Firearms and violence: a critical review

A committee of the National Research Council in the United States was charged with providing an assessment of the strengths and limitations of the existing research and data on gun violence. In December 2004, the committee issued its final report, in book form. The book contains nine chapters, and five appendices, on such topics as firearms data, patterns of firearm violence, self‐defense gun use, right‐to‐carry laws, firearms and suicide, and criminal justice interventions.

The committee consisted of 15 highly respected scientists—experts in economics, criminology, epidemiology, statistics, sociology, psychiatry, psychology, and public policy. By design, they were not experts on firearms issues. Unfortunately, none were injury control professionals, and few have worked directly in the public health field.

Nonetheless, injury control professionals can fully support the committee's major recommendation that “the federal government needs to support a systematic program of data collection and research” (p 3) to give policymakers a solid empirical and research base for decisions about firearms and violence.

Indeed, I think most of us would agree with every specific data and research recommendation. For example, the committee supports the development and maintenance of the National Violence Death Reporting System, and recommends that “appropriate access be given to data maintained by regulatory and law enforcement agencies, including the trace data maintained by the Bureau of Alcohol, Tobacco and Firearms; registration data maintained by the Federal Bureau of Investigation and state agencies; and manufacturing and sales data for research purposes” (p 4).

Personally, I also fully agree with the committee's main conclusions concerning the scientific literature on concealed carry laws, self‐defense gun use, and the effectiveness of children's firearm education programs. For example, the committee found that “the evidence to date does not adequately indicate either the sign or the magnitude of a causal link between the passage of right‐to‐carry laws and crime rates”(p 7). With respect to self‐defense gun use, the committee found that “self‐defense is an ambiguous term” (p 106), that whether one is a defender or a perpetrator may depend on perspective, and that “we do not know accurately how often armed self‐defense occurs or even how to precisely define self‐defense” (p 13). With respect to children's firearm education programs, such as the National Rifle Association's Eddie Eagle program, the committee found virtually no empirical evidence that “prevention programs focused on gun‐related violence have had any effect on children's behavior, knowledge, attitudes or beliefs about firearms” (p 2).

I do have some points of disagreement. Of concern, for example, was their conclusion about the connection between guns and suicide. They do not discuss the literature that finds that many suicides appear to be impulsive acts; the risk period is transient. While they agree that “all of the (case‐control) studies that the committee reviewed have found a positive association between household gun ownership and suicide risk” (p 173) and that “there also appears to be a cross‐sectional association between rates of household gun ownership and overall rates of suicide, reported by investigators on both sides of the gun policy debate” (p 193), their weak conclusion is that “the committee cannot determine whether these associations demonstrate causal relationships” (p 6). The committee's claim that “the issue of substitution has been almost entirely ignored in the literature of guns and suicide” (p 194) is a complete misreading of the literature.¹

Part of the problem—and a warning to the reader—is that although the report was released at the end of 2004 with a 2005 publication date, most of the book was completed by 2002. The book misses many published articles from 2003 and 2004. The committee rightly argues for the regular inclusion of gun ownership questions on the Behavioral Risk Factor Surveillance System, but seems unaware that such questions were, in fact, included in the 2001 and 2002 surveys. Using these actual survey measures, there is a robust association between ownership levels and suicide: in states where there are more guns, there is more suicide, because there are more firearm suicides. This relationship remains true after accounting for urbanization, unemployment, alcohol consumption, divorce rates, and other potential confounders.

Most disturbing in the chapter on suicide was the committee's superfluous comment about the injury prevention field. “Some of the problems in the suicide literature may also be attributable to the intellectual traditions of the injury prevention field, which has been strongly shaped by successes in the prevention of car crashes and other unintentional injuries. An unintentional injury prevention model can lead to misunderstandings when it is applied to the study of intentional injury; the investigation of intentional injury should take account of the complexities of preference, motivation, constraint, and social interaction among the individuals involved.” We clearly need to do a better job explaining our approach to violence prevention to experts outside of public health!

Despite these specific concerns, most of my disagreements with the report are relatively minor. The committee's overarching conclusions are certainly correct. The hard work put forward by this team of accomplished scientists deserves to be applauded.

For full review see http://www.injuryprevention.com/supplemental