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Tuesday Mar 28, 2017

Two Common-sense Interventions Could Prevent Gun-related Deaths

"Happiness is a warm gun."

John Lennon saw this sentence on the cover of a gun magazine and said he chose it as a song title because, "it was a fantastic, insane thing to say."

"A warm gun means you just shot something."

Nearly 50 years after the song was recorded and 36 years after Lennon was shot in New York, gun control remains one of the most divisive topics in the United States.

Let me start by saying that I own a gun. OK, full disclosure: It's just a pellet gun, but I love to target-shoot, and I intend to learn to hunt (with a real gun) this year.

I know this is an oft-heard refrain, but I mention it here to establish a tone -- collegiality. Today, I am going to lay out what I consider the least controversial things we could do to reduce gun-related deaths. I hope my effort rings true.

The Problem: Suicide  
In 2014, there were 33,599 deaths related to guns. Of these, 21,334 -- or 63.5 percent -- were suicides. Importantly, although only 5.6 percent of suicide attempts involved firearms, more than half of completed suicides were with a firearm. That's because 85 percent of suicide attempts with firearms are fatal. They are, in fact, more than 45 times more fatal than attempts that involve overdosing and 30 times more fatal than those that involve cutting or stabbing.

All that said, it's important to keep in mind that 90 percent of people who attempt suicide and survive do not go on to die by suicide.

Suicide is the second-leading cause of death for Americans ages 10 to 34 years. Firearms are used in 44 percent of cases in this group. Additionally, more than 70 percent of all Americans age 65 and older who die by suicide use a firearm.

Finally, in the first year after a handgun purchase, suicide was the leading cause of death among handgun owners, accounting for 24.5 percent of all deaths. In the first week after such a purchase, the rate of suicide by means of firearms among purchasers was 57 times higher than that of the general population.  

I recognize that this does not mean that if you are purchasing a handgun for sport, you are suddenly more likely to attempt suicide. This is simply data that we all should know.

An Intervention: Delay Receipt of a Handgun
As of 2013, there were 11 states that made purchasers of handguns wait to receive their handguns. These states have 27 percent fewer suicides per capita and 51 percent fewer firearm suicides.

Perhaps more tellingly, in 2009, South Dakota repealed a 48-hour waiting period to receive a handgun, and in the year immediately following the repeal, the state saw a 7.6 percent increase in its overall suicide rate compared with a 3.3 percent increase for the rest of the country.

In 2011, Washington, D.C., changed its waiting period to begin at the time of purchase rather than the time of application. In the following year, the nation's capital saw a 2.2 percent decrease in its overall suicide rate compared with a 2.1 percent increase nationwide.

If people are willing to wait a few days to get their guns, states can reduce their suicide rates. That seems reasonable.

So, is waiting to get a gun worth it?

The Problem: Domestic Violence
Abused women are five times more likely to be killed by their abuser if the abuser owns a firearm. Domestic violence assaults involving a gun are 12 times more likely to result in death than those involving other weapons or bodily force. If there was a gun in the house, nearly two thirds (64.5 percent) of abusers used the firearm against the victim, usually threatening to shoot or kill them. More than two-thirds of spouse and ex-spouse homicide victims between 1980 and 2008 were killed with firearms.  

An Intervention: Don't Let Domestic Abusers Possess Guns
Federal law prohibits people convicted of domestic violence misdemeanors and abusers subject to certain restraining orders from possessing guns. Such prohibitions, however, do not ensure that guns already in the possession of an abuser are removed. As one might expect, domestic violence perpetrators who continued to possess firearms after they were prohibited from doing so by federal law were more likely to attempt homicide or threaten their partners with guns than perpetrators who had relinquished their firearms.

There are several things we could do here. Before purchasing most guns, you need a background check, which should include screening for domestic violence. Many states, however, do not comprehensively enter domestic violence protective order and offender information into the proper databases. For a background check database to be effective, it has to have data, and only three states have enacted laws to facilitate the reporting of domestic violence misdemeanants to the database used for background checks.

Only 18 states have laws that authorize police to remove firearms when responding to a domestic violence incident, and only half of the states authorize or require a court that is issuing a domestic violence protective order to require the abuser to surrender firearms. Given that 81 percent of Americans, including 75.6 percent of gun owners, support prohibiting gun ownership (not just gun purchasing) for 10 years after a person has been convicted of violating a domestic violence restraining order, one would think we would empower our police to make that happen. Of note, the same survey found that 73.7 percent of gun owners and 72.4 percent of non-gun owners support prohibiting gun ownership for 10 years after a person is convicted of domestic violence.

Adding Physicians' Voices
There are some reasonable things we could do to reduce gun-related deaths, and physicians are recognized as an important voice in this conversation. Just last week, a conference in Chicago on preventing gun violence -- which the AAFP cosponsored with the AMA, the American Bar Association and several other medical and legal organizations -- discussed evidence-based and public health approaches to the problem.

If the ideas I presented here make sense to you, be sure to tell your legislators. I truly hope that I have found some measures that are both generally agreeable and effective. If you have other ideas, please feel free to post them below in the same collegial spirit I've done my best to use here. I'm sure we all agree that the goal is to have fewer people die. We just have to find the right mix of interventions.

Stewart Decker, M.D., is the resident member of the AAFP Board of Directors.

Comments:

The question I ask in health screenings is, "Do you have any unlocked firearms in the home?"
It appears that many "accidental" and intimate partner shootings occur when an unlocked firearm is lying around: http://smartgunlaws.org/gun-laws/policy-areas/consumer-child-safety/safe-storage-gun-locks/

Asking the above question is occasionally fruitful in prompting a recommendation that less than $10 be spent to buy a trigger or cable lock for the firearm.

A legislative approach would be to require all firearms to be sold with a lock, as many do (see above web-site).

This would seem to be low-hanging fruit, and politically do-able.

Posted by Jonathan Adams, MD on March 30, 2017 at 09:37 AM CDT #

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