injuries and deaths. Targeted interventions must include individuals aged 10-19 and specifically focus on suicides and homicides in the most relevant demographic segments of the population.

Firearm businesses as partners in suicide prevention: a cross-sectional study of the Gun Shop Project in Colorado, USA

BACKGROUND

The Gun Shop Project aims to reduce firearm suicide and is widely implemented in the USA, yet little is known about the core firearm business practices and behaviours that might contribute to preventing firearm suicide.

METHODS

Owners or managers of all firearm businesses identified as participants in Colorado's Gun Shop Project were invited to respond to a questionnaire. Data collection occurred from March to May 2021. Analyses included unweighted descriptive statistics with CIs and Pearson χ2 tests for categorical associations.

RESULTS

54 firearm businesses participated (response rate: 28%). Under half reported practices that are Gun Shop Project core aspects (range: 14%-45%). 22% of businesses frequently engaged customers on the importance of safe firearm storage in suicide prevention while 26% had denied a firearm sale and 14% had assisted with temporary secure storage in the past year with customers perceived to be in suicidal crisis. However, high proportions reported willingness to engage in these behaviours if a customer was in crisis: 74% were willing to refuse a sale of a firearm or ammunition, 70% were willing to discuss temporary secure storage options and 70% were willing to direct customers to mental health services.

CONCLUSIONS

This study suggests that efforts to continue educating and involving firearm businesses may have an impact on the adoption of organisational suicide prevention practices and behaviours. Ongoing efforts are needed to understand core components of Gun Shop Project to inform standardised recommendations for effective firearm business practices that prevent firearm suicide.

Voluntary, temporary out-of-home firearm storage: A survey of firearm retailers and ranges in two states

Out-of-home storage of personal firearms is one recommended option for individuals at risk of suicide, and statewide online maps of storage locations have been created in multiple states, including Colorado and Washington. We sought to examine both the extent to which firearm retailers and ranges offer temporary, voluntary firearm storage and the perceived barriers to providing this service. We invited all firearm retailers and ranges in Colorado and Washington to complete an online or mailed survey; eligible sites had to have a physical location where they could provide storage. Between June-July 2021, 137 retailers/ranges completed the survey (response rate = 25.1%). Nearly half (44.5%) of responding firearm retailers/ranges in Colorado and Washington State indicated they had ever provided firearm storage. Among those who had ever offered storage, 80.3% currently offered storage while 19.7% no longer did. The majority (68.6%) of participants had not heard of the Colorado/Washington gun storage maps and 82.5% did not believe they were currently listed on the maps. Respondents indicated liability waivers would most influence their decision about whether to start or continue providing temporary, voluntary storage of firearms. Understanding current practices, barriers, and concerns about providing out-of-home storage by retailers and ranges may support development of more feasible approaches for out-of-home firearm storage during times of suicide risk.

What is "safety"?: Lethal means counseling as a cross-cultural communication

U.S. suicide rates have risen every year over the past two decades with self-directed firearm use as the method accounting for the highest proportion of deaths. This pattern is particularly pronounced among veterans and members of the U.S. Armed Forces. The numerical burden of firearm-related suicide accompanied by characteristics of self-directed firearm injury have motivated the development of lethal means safety initiatives focused on firearms. Simultaneously, research has sought to characterize patterns of firearm ownership and use among veterans as well as optimal strategies for clinicians to deliver suicide prevention messages to firearm owners. Increasingly, findings from research have been understood as cultural factors that warrant greater attention to improve the quality of lethal means counseling. Here, we review and interpret selected research on cultural aspects of firearm ownership and suggest that cultural differences between health care practitioners and firearm owners may result in health care practitioners delivering clinical interventions that are broadly divergent from perspectives within the cultural frameworks of firearm owners. We follow by organizing these cultural factors into existing frameworks of cultural competency training as a basis for developing curriculum for health care practitioners to improve clinical care.

Handgun purchasing characteristics and firearm suicide risk: a nested case-control study

Background

Firearms are the most lethal method of suicide and account for approximately half of all suicide deaths nationwide. We describe associations between firearm purchasing characteristics and firearm suicide.

