Firearm Violence:

What We Know
What to Do

Garen Wintemute, MD, MPH

National Press Foundation
November 10, 2019

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On violence:

“If it’s not a health problem,

then why are all those
people dying from it?”

- Dr. David Satcher, 1993

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 VPRP
Chip Somodevilla/Getty Images
 All Those People
US, 2008-2017:
• 329,969 deaths from firearm violence (homicide,
suicide)
• 342,439 total firearm deaths
US, 2017:
• 38,396 deaths from firearm violence
• 75% of homicides, 51% of suicides involved
firearms
 Death Rates from Motor Vehicle Traffic Events and
Firearms, 1950-2017
Motor Vehicles
30
Deaths/100,000 Population

Firearms
25

20

15

10

0
1960
1950

1955

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015
Year

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 Death Rates from Firearm Suicide and Homicide,
1981-2017
8
Deaths/100,000 Population

7
6
5
4
3
2 Suicide

1 Homicide
0

2005

2017
1981

1984

1987

1990

1993

1996

1999

2002

2008

2011

2014
Year

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 Deaths/100,000 Population

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0
20
40
60
80
100
0-4

5-9

10-14
Males, 2017

15-19

20-24

25-29

30-34

Age 35-39

40-44

45-49

50-54
Death Rates from Firearm Homicide

55-59

60-64

65-69

70-74

75-79
Black

White

80-84
Hispanic

≥85
 Deaths/100,000 Population

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0
10
20
30
40
50
0-4

5-9

10-14
Black

White
Males, 2017

Hispanic

15-19

20-24

25-29

30-34

35-39
Age
40-44

45-49
Death Rates from Firearm Suicide

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85
 Deaths/100,000 Population

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0
2
6
8
10

4
0-4

5-9

10-14

15-19
Females, 2017

20-24

25-29

30-34

35-39
Age
40-44

45-49

50-54
Death Rates from Firearm Homicide

55-59

60-64

65-69

70-74

75-79

80-84
Black

White

≥85
Hispanic
 Deaths/100,000 Population

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0
1
3
4
5
6

2
0-4

5-9

10-14

15-19
Females, 2017

20-24

25-29

30-34

35-39
Age
40-44

45-49
Death Rates from Firearm Suicide

50-54

55-59

60-64

65-69

70-74

75-79

80-84
Black

White
Hispanic

≥85
 Deaths/100,000 Population

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0
25
75

50
100
125
0-4

5-9

10-14
Males, 2017

15-19

20-24

25-29

30-34

Age 35-39

40-44

45-49

50-54
Death Rates from Firearm Violence

55-59

60-64

65-69

70-74

75-79

80-84
Black

White

≥85
Hispanic
 Number of Deaths

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0
500
1500
2000

1000
0-4

5-9

10-14
Males, 2017

15-19

20-24

25-29

30-34

Age 35-39

40-44
Deaths from Firearm Violence

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84
Black

White
Hispanic

≥85
Selected Policy Options

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Do Background Checks Work?
• Yes, on those directly affected
• Implementation problems
• Poor reporting and false negatives
• Poor definitions of prohibiting events
• Firearm release before checks completed
• Poor compliance and enforcement
• Design problems
• Overly-narrow denial criteria
• Failure to include private party transfers

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Expanding Denial Criteria
• Violent misdemeanors
• Violence risk increased 5x if 1 prior conviction,
15x if 2+ priors
• Denial reduces risk 25-30%
• Alcohol-related crime (e.g., DUI: 3 states)
• Violence risk increased 3-4x (no dose response)
• No data on effects of denial
• Domestic violence restraining orders
• Ex parte orders
• “Boyfriend loophole”

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Extreme Risk Protection Orders
• Intent to harm; imminent risk
• Enacted in response to mass shootings
• Most often used for self-harm
• Modeled on CA’s DVRO statute
• Rapid, individualized response
• Due process protections
• Evaluations in CT, IN: NNT 10-20
• This just in: use in mass shootings

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Firearm Recovery: APPS
• Legal purchase, subsequent prohibition
• Incidence of felony, violent misdemeanor= 1-5% over 5y
• Prohibiting events associated with violence
• How APPS functions
• Screening, workup, intervention
• Does APPS reduce risk for future violence?
• Randomized trial, ~1,000 communities
• Outcomes at individual and community levels

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What Clinicians Can Do

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VPRP
The only thing necessary
for the triumph of evil is
for good people to do
nothing.
- After Edmund Burke

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Building for the Future
• CVPR
• The California Center
• People
• Projects
• Place

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Building for the Future
• Research: causes, consequences, prevention
• Policy development
• Communication
• Education and training

• Proving what can be done

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Five Presentations at ASC 2019
• Thu 8a
• Julia Schleimer, Firearm ownership in California: a latent class analysis.
• Fri 1230p
• Nicole Kravitz-Wirtz, Results from a 2018 survey on firearm-related
topics in California.
• Rose Kagawa, Using crime data for research and policy: the potential for
built-in bias.
• Hannah Laqueur, Machine learning to identify high risk firearm buyers.
• Garen Wintemute, California’s Armed and Prohibited Persons System:
Effectiveness as an intervention to prevent firearm violence.

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Thank you.

Website: https://health.ucdavis.edu/vprp/

Contact: gjwintemute@ucdavis.edu

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