Nonfatal Gun Use in Intimate Partner Violence: A Systematic Review of the Literature

Firearms and post-separation abuse: Providing context behind the data on firearms and intimate partner violence

AIM

The aim of this study is to provide insight from maternal survivors of intimate partner violence (IPV) describing their experiences with their ex-partners' firearm ownership, access, storage and behaviours in the context of co-parenting and separation.

DESIGN

We conducted a qualitative descriptive study informed by the IPV and Coparenting Model.

METHODS

The analytic sample consists of self-identified maternal survivors (n = 14) who completed semi-structured qualitative interviews between January and May 2023 describing experiences of post-separation abuse. Participants were recruited through social media and domestic violence advocacy and legal aid organizations. In the interview guide, participants were asked one item about firearm exposure: Have you or your children had any experiences with guns and your ex-partner that made you or your children feel scared? Interviews were audio-recorded and transcribed. Interview transcripts were managed and coded in ATLAS.ti using a codebook. Codes were applied using descriptive content analysis, discrepancies reconciled and themes related to firearm exposure in the context of post-separation abuse identified.

RESULTS

Six themes emerged related to firearm experiences and post-separation abuse: (1) gun ownership (2) gun access; (3) unsafe storage; (4) direct and symbolic threats; (5) involving the children; (6) survivors' protective actions.

CONCLUSION

This manuscript provides context on how abusive ex-partners' firearm ownership, access and threats cause terror and pervasive fear for mothers and children following separation. Analysis of qualitative data provides important insights into opportunities to address firearm injury prevention.

IMPACT

Findings add to the contextual understanding of how survivors of IPV experience non-fatal firearm abuse. Existing quantitative data may not capture the full extent of fear caused by perpetrators' gun ownership access and symbolic threats. Data from this study can help inform firearm injury prevention efforts.

PATIENT OR PUBLIC CONTRIBUTION

The authors would like to acknowledge and thank the individuals who helped in cognitive testing of the interview guide prior to conducting interviews with participants, including (3) survivors of post-separation abuse. The authors would also like to acknowledge domestic violence advocates and those individuals who helped with recruitment and connected us with participants. Importantly, with deep gratitude, the authors would like to thank the participants who generously shared their time and stories with us.

Firearm ownership and storage among US college students: results from the healthy minds study, 2021-2022

The purpose of this study is to address a significant gap in knowledge on firearm ownership rates and storage characteristics in a national sample of college students. We used 2021-2022 survey data from the Healthy Minds Study, which included approximately 88,500 students at over 100 US colleges and universities. We conducted analyses using descriptive statistics and two-sample proportion tests. About 4% of respondents reported having a firearm on or around campus. Among firearm owners, 68.8% reported storing firearms at their permanent address within an hour's drive from campus, and 43.1% reported storing their firearms unloaded and locked. Firearm ownership rates were significantly higher for respondents who were positive for specific risk factors (i.e., in a relationship, suicide ideation, recent binge drinking, and having been physically assaulted) versus those who were negative. These findings support the need for targeted messaging and firearm safety training for college students to reduce firearm-related risks.

Examining the role of firearm involvement in repeat intimate partner violence assaults

BACKGROUND

Intimate partner violence (IPV) remains a pervasive and complex issue with significant social and public health implications. The nexus of firearms and intimate partner violence (IPV) is an especially dangerous one. However, little is known about how firearm involvement can influence the risk of repeat IPV assaults.

METHODS

We use data from 346 male perpetrated IPV incidents reported to the Detroit Police Department between December 2016 and April 2017 to examine the role of firearm involvement in IPV recidivism during a 5 and half year follow up period. Employing a conditional gap-time frailty model that accommodates heterogeneity among individuals through a frailty term, we analyze time to multiple IPV assaults that occur over the follow up period. We identify various pathways through which firearms impact the likelihood of subsequent IPV incidents, including intimidation, threats, and use of firearms, while controlling for observable perpetrator characteristics to understand the explicit roles of firearms.

RESULTS

Firearm involvement at the index assault was not associated with IPV recidivism. However, involvement of firearms in past IPV assaults significantly increased the risk of subsequent physical IPV. The discrepancy is likely arising from a high degree of censoring among individuals who were armed with a firearm during the index assault.

CONCLUSION

Our research reveals a nuanced relationship between firearm involvement and IPV recidivism, shedding light on the multifaceted dynamics at play. By elucidating the intricate dynamics at the intersection of firearms and intimate partner violence, our study underscores the need for targeted policy interventions and preventative measures aimed at reducing IPV recidivism.

