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Firearm Policy in the Hospital Setting

To the Editor In their article, Mr Romero and colleagues discussed the consequences of recent Supreme Court decisions on the possession of firearms, especially the possibility that declaring hospitals a firearm-free domain breaches Second Amendment rights. If that is true, then it applies to hospital staff as well as patients and their relatives. How will patients feel about their physician having an AR-15 on their desk during an examination?

Firearm Policy in the Hospital Setting

In Reply In September 2024, a US appeals court struck down California’s prohibition on firearms in health care settings, citing the Supreme Court’s new requirement that modern gun laws be evaluated based on whether they are consistent with historical tradition rather than their ability to address the threat and reality of gun violence. Under this “originalist” approach, whether hospitals qualify as “sensitive places” where guns can be prohibited turns on whether judges believe hospitals to be sufficiently similar to places where guns have historically been prohibited.

Renewing Assault Weapons Ban Could Have Prevented Mass Shootings

Between 1994 and 2004, the federal assault weapons ban prohibited the sale and manufacture of certain military-style semiautomatic weapons and high-capacity magazines in the US. A study in JMIR Public Health and Surveillance now suggests that the ban not only prevented an estimated 5 public mass shootings during those 10 years, but would have averted many more between 2005 and 2022 if it had stayed in place instead of being allowed to expire.

Saving Lives by Regulating Guns: Evidence for Policy

Gun violence is a leading cause of death in the United States, where over 36,000 people were killed by gunshot in 2015 [including homicide, suicide, and accident (1)]. The gun-murder rate is 25 times as high in the United States as in other high-income nations, and the gun-suicide rate is eight times as high (2). Interpersonal gun violence has deleterious effects on economic development and standard of living in heavily impacted neighborhoods (3). Given this heavy burden, it is greatly concerning that many aspects of the body of research on gun violence have been deemed inadequate and inconclusive by expert panels of the U.S. Centers for Disease Control and Prevention (CDC) and of the National Academies of Sciences, Engineering, and Medicine (4–6). Fortunately, the flow of high-quality research has increased in recent years. Although the CDC largely withdrew from funding research on gun violence more than 20 years ago (under intense congressional pressure), there are active research programs in medicine, public health, law, and the social sciences under way in universities and think tanks. This good news, often lost in the well-justified complaints about the lack of federal funding, deserves greater recognition. New findings are providing a sound evidence base for policy-making and, among other contributions, have helped demonstrate efficacy in three important domains of gun policy: add-on sentences for gun use in violent crime, bans on gun possession by those convicted of domestic violence, and restrictions on carrying concealed firearms in public.

What Are the Most Effective Policies in Reducing Gun Homicides?

The public mass shootings in Newtown, Charleston, Orlando, Las Vegas, Sutherland Springs, Pittsburgh, and, especially, Parkland have brought the issue of firearm violence to the forefront. These tragedies have sparked a national debate about federal and state policies to reduce firearm violence. State policymakers are grappling to identify solutions by considering multiple legislative proposals, from red flag laws to universal background checks to bans on assault weapons to stricter regulation of semiautomatic weapons. Some states are considering laws that make it easier to carry and use firearms in public. Still others are debating laws aimed at eradicating gun culture, by — for example — banning all gun-related activities (such as shooting clubs or trainings) at public high schools. With a myriad of often conflicting ideas and proposals, where does a state policymaker begin?

This policy brief will help state policymakers navigate the scientific evidence regarding the impact of state firearm laws on gun-related homicide. Taking advantage of new data resulting from a research project at the Boston University School of Public Health and with funding from the Robert Wood Johnson Foundation’s Evidence for Action Program,[1] we developed a comprehensive database of state firearm laws spanning the period 1991-2016.  We then examined the impact of a range of state firearm laws on total, firearm-related, and nonfirearm-related homicide rates at the state level during this time period. The State Firearm Laws Database is publicly available at www.statefirearmlaws.org.

Our analysis found three priority pieces of legislation that would have the greatest impact in reducing overall firearm homicide rates:

Universal background checks.

+ Prohibition of gun possession by people with a history of any violent misdemeanor, threatened violence, serious alcohol-related crime, or subject to a domestic violence restraining order. This must be accompanied by: (1) a requirement that firearms already in their possession be surrendered; (2) a procedure for confiscating guns if they are not relinquished voluntarily; and (3) procedures for confiscating guns in situations where a person becomes prohibited from owning firearms after having passed an earlier background check.

+ Laws that give discretion to law enforcement officials (“may issue” laws) in denying concealed carry permits to those who are at high risk for violence, especially those who have a criminal history of violence.

The purpose of this research was not simply to identify a list of laws that “work” and laws that “do not work.” The advantage of this research is that it allowed us to compare the impact of multiple laws at the same time, enabling us to obtain a sense of what laws appear to be most strongly associated with lower rates of firearm homicide. Ultimately, our goal was to identify the types of laws that appear to have the greatest impact and which should therefore be a priority for policymakers.