Understanding Gun Violence:

Epidemiology and Evidence-based Policy

November 18th, 2018

Cassandra Crifasi, PhD, MPH

Assistant Professor, Department of Health Policy and Management
Deputy Director, Center for Gun Policy and Research
Outline
• Background and epidemiology of gun violence
• Standards for legal gun ownership
• Regulation of gun purchasing
• Regulation of gun carrying
• Public opinion on gun policy

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Background and Epidemiology
Public Health Perspective
• Consider ALL deaths: homicide, suicide, and unintentional injuries for
ALL victims
• Consider the role of the “vector”
• Violence as a contagious process
• Design, implement, and evaluate interventions
• Focus on prevention rather than punishment Person

• Multi-faceted approach:
• Education
• Environment
Environment Vector
• Enforcement

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Distribution of Firearm-related Deaths in the U.S.,
2016

Homicide: Suicide:
14,415 22,938

Total Firearm Deaths = 38,658

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Firearm Suicide Rates, by Age and Race
18
16
Rate per 100,000 popluation

14
12
10
8
6
4
2
0
<1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 > 85
Age
Black White
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Percent of All Suicide Attempts by Mechanism
6%

71%

Overdose Cut/Pierce Gun Hanging Gas Jump Drowning Other

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Case Fatality Rates for Suicide Means
Cut/Pierce

Overdose

Other

Jump

Gas

Hanging

Drowning

Gun

0 10 20 30 40 50 60 70 80 90

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Distribution of Fatal Suicide Attempts

54%

Overdose Cut/Pierce Gun Hanging Gas Jump Drowning Other

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Homicide Rates in Select High Income Countries, 2014

USA 3.82

Israel 1.75

Canada 1.44

France 1.2

Australia 1.07

United Kingdom 0.96

Sweden 0.92

Japan 0.29

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

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 U.S. Homicide Rates, 1999-2016
5
4.5
Rate per 100,000 population

4
3.5
3
2.5
2
1.5
1
0.5
0

Firearm Homicide Non-Firearm Homicide

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Firearm Homicide Victimization, by Age and Race
60

50
Rate per 100,000 population

40

30

20

10

0
<1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 > 85
Black White

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Type of Guns Used in Homicide, 2016
(n = 7,927 known gun type)
3%
5%

90%

Handgun Rifle Shotgun Other Gun

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Standards for Legal Gun Ownership
 Important Events in Gun Policy

Heller v District
Tiahrt of Columbia
2nd Amendment Gun Control Act Brady Law Amendments (2008)
of 1968 (1994) (2003)

Firearm Owners Lawsuits against Protection of

Protection Act of gun industry Lawful
1986 (late 1990s) Commerce in
Arms Act
(2005)

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Federal and State Gun Laws
Prohibited Federal State
Felons, juveniles, dangerously mentally ill Yes --
Violent misdemeanors Only Domestic 13
Violence
Legal age for handgun purchase / possession = 21 No 13
Temporary prohibition for serious juvenile offenses No 27
Private sales regulated (background checks, records) No 20*
Permit to purchase handgun licensing for all purchasers
- any No 9
- in-person application (usually with fingerprinting) 7
Handgun registration No 7

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Gun ownership status of persons before they committed a gun crime
leading to incarceration in 13 states with weakest standards for legal
gun possession

Probibited: 40%

Not prohibited even under

stricter standards: 31%

Prohibited under stricter

standards: 29%

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Regulation of Gun Purchasing
States Requiring PTP for EVERY Handgun Purchase

WA

ME
MT ND

MN
OR VT
ID NH

SD WI
MI MA
NY
WY CT RI

IA PA NJ
NE
NV OH
UT IN MD DE
IL
CO WV
CA
KS MO VA
KY

NC
TN
OK
AZ AR
NM SC

MS AL GA

TX
LA

FL

AK

Legend
HI
No License
License Required
PTP Laws in Connecticut and Missouri
• Connecticut – enacted PTP law in October 1995
• Mandated PTP for all handgun transfers contingent on passing background
check and safety training course
• Permits good for 5 years, revoked if the holder become disqualified
• Law led to reductions in firearm homicide and suicide

• Missouri – repealed PTP law August 2007

• Required PTP for all handgun transfers contingent upon passing a background
check
• Permits obtained in-person from sheriff and good for 30 days
• Repeal led to increases in firearm homicide and suicide

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Share of recovered guns in Missouri by original sale
state
80%

70%

60%

50%

40%

30%

20%

10%

0%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Missouri other states

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Share of recovered guns with short time-to-crime in
Missouri
25%

20%

15%

10%

5%

0%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

< 3 mo. 3-12 mo.

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Maryland’s Firearm Safety Act of 2013
• Banned assault rifles and ammo clips more than 10 rounds

• Require license for handgun purchase – fingerprinting and safety training

requirement

• Mandatory loss and theft reporting

• Gave MSP authority to sanction licensed dealers

• Bars person with PBJ for violent crimes from possessing firearms

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Percent of in-state crime guns with 1-year time-to-
crime, 2010-2017
30

25

20

15

10
2010 2011 2012 2013 2014 2015 2016 2017
MD PA VA

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Regulation of Gun Carrying
State Laws Regulating Civilian Concealed Carry - 1980

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State Laws Regulating Civilian Concealed Carry - 1990

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State Laws Regulating Civilian Concealed Carry - 2000

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State Laws Regulating Civilian Concealed Carry - 2010

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State Laws Regulating Civilian Concealed Carry - 2017

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Impact of Deregulating Civilian Concealed Carry
• “RTC” laws associated with increases in violent crime
• Dose response relationship
• More years with RTC  more CCW permits
• More years with RTC  more violent crime

• Positive, linear relationship between number of permits and violent crime

• Higher levels of baseline gun ownership increases RTC effects

• Trend toward permitless carry removes barriers to civilian gun carrying

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Public Opinion on Gun Policy
Overall Public Support for Gun Policies Among
National Sample of U.S. Adults, 2017
Policy %
support
Requiring a background check system for all gun sales to make sure a purchaser is not legally prohibited from having a
gun 87.8
Allowing the Bureau of Alcohol, Tobacco and Firearms to temporarily take away a gun dealer’s license if an audit reveals
record-keeping violations and the dealer cannot account for 20 or more of his guns 84.8
A person who can legally carry a concealed gun should be required to pass a test demonstrating they can safely and
lawfully handle a gun in common situations they might encounter 84.7
Requiring states to report a person to the background check system who is prohibited from buying a gun due either to
involuntary commitment to a hospital for psychiatric treatment or to being declared mentally incompetent by a court of
law 83.6
Prohibiting a person subject to a temporary domestic violence restraining order from having a gun for the duration of
the order 81.0
Allowing family members to ask the court to temporarily remove guns from a relative who they believe is at risk of
harming himself or others 78.9
Requiring a person to obtain a license from a local law enforcement agency before buying a gun to verify their identity
and ensure that they are not legally prohibited from having a gun 76.8
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Differences in Public Support for Policies by Gun
Ownership

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