Involvement of Guns in Nonfatal Conflict Between Adult Children and Their Parents

The objectives of the present analyses are to examine the frequency, nature, and correlates of nonfatal gun use in incidents of conflict between adult children and their parents, to which police were summoned. A cross-sectional study design was used with all cases of domestic violence to which police were called between adult children and their parents, in Philadelphia, PA, in 2013 (N = 6,248). Data were drawn from forms required to be completed by police when responding to domestic violence calls for assistance. A series of multivariate logistic regression models were estimated. Of the 6,248 incidents, 5,486 involved no weapon, 522 involved a bodily weapon, 190 involved a non-gun external weapon, and 50 involved a gun. Guns were most often used to threaten victims (66%), with guns less often fired (6%) or used to pistol whip victims (4%). Compared to incidents involving a bodily weapon, when guns were involved, offenders were less likely to have pushed, grabbed, or punched the victim and victims were less likely to have visible injuries; however, offenders were more likely to have threatened victims and victims were more likely to be observed as frightened. Police officers intervened similarly to incidents involving guns vs. bodily weapons. This is the first study we are aware of to focus on nonfatal gun use between family members who are not intimate partners, with the results extending much of what is known regarding nonfatal gun use among intimate partners to nonfatal gun use among adult children and parents.

Suicide-related behavior and firearm access among perpetrators of domestic violence subject to domestic violence protection orders

Perpetrators of domestic violence (DV) may be a population at elevated risk of suicide. Domestic violence protection orders (DVPOs) can include the removal of firearms from the individual subjected to the order (i.e., the respondent) to protect the victim-survivor. While removal of firearms in a DVPO is designed to protect the victim-survivor; it may also prevent suicide of the respondent by reducing access to lethal means. Therefore, we examined the association of respondent suicide-related behaviors with firearm possession and weapon use in DV among a sample of granted DVPO petitions in King County, Washington (WA), United States from 2014 to 2020 (n = 2,537). We compared prevalence ratios (PR) of respondent firearm possession and use of firearms or weapons to threaten or harm by suicide-related behavior. Overall, respondent suicide-related behavior was commonly reported by petitioners (46 %). Approximately 30 % of respondents possessed firearms. This was similar between respondents with and without a history of suicide-related behavior (PR: 1.03; 95 % CI: 0.91-1.17). Respondents with a history of suicide-related behavior were 1.33 times more likely to have used firearms or weapons to threaten/harm in DV compared to those without a history of suicide-related behavior (44.1 % vs. 33.8 %; 95 % CI: 1.20-1.47). In conclusion, both firearm possession and suicide-related behaviors were common among DVPO respondents. History of suicide-related behavior may be a marker for firearm-related harm to the victim-survivor. Evaluations of DVPO firearm dispossession should consider both firearm-related injury of the victim-survivor and suicide of the respondent.

Gun shows and universal background check laws across state lines

States with more gun laws have fewer gun assaults, and associations are strongest for background check laws. However, sales between private buyers and sellers (i.e., gun shows) are exempt from some background check requirements according to federal and most state laws. The aim of this study was to determine whether gun shows are more likely to take place in counties that are near states with universal background check laws. This cross-sectional study used gun show data from a 2018 public online listing aggregated within 3107 counties in the contiguous 48 states. The main independent variable was the presence of a universal background check law in neighboring states. We controlled for potential drivers of demand for gun shows, including the total number of gun laws within-state and in neighboring states, local and in-flowing population size, and proportion of the local and in-flowing population who were gun owners. Bayesian conditional autoregressive Poisson models estimated associations between neighboring-state universal background check law and the presence of a gun show in each county while accounting for spatial dependencies and nesting of counties within states. Of the 1869 identified gun shows, nine of the states in which they occurred had a universal background check law. The presence of excess gun shows in counties near states with universal background check laws is consistent with the hypothesis that gun shows service demand from people seeking to circumvent prohibitions against gun purchases.

Understanding Escalation Through Intimate Partner Homicide Narratives

The study aims to expand our understanding of escalation from intimate partner violence to intimate partner homicide (IPH) by exploring the known circumstances leading up to a lethal event. The study draws on qualitative data from law enforcement reports and coroner/medical examiner reports within the National Violent Death Reporting System to identify themes preceding and surrounding IPH incidents. Findings support the utility of risk assessments in identifying escalation while illustrating the complex ways that violence between current or former intimate partners can escalate to lethality, particularly the role of separation and the use of firearms.