Methods

Data on all legal handgun transactions in California from 1996 to 2015 were obtained from the California Department of Justice Dealer’s Record of Sale database. Handgun purchasers were linked to mortality data to identify those who died between 1996 and 2015. To account for variation in timing and duration of observation time, analyses were stratified by birth cohort. The primary analysis focused on those aged 21–25 in 1996. A secondary analysis tested associations among those aged 50–54 in 1996. Using incidence density sampling, purchasers who died by firearm suicide (cases) were each gender-matched to 5 purchasers (controls) who remained at risk at the case’s time of death. We examined the characteristics of purchasers and transactions, focusing on the transaction closest in time to the case’s death. Data were analyzed with conditional logistic regression.

Results

There were 390 firearm suicides among the younger cohort and 512 firearm suicides among the older cohort. Across both cohorts, older age at first purchase and the purchase of a revolver were associated with greater risk of firearm suicide. For example, among the younger cohort, those who purchased a revolver versus semiautomatic pistol had 1.78 times the risk of firearm suicide (95% CI 1.32, 2.40) in multivariable models. Other associations varied across cohorts, suggesting cohort or age effects in purchasing patterns.

Conclusions

Findings add to the evidence on firearm suicide risk and may help inform prevention strategies and future research.

Firearm-related research articles in health sciences by funding status and type: A scoping review

Federal funding for firearm-related research in the health sciences has incurred Congressional restrictions and executive actions. Little is known about the funding landscape for published scholarship in this field. This study's aim was to characterize the number and sources of funding, including federal and non-federal sources, for firearm-related research articles published in health sciences journals. We performed a scoping review of original, empirical, peer-reviewed articles related to firearms published in health science journals and indexed in PubMed between January 2000 and December 2019, using the PRISMA extension for Scoping Review checklist. Four reviewers independently screened each article twice for inclusion. Included articles were reviewed again to identify funding sources. Articles were characterized as having explicitly declared funding, explicitly declared no funding, or no explicit funding declaration. Among articles with funding, we examined proportions by funding source. 812 articles met the inclusion criteria. 119 (14.7%) of the articles declared not having received any funding, and 240 (29.6%) had no funding declaration. 453 (55.8%) of the articles declared at least one source of funding. Of those, 221 (48.8%) reported at least one federal grant, and 232 (51.2%) reported at least one philanthropic grant. The number of published articles increased by 328.6% between 2000 and 2019. While the volume increased during the study period, the proportion of articles with funding was lower in 2019 (55.6%) than it was in 2000 (87.5%; proportion difference: 31.9%; 95% CI: 16.7%-47.2%). This study highlights the continued funding limitations in this field despite a growing volume of research.

Mental Illness and Gun Violence: Research and Policy Options

This article provides an overview of current knowledge about the relationship between mental illness, violence, homicides, and suicides, with a view towards crafting sensible public policy options for reducing gun violence towards self or others. With this knowledge as a backdrop, the limitations of the federal National Instant Background Check System (NICS) as both over-inclusive and under-inclusive in identifying people with mental illness who pose potential risks are discussed. Finally, the article describes emerging approaches for identifying and removing firearms from persons who pose potential risks of gun violence towards self or others, including Extreme Risk Protection Orders ("Red Flag Laws") and other options.

'Gun shop projects' for suicide prevention in the USA: current state and future directions

OBJECTIVES

To describe community-driven suicide prevention partnerships between firearm retailers and public health officials ('gun shop projects'), including common elements and challenges.

METHODS

We conducted qualitative interviews with leaders from state-level and national-level partnerships to determine common features, challenges and strategies used by these groups. Data were coded via theme analysis; two independent coders followed a shared codebook developed in an iterative fashion and with high inter-rater reliability.

RESULTS

Across 10 interviews, data revealed four main themes: (1) community building was a cornerstone of these efforts; (2) appropriate messaging and language were vital to successes; (3) groups employed various educational and outreach campaigns and (4) groups identified common challenges and obstacles.

CONCLUSIONS

Gun shop project partnerships between firearm retailers and public health officials show promise, with thematic data demonstrating common trends and steps towards successful programme implementation. Evaluative data are needed to determine the impact of these efforts on suicide prevention in local communities.