PRIORITIES FOR RESEARCH TO REDUCE THE THREAT OF

FIREARM-RELATED

   VIOLENCE

Committee on Priorities for a Public Health Research Agenda to Reduce
the Threat of Firearm-Related Violence

Executive Office
Institute of Medicine

Committee on Law and Justice
Division of Behavioral and Social Sciences and Education

Alan I. Leshner, Bruce M. Altevogt, Arlene F. Lee, Margaret A. McCoy,
and Patrick W. Kelley, Editors

INSTITUTE OF MEDICINE AND
NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



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Committee on Priorities for a Public Health Research Agenda to Reduce the Threat of Firearm-Related Violence Executive Office Institute of Medicine Committee on Law and Justice Division of Behavioral and Social Sciences and Education Alan I. Leshner, Bruce M. Altevogt, Arlene F. Lee, Margaret A. McCoy, and Patrick W. Kelley, Editors

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This project was supported by awards between the National Academy of Sciences and both the Centers for Disease Control and Prevention (CDC) (#200- 2011-38807) and the CDC Foundation with the Foundation’s support originating from The Annie E. Casey Foundation, The California Endowment, The California Wellness Foundation, The Joyce Foundation, Kaiser Permanente, the Robert Wood Johnson Foundation, and one anonymous donor. The views presented in this publication are those of the editors and attributing authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-28438-7 International Standard Book Number-10: 0-309-28438-4 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2013. Priorities for research to reduce the threat of firearm-related violence. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON PRIORITIES FOR A PUBLIC HEALTH RESEARCH AGENDA TO REDUCE THE THREAT OF FIREARM-RELATED VIOLENCE ALAN I. LESHNER (Chair), American Association for the Advancement of Science, Washington, DC LOUIS ARCANGELI, Georgia State University, Atlanta ALFRED BLUMSTEIN, Carnegie Mellon University, Pittsburgh, PA C. HENDRICKS BROWN, University of Miami Miller School of Medicine, Miami, FL DONALD CARLUCCI, Picatinny Arsenal, Rockaway Township, NJ BG (Ret.) RHONDA CORNUM, TechWerks, North Middletown, KY PAUL K. HALVERSON, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis STEPHEN W. HARGARTEN, Medical College of Wisconsin, Milwaukee RONALD C. KESSLER, Harvard Medical School, Boston, MA GARY KLECK, Florida State University, Tallahassee JOHN A. RICH, Drexel University School of Public Health, Philadelphia, PA JEFFREY W. RUNGE, Biologue, Inc., Chapel Hill, NC SUSAN B. SORENSON, University of Pennsylvania, Philadelphia DAVID VLAHOV, University of California, San Francisco IOM and NRC Staff BRUCE M. ALTEVOGT, Senior Program Officer, Board on Health Sciences Policy MARGARET A. MCCOY, Program Officer, Board on Health Sciences Policy JULIA K. HOGLUND, Research Associate, Food and Nutrition Board KATHERINE M. BLAKESLEE, Global Program Advisor, Board on Global Health MORGAN E. HELLER, Assistant to the IOM President for Special Projects BRADLEY A. ECKERT, Research Assistant, IOM Executive Office PATRICK W. KELLEY, Senior Board Director, Boards on Global Health and African Science Academy Development ARLENE F. LEE, Board Director, Committee on Law and Justice v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Jeremiah A. Barondess, New York Academy of Medicine Carl C. Bell, Community Mental Health Council, Inc. Paul Blackman, Criminal Justice Independence Institute Charles Branas, University of Pennsylvania John Donohue, Stanford University Jeffrey Gunzenhauser, Los Angeles County Department of Public Health L. Rowell Huesmann, University of Michigan Nadine Kaslow, Emory University School of Medicine Arthur L. Kellermann, RAND Corporation Hyla S. Napadensky, Napadensky Energetics, Inc. Charles H. Ramsey, Philadelphia Police Department Robert J. Sampson, Harvard University Donald Sebastian, New Jersey Institute of Technology vii

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viii REVIEWERS Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Enriqueta C. Bond, Burroughs Wellcome Fund, and Johanna T. Dwyer, Tufts Medical Center. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this re- port rests entirely with the editors and the institution.

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Contents SUMMARY 1 INTRODUCTION 11 Scope of the Public Health Problem, 13 Firearm-Related Violence as a Public Health Issue, 16 Applying Public Health Strategies to Reducing Firearm Violence, 17 Study Goals, Methods, and Organization of the Report, 19 AN OVERARCHING ISSUE: RESEARCH DESIGN AND DATA 22 Impact of Existing Federal Restrictions on Firearm Violence Research, 23 Data Quality, Accessibility, and Aggregation, 24 Data to Assess Gun Acquisition and Storage, 24 Data Fragmentation and Standardization, 25 Research Methods and Challenges, 25 CHARACTERISTICS OF FIREARM VIOLENCE 26 Types and Numbers of Firearms, 27 Types of Firearm Violence, 28 Research Questions, 33 ix

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x CONTENTS RISK AND PROTECTIVE FACTORS ASSOCIATED WITH FIREARM-RELATED VIOLENCE 34 Society-Level Factors, 35 Community-Level Factors, 36 Situational Factors, 37 Individual-Level Factors, 38 Research Questions, 39 FIREARM VIOLENCE PREVENTION AND OTHER INTERVENTIONS 43 Targeting Unauthorized Gun Possession or Use, 44 Individual Risk and Protective Factors, 45 Social, Physical, and Virtual Environmental Interventions, 46 Research Questions, 48 IMPACT OF GUN SAFETY TECHNOLOGY 53 Gun Technology Safety Features, 53 Overview of Past and Ongoing Research on Gun Safety Technology, 54 Challenges to Developing Gun Safety Technologies, 55 Current and Ongoing Research, 58 Research Questions, 59 VIDEO GAMES AND OTHER MEDIA 62 Overview of Past and Ongoing Research on Media Violence and Violent Acts, 63 Longer-Term Longitudinal Studies in Youth on Exposure to Media Violence, 65 Research Question, 66 APPENDIXES A References 69 B Public Meeting and Workshop Agenda 89 C Committee Biographies 101