"Always Know Where the Gun Is": Service Providers Perceptions of Firearm Access, Violence, and Safety Planning During the COVID-19 Pandemic

Given the heightened risk for fatality and known non-fatal harm firearms pose in abusive situations, it is critical to consider the impact of the COVID-19 pandemic on firearm-related abuse and safety planning-particularly considering the surge in firearm sales in 2020. This study documented the impact of the pandemic on firearm access and violence, advice and safety planning surrounding firearms, and firearm-related abuse tactics through the perspective of victim service providers across the US participants included victim service professionals from both rural (n = 93) and urban/suburban (i.e., non-rural; n = 78) areas who worked with victims of gender-based violence (i.e., intimate partner abuse and dating violence, child abuse, elder abuse, sexual assault, stalking, or human trafficking victims). Results revealed that nearly half of participants reported that abusers threatening to shoot victims or others became more frequent since the start of the pandemic, while nearly 30% reported that homicide involving firearms became more frequent during the pandemic. Further, nearly 40% of participants indicated an increase in firearm sales during pandemic-with higher sales in non-rural versus rural areas. Common themes related to safety planning with firearms included advising the victim to contact the system for help, assessing the location of firearms and/or remove the firearms, and leaving the abuser. The results stress the importance for safety planning around firearms when victims are isolated with an abuser at home and potential impact of abuser firearm access on public safety.

Should we be paying more attention to firearm threats in ex-partner stalking cases?

This study examined relationship abuse, firearm threats, and threat credibility factors as well as help-seeking for (ex)partner-stalking victims with partners who did (n = 153) and did not own guns (n = 263). Victims with (ex)partners who owned guns experienced increased coercive control and physical violence, a longer duration of stalking, and more threats during the relationship and during the course of stalking. Victims reported that (ex)partner gun owners had more extremist beliefs and other risk factors, and more of them believed their (ex)partner was extremely capable of harming them. Most, regardless of partner gun ownership, turned to informal sources of help, while about one-quarter of victims whose partners did not own guns tried to obtain a protective order or talked to police, compared to about 40% of stalking victims with abusers who owned guns. Fear of harm from guns, coercive control during the relationship, and believing their partner was capable of harming harm them were all associated with an increased number of help-seeking sources whereas being threatened with a firearm and abuser gun ownership were not.

Firearm-related Abuse and Protective Order Requests Among Intimate Partner Violence Victims

Firearms play a critical role in the murder of intimate partner violence (IPV) victims and there is evidence that laws prohibiting protective order (PO) respondents from possessing a firearm reduce IPV fatalities. However, little research has compared specific abuse tactics involving firearms among victims who have and have not sought a PO against an abuser. This study investigates IPV victims' experiences with a range of firearm-related abuse tactics across victim race/ethnicity, in addition to the relationship between firearm IPV and PO requests, above and beyond IPV not involving firearms. Questionnaires were administered to 215 female victims recruited from six domestic violence shelters in Texas. Over one-half of victims who sought a PO were threatened to be shot by their abuser and victims who experienced high levels of firearm abuse incurred a 302% increase in the odds of requesting a PO. There were no significant differences between White, Black, and Hispanic victims regarding firearm IPV tactics. The results shed light on the magnitude of risk IPV victims can experience when seeking a PO against an abusive partner.

Firearm-related threat exposure and associated factors among men and women entering a supportive housing substance use disorder recovery program

Background: Exposure to firearm victimization has often been overlooked as a sequela of substance use disorders (SUD).Objectives: The overall objective of this study was to explore firearm-related victimization and associated factors among men and women entering a supportive housing SUD recovery program.Methods: This study used program intake information from men (n = 1,758) and women (n = 1,066) clients entering a SUD recovery program.Results: Results found that almost half (49.3%) of the clients entering the program had ever been threatened with a firearm or held at gunpoint, and one-quarter of those clients had experienced firearm-related threats in the 6 months before entering the program. Economic vulnerability, mental health problems, polysubstance use, interpersonal victimization, and early use of drugs and alcohol were associated with firearm-related threat exposure. Many of the factors associated with firearm-related threat exposure were similar for men and women. Multivariate results found that polysubstance use (OR 1.16 men and 1.13 women), number of adverse childhood events (OR 1.13 men and 1.09 women), and interpersonal victimization (OR 3.41 men and 2.05 women) in the 6 months before program entry were significantly associated with ever being threatened with a firearm. Suicidality (OR 1.53 men and 1.80 women) and interpersonal victimization (OR 6.38 men and 6.08 women) were associated with being threatened with a firearm in the 6 months before program entry for both men and women.Conclusion: Results suggest there is a need for firearm-related risk reduction interventions for individuals in SUD recovery programs.

Experiences of Intimate Partner Violence during Lockdown and the COVID-19 Pandemic

Previous studies have demonstrated that there is an increase in Intimate Partner Violence (IPV) during times of crisis (e.g., financial, environmental, or socio-political situations). The COVID-19 pandemic has triggered an unprecedented global health and financial tragedy, but research is yet to establish exactly how the situation may impact on IPV. The present study investigates victims' experience of IPV during lockdown and the COVID-19 pandemic. We report a qualitative thematic analysis of 50 discussion forum posts written by victims of IPV. Of these, 48 forum posts were written by female victims of male perpetrated violence. All forum posts were obtained from the popular online platform, Reddit. We identified four themes associated with IPV victims' experiences during lockdown and the global pandemic: (i) Use of COVID-19 by the Abuser, (ii) Service Disruption, (iii) Preparation to Leave, and (iv) Factors Increasing Abuse or Distress. The COVID-19 pandemic has had a substantial impact on those living with IPV, often increasing the severity of IPV experienced. The experiences of those affected by IPV during this period inform interventions and the guidance and support provided to IPV victims during times of crisis.

The Association of Suicidal Ideation With Firearm Purchasing During a Firearm Purchasing Surge

IMPORTANCE

Firearm access is associated with risk for suicide, and, since early 2020, the US has experienced an unprecedented surge in firearm sales.

OBJECTIVE

To assess frequency of suicidal ideation among individuals who purchased firearms during the surge period (surge purchasers), other firearm owners, and non-firearm owners.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional online survey data were collected from January to June 2021. Participants were recruited via quota sampling through Qualtrics Panels. Within Minnesota, zip codes from Minneapolis and St Paul were oversampled. Participants included 6404 US adults recruited from 3 states: New Jersey (n = 3197), Minnesota (n = 1789), and Mississippi (n = 1418). Participants identified as becoming a first-time firearm owner during the surge period, being an established firearm owner who purchased a firearm during the surge period, being a firearm owner who did not buy firearms during the surge period, and not owning firearms.

MAIN OUTCOMES AND MEASURES

The primary outcomes were lifetime, past year, and past month suicidal ideation as measured by the Self-injurious Thoughts and Behaviors Interview-Revised.

RESULTS

The mean (SD) age within the full sample was 44.81 (18.45) years, with 3132 males (48.8%), 4706 White adults (73.4%), 2674 reporting annual household income less than $50 000 (41.7%), and 1546 (24.1%) reporting current firearm ownership. In the full sample, individuals who purchased firearms during the surge period were more likely than were non-firearm owners to report lifetime suicidal ideation (odds ratio [OR], 2.21; 95% CI, 1.82-2.68), past-year suicidal ideation (OR, 2.10; 95% CI, 1.72-2.55), and past-month suicidal ideation (OR, 1.80; 95% CI, 1.41-2.29). In addition, among individuals who purchased firearms during the surge period, first-time owners were more likely than established firearm owners to report lifetime suicidal ideation (OR, 2.12; 95% CI, 1.43-3.14) and past-year suicidal ideation (OR, 2.37; 95% CI, 1.59-3.53). Results were largely consistent across states.

CONCLUSIONS AND RELEVANCE

In this survey study, results highlighted that individuals who acquired firearms during the purchasing surge were more likely than other firearm owners and non-firearm owners to have experienced suicidal thoughts. This is particularly true for individuals who purchased a firearm for the first time during the surge period. This illustrates the need to implement policies and interventions that increase safety among firearm purchasers (eg, safe firearm storage) as well as those that promote the acquisition of alternative forms of protection (eg, home alarm systems).

What is the role of firearms in nonfatal intimate partner violence? Findings from civil protective order case data

BACKGROUND

Perpetrators of intimate partner violence (IPV) use firearms to injure, scare, and manipulate their partners. Abusers who have a firearm in their homes are more likely to threaten and/or kill their partner. To date, however, limited research documents the nature of IPV perpetrator firearm access or the prevalence of nonfatal firearm abuse behaviors.

METHODS

Federal law restricts firearm access for IPV perpetrators in qualifying domestic violence protective order (DVPO) cases and information about firearms should be disclosed during the DVPO process. We used secondary data from civil DVPO cases (n = 406) in North Carolina that were collected using a representative sampling strategy. Data were from DVPO case files and structured DVPO hearing observations. We conducted a content analysis to record IPV perpetrator access to guns and reported firearm abuse behaviors. We used a linear regression analysis to determine whether IPV perpetrator gun access was associated with higher levels of reported abuse. We also examined factors associated with perpetration of nonfatal firearm abuse.

RESULTS

We found evidence of perpetrator firearm access in nearly half of all cases (46%, n = 108). Controlling for covariates, gun access was significantly associated with higher levels of reported IPV (b = 0.5, p < .001). Firearm abuse was reported in nearly one out of four cases (23.1%, n = 101), and often entailed spoken threats, displaying a gun, or holding a partner at gun point. The only factors associated with firearm abuse in the multivariate models were related to English language speaking/fluency.

CONCLUSIONS

Gun access should be considered an indicator for severe IPV. We must ensure that existing legal mechanisms to identify and restrict abuser access to firearms are fully implemented and enforced. Firearm abuse often manifests as non-physical coercive control which is traumatic and has the potential to escalate to homicide, even in the absence of past physical violence.

Public guns, private violence: The association of city-level firearm availability and intimate partner homicide in the United States

This city-level study examines the association of federally licensed firearm dealers (FFLs) and measures of illegal firearm availability with the risk of intimate partner homicide. Annual data for a sample of 286 large cities in the United States were collected for the years 2010-2019, incorporating city-level information on the number of gun-perpetrated homicides, the rate of licensed firearm dealers, and guns reported lost or stolen. All data were compiled and analyzed in 2020. Negative binomial models were used to assess the relation of firearm availability and gun homicide by intimate partners, in comparison to gun homicide between non-intimates. Results indicate that a higher rate of licensed firearm dealers was associated with a higher risk of intimate partner homicide, although more pronounced in states with lower-than-average existing gun ownership. This association was robust to different analytical methods and alternate ways of capturing illegal guns. A supplementary analysis using unique data from The Trace further supports the argument that FFL presence is a risk factor for intimate partner firearm homicide specifically, but not necessarily firearm homicide characterized by other motives.

Opinions on a Firearm Prohibition Policy That Targets Intimate Partner Violence

Firearms and intimate partner violence form a nexus of dangerousness and lethality. But, some policies aim to separate the two phenomena. The present study aims to fill a gap in the literature focusing on opinions toward a firearm prohibition for persons with injunctions for protection in effect against them by analyzing data from a convenience sample of 290 undergraduate students at a large research university in Florida, United States. Overall, any agreement with the policy was high. Multivariate analyses indicated that females/women and gender identity minorities, together, tended to express more agreement with firearm prohibition than males/men. Multivariate analysis also showed that participants who experienced sexual violence also displayed more agreement with the prohibition when compared to individuals who did not experience sexual violence victimization. "Lower" severity sexual violence victimization had the strongest relationship with policy opinions. Possible explanations for the gender difference in opinions include the implications of hegemonic masculinity and power differentials among genders. A possible explanation for the relationship between sexual violence victimization and policy opinions includes empathy. Policy implications and directions for future research include investigating the potential relationship gap in firearm prohibitions within Florida, engaging college men to change the conceptions around firearms through educational intervention, harnessing the tech-savvy power that college students have to generate awareness of policies, and considering interconnections among opinions, polyvictimization, and firearm policies.

Nonfatal use of firearms in intimate partner violence: Results of a national survey

Research on intimate partner violence (IPV) and firearms has typically focused on homicide, so there is limited information on how firearms are used in nonfatal ways, particularly in community samples. We sought to estimate the prevalence of nonfatal firearm abuse in the context of IPV, understand how and against whom firearms are used, and examine consequences of this abuse. Using a national web-based survey of US adults who experienced IPV (n = 958), we asked respondents about experiences with nonfatal firearm abuse, including the frequency of firearm behaviors and consequences. Based on screening data weighted to be nationally representative, we estimated that 9.8% (95% CI: 9.0%, 10.6%) of US adults - or nearly 25 million - have experienced nonfatal firearm abuse by an intimate partner (i.e., were threatened with a firearm, had a firearm used on them, or were threatened by a partner who possessed or had easy access to a firearm). IPV victims who experienced nonfatal firearm abuse commonly reported experiencing other forms of IPV. The most common behaviors included the partner displaying a firearm (67.5%) and threatening to shoot the victim (63.0%). The majority (80.5%) of perpetrators were male, and 49.2% of respondents had a child at home at the time of abuse. The most common consequences of nonfatal firearm abuse were concerns for safety (86.2%) and feeling fearful (82.7%). Additionally, 43.1% of respondents reported physical injury, and 37.4% missed days of work or school. Practice and policy around firearm access for IPV perpetrators should attend to nonfatal firearm use against intimate partners.

The role of domestic violence in fatal mass shootings in the United States, 2014-2019

Background

Fatal mass shootings, defined as four or more people killed by gunfire, excluding the perpetrator, account for a small percentage of firearm homicide fatalities. Research has not extensively focused on the role of domestic violence (DV) in mass shootings in the United States. This study explores the role of DV in mass shootings in the United States.

Methods

Using 2014–2019 mass shooting data from the Gun Violence Archive, we indexed our data by year and mass shooting and collected the number of deaths and injuries. We reviewed news articles for each mass shooting to determine if it was 1) DV-related (i.e., at least one victim of a mass shooting was a dating partner or family member of the perpetrator); 2) history of DV (i.e., the perpetrator had a history of DV but the mass shooting was not directed toward partners or family members); or 3) non-DV-related (i.e., the victims were not partners or family members, nor was there mention of the perpetrator having a history of DV). We conducted descriptive analyses to summarize the percent of mass shootings that were DV-related, history of DV, or non-DV-related, and analyzed how many perpetrators died during the incidents. We conducted one-way ANOVA to examine whether there were differences in the average number of injuries or fatalities or the case fatality rates (CFR) between the three categories. One outlier and 17 cases with unknown perpetrators were excluded from our main analysis.

Results

We found that 59.1% of mass shootings between 2014 and 2019 were DV-related and in 68.2% of mass shootings, the perpetrator either killed at least one partner or family member or had a history of DV. We found significant differences in the average number of injuries and fatalities between DV and history of DV shootings and a higher average case fatality rate associated with DV-related mass shootings (83.7%) than non-DV-related (63.1%) or history of DV mass shootings (53.8%). Fifty-five perpetrators died during the shootings; 39 (70.9%) died by firearm suicide, 15 (27.3%) were killed by police, and 1 (1.8%) died from an intentional overdose.

Conclusions

Most mass shootings are related to DV. DV-related shootings had higher CFR than those unrelated to DV. Given these findings, restricting access to guns by perpetrators of DV may affect the occurrence of mass shootings and associated casualties.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-021-00330-0.

Coercive Control Between Intimate Partners: An Application to Nonfatal Strangulation

Nonfatal strangulation between intimate partners represents an extreme controlling form of violent behavior, increasing the risk that intimate partner violence (IPV) becomes lethal. Guided by Dutton and Goodman's conceptualization of coercive control, the present research explored the relation between death threats and subsequent nonfatal strangulation to amplify the credibility of those threats, using a large sample of IPV perpetrators (n = 6,488). Logistic regression analyses determined the relation between overt threats to a partner's life during an initial incident arrest and subsequent nonfatal strangulation postincident arrest, accounting for perpetrator characteristics and assessed risk. Results showed the highly gendered nature of this violent behavior, noting that men were significantly more likely than women to persist in nonfatal strangulation. Given the potential lethality of this violent behavior, the analysis also explored whether treatment service recommendations (family violence education, counseling, and mental health evaluation) mitigate these patterns. These preliminary findings support the further exploration of treatment and intervention efforts for reducing nonfatal strangulation.

Associations between state intimate partner violence-related firearm policies and injuries among women and men who experience intimate partner violence

Background

Comprehensive state firearm policies related to intimate partner violence (IPV) may have a significant public health impact on non-lethal IPV-related injuries. Research indicates that more restrictive firearm policies may reduce risk for intimate partner homicide, however it is unclear whether firearm policies prevent or reduce the risk of non-lethal IPV-related injuries. This study sought to examine associations between state-level policies and injuries among U.S. IPV survivors.

Methods

Individual-level data were drawn from the National Intimate Partner and Sexual Violence Survey, a nationally-representative study of noninstitutionalized adults. State-level data were drawn from a firearm policy compendium. Multivariable regressions were used to test associations of individual policies with non-fatal IPV-related injuries (N = 5493). Regression models were also conducted to explore differences in the policy-injury associations among women and men survivors.

Results

Three categories of policies were associated with IPV-related injuries. The odds of injuries was lower for IPV survivors living in states that prohibited firearm possession and require firearm relinquishment among persons convicted of IPV-related misdemeanors (aOR [95% CI] = .76 [.59, .97]); prohibited firearm possession and require firearm relinquishment among persons subject to IPV-related restraining orders (aOR [95% CI] = .81 [.66, .98]); and prohibited firearm possession among convicted of stalking (aOR [95% CI] = .82 [.68, .98]) than IPV survivors living in states without these policies. There was a significant difference between women and men survivors in the association between IPV-related misdemeanors policy and injuries (B [SE] = .60 [.29]), such that the association was stronger for men survivors (aOR [95% CI] = .10 [.06, .17]) than women survivors (aOR [95% CI] = .60 [.48, .76]).

Conclusions

Restrictive state firearm policies regarding IPV may provide unique opportunities to protect IPV survivors from injuries.

Firearm exposure and the health of high-risk intimate partner violence victims

RATIONALE

The negative physical and mental health consequences of intimate partner violence (IPV) have been well-documented, as those who are exposed to trauma experience more physical health issues. Further, an abuser's direct access to a firearm drastically increases the risk for fatality, which can exacerbate ongoing stress and trauma in an abusive relationship. However, very little research has investigated the intersection of exposure to firearms and adverse health outcomes in the context of IPV.

OBJECTIVE

This study investigates the sensitivity of firearm exposure in IPV contexts by examining if abusive partner firearm ownership-regardless of actual use of a gun in the abuse-is associated with negative health outcomes.

METHODS

The research team administered questionnaires to IPV victims (N = 215) from six domestic violence shelters across rural and urban locations in a single state.

RESULTS

Having an abusive partner who owned a firearm was associated with significantly worse physical health-above and beyond IPV experienced in the relationship. Even so, IPV involving firearms was not significantly associated with physical health beyond partner firearm ownership. The relationship between partner firearm ownership and negative health outcomes was primarily attenuated by sleep disturbances among victims.

CONCLUSIONS

The results provide initial information about the role that firearms play in adverse victim health beyond injuries (e.g., gunshot wounds) and fatalities.

Understanding the Role of Law in Reducing Firearm Injury through Clinical Interventions

Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies.

Analysis of Domestic Violence Related Homicides in Los Angeles County: Media Portrayals, Demographics, and Precipitating Circumstances

Intimate partner violence (IPV) remains a pressing public health issue. Nationally, 1 in 5 women and 1 in 10 men have sustained severe physical violence from an intimate partner. Intimate partner homicides (IPH) are the most serious IPV outcome. This study examined documented IPH in Los Angeles County during 2017, analyzing if precipitating circumstances, victim demographics, victim/suspect relationship, and weapon type were related to how often a homicide was reported in online media stories. Cases were identified from the National Violent Death Reporting System (NVDRS), and standardized internet searches identified media articles associated with each case. Victim demographics from NVDRS and media articles were compared using Chi Square tests. Media report frequency, within different categorical predictor values, were examined using ANOVA models. 44 incidents were identified; averaging 5.2 articles per decedent. Univariate analyses showed significant difference in media reporting by poverty level (low versus high socioeconomic status) and presence of preceding argument. Multivariate analyses found significantly more media reports (p = 0.002) for incidents in which a preceding argument is reported, the victim was 30-39 years old and from a low socioeconomic status zip code. From our results certain characteristics of IPH are associated with greater media reporting. Promotion of consistent and responsible IPH media reporting guidelines is an opportunity to reinforce public health messaging and dispel myths. In turn, this will encourage the development of future policies and funding streams across the spectrum of preventing and stopping IPV.

Variation in State Laws on Access to Civil Protection Orders for Adolescents Experiencing Intimate Partner Violence

PURPOSE

Intimate partner violence (IPV) is prevalent among adolescents. Civil protection orders (CPOs) are the most common legal remedy used by individuals experiencing IPV to prevent recurrence. However, laws on whether adolescents can access CPOs vary by state. We assessed the landscape of state legislation regarding adolescents' access to CPOs for IPV.

METHODS

We systematically assessed statutes across all 50 U.S. states and the District of Columbia for 5 indicators: whether minors can be granted CPOs, whether minors can file on their own behalf, whether dating relationships are eligible, definitions of abuse qualifying for CPOs, and whether a CPO prohibits firearm possession and requires surrender of firearms.

RESULTS

A total of 48 states (94%) explicitly allow minors to obtain CPOs. Fourteen states (27%) explicitly allow minors to file for a CPO on their own behalf. Forty-four states (86%) recognize dating relationships as qualifying relationships for a CPO. A CPO may be issued for physical violence in all 51 states (100%), sexual violence in 46 states (90%), threats of physical or sexual violence in 47 states (92%), stalking in 44 states (86%), and psychological/emotional violence in 28 states (55%). In 22 states (43%), an individual subject to a CPO is prohibited from possessing firearms and is required to surrender firearms they already have.

CONCLUSIONS

There is a significant variation in states' CPO statutes related to adolescent IPV. Improvements in legislation that reduce the barriers to legal relief for those experiencing violence can be an important part of a comprehensive solution to reducing IPV among adolescents.

After the gun: examining police visits and intimate partner violence following incidents involving a firearm

Laws have been enacted to keep firearms out of the hands of abusers. In this study, we examined one such effort-removal of a firearm at the scene of intimate partner violence (IPV)-to assess the subsequent occurrence and number of IPV incidents responded to by police and subsequent risk of injury to the victim. Using the 28,977 IPV calls in one large U.S. city to which officers responded during the 2013 calendar year, we identified 220 first-time incidents in which offenders used (i.e., brandished, pistol whipped, shot) a pistol, revolver, rifle, or shotgun. Officers reported removing a firearm from 52 (24%) of the offenders. After using full propensity score matching to control for potential confounders, logistic and Poisson regressions were used to assess differences between those from whom a firearm was removed and those whose firearm was not removed. Firearm removal at the scene of an IPV incident appears to increase the likelihood of subsequent IPV reports to police and suggestive evidence that subsequent injury to the victim might increase as well. The offender shifting from threats with a firearm to physical violence and a change (an increase as well as a decrease) in victim willingness to summon police may account for the findings.

Mental health, violence and psychological coercion among female and male trafficking survivors in the greater Mekong sub-region: a cross-sectional study

BACKGROUND

Human trafficking is a pervasive global crime with important public health implications that entail fundamental human rights violations in the form of severe exploitation, violence and coercion. Sex-specific associations between types of violence or coercion and mental illness in survivors of trafficking have not been established.

METHODS

We conducted a cross-sectional study with 1015 female and male survivors of trafficking (adults, adolescents and children) who received post-trafficking assistance services in Cambodia, Thailand or Vietnam and had been exploited in various labor sectors. We assessed anxiety and depression with the Hopkins Symptoms Checklist (HSCL-25) and post-traumatic stress disorder (PTSD) symptoms with the Harvard Trauma Questionnaire (HTQ), and used validated questions from the World Health Organization International Study on Women's Health and Domestic Violence to measure physical and sexual violence. Sex-specific modified Poisson regression models were estimated to obtain prevalence ratios (PRs) and their 95% confidence intervals (CI) for the association between violence (sexual, physical or both), coercion, and mental health conditions (anxiety, depression and PTSD).

RESULTS

Adjusted models indicated that for females, experiencing both physical and sexual violence, compared to not being exposed to violence, was a strong predictor of symptoms of anxiety (PR = 2.08; 95% CI: 1.64-2.64), PTSD (PR = 1.55; 95% CI: 1.37-1.74), and depression (PR = 1.57; 95% CI: 1.33-1.85). Among males, experiencing physical violence with additional threats made with weapons, compared to not being exposed to violence, was associated with PTSD (PR = 1.59; 95% CI: 1.05-2.42) after adjustment. Coercion during the trafficking experience was strongly associated with anxiety, depression, and PTSD in both females and males. For females in particular, exposure to both personal and family threats was associated with a 96% elevated prevalence of PTSD (PR = 1.96; 95% CI: 1.32-2.91) and more than doubling of the prevalence of anxiety (PR = 2.11; 95% CI: 1.57-2.83).

CONCLUSIONS

The experiences of violence and coercion in female and male trafficking survivors differed and were associated with an elevated prevalence of anxiety, depression, and PTSD in both females and males. Mental health services must be an integral part of service provision, recovery and re-integration for trafficked females and males.

Dangerous Liaisons: Examining the Connection of Stalking and Gun Threats Among Partner Abuse Victims

Little is known about the scope and nature of how guns are used to threaten (ex)partners particularly during periods of stalking, which often occurs after victims leave their abusers. This study examines survey results from over 500 women from across the United States who contacted the National Domestic Violence Hotline. Specifically, this study (a) describes the prevalence and characteristics of partner abuse victims who were and were not stalked and who were and were not threatened with guns, (b) compares types of gun threats experienced by partner abuse victims who were and were not stalked, (c) examines worries about gun threats for those who were and were not stalked among partner abuse victims not threatened with a gun, and (d) assesses factors associated with advice to obtain a gun for personal safety. This article also provides open-ended comments selected to highlight themes from the quantitative information around participant fears and worries about gun threats and stalking. Findings from this study show one-third of the participants had experienced threats with guns, and one-fifth of those without gun threats worried their (ex)partner would harm them with a gun. Furthermore, there was a significant association between stalking and gun threats, as three-fourth of those who were threatened with a gun reported being stalked. Victims who experienced stalking were also more likely to report their (ex)partner threatened others with guns and were more likely to carry a firearm on their body or in their car, which suggests stalkers who threatened with guns may pose a significant risk to public safety. Implications for future research are discussed.

Guns in Intimate Partner Violence: Comparing Incidents by Type of Weapon

Objective: The goal of this study was to assess the frequency, nature, and outcome of weapon use in intimate partner violence (IPV) and to assess compliance with related gun policies.

Methods: Data were drawn from forms police are mandated to complete at the scene of IPV in the fifth largest U.S. city during 2013. Proportions were calculated and odds ratios were adjusted for demographic and contextual characteristics and a Bonferroni correction for multiple statistical tests was applied.

Results: Of the 35,413 incidents, 6,573 involved hands, fists, or feet, and 1,866 involved external weapons of which 576 were guns. Most incidents were male-on-female: 63.4% (no weapon), 77.4% (bodily weapon), 50.2% (nongun external weapon), and 79.5% (gun). Guns were used most often to threaten the partner (69.1%). When a gun (vs. bodily or nongun external weapon) was used, IPV victims were less likely to have visible injuries (adjusted odds ratio [AOR] = 0.64 and 0.23, respectively)—offenders were less likely to have pushed or shoved, grabbed, punched, or kicked the victim—but (victims) were more likely to be frightened (AOR = 3.13 and 1.49, respectively).

Conclusions: Weapon use of any type by an intimate partner is associated with a wide range of violent offender behavior and multiple negative outcomes for victims. The use of a gun has implications that include, but go beyond, physical injury of the victim. Documentation of the enforcement of state law regarding gun removal merits improvement, which has important implications for the evaluation of policies designed to keep guns out of the hands of abusers.