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Population-level effects on crime of recovering firearms from armed prohibited persons: intention-to-treat analysis of a pragmatic cluster-randomised trial in California cities

Background

Too little is known about the effectiveness of efforts to prevent firearm violence. We evaluated California’s Armed and Prohibited Persons System (APPS), which identifies legal purchasers of firearms who have become prohibited persons and seeks to recover all firearms and ammunition to which they have access.

Design and methods

This cluster-randomised pragmatic trial was made possible by APPS’s expansion from a small pilot to a continuing statewide programme. We included 363 California cities, allocated to early (n=187) or later (n=176) intervention in blocks stratified by region within the state, and within region by population and violent crime rate. The study period began 1 February 2015; region-specific end dates ranged from 1 May 2015 to 1 February 2016. Analysis was on an intention-to-treat, difference-in-difference basis using generalised linear mixed models and generalised estimating equations with robust SEs. The population-level primary outcome measures were monthly city-level counts of firearm-related homicides, robberies and aggravated assaults. The primary model was adjusted for stratification variables; city-level population, population density, socioeconomic status and firearm purchasing; year; and month.

Findings

Allocation groups were well balanced on baseline characteristics and implementation measures. In adjusted models, allocation to early intervention was not associated with statistically significant differences in any primary outcome measure; these findings were robust to multiple sensitivity analyses. There was some heterogeneity across regions.

Conclusions

The APPS intervention directly affects a very small percentage of the population, limiting its potential for population-level effects. Individual-level analyses may provide a better estimate of the intervention’s effectiveness.

Trial registration number

NCT02318732.

State assault weapons bans are associated with fewer fatalities: analysis of US county mass shooting incidents (2014-2022)

Background

The need for evidence to inform interventions to prevent mass shootings (MS) in the USA has never been greater.

Methods

Data were abstracted from the Gun Violence Archive, an independent online database of US gun violence incidents. Descriptive analyses consisted of individual-level epidemiology of victims, suspected shooters and weapons involved, trends and county-level choropleths of population-level incident and fatality rates. Counties with and without state-level assault weapons bans (AWB) were compared, and we conducted a multivariable negative binomial model controlling for county-level social fragmentation, median age and number of gun-related homicides for the association of state-level AWB with aggregate county MS fatalities.

Results

73.3% (95% CI 72.1 to 74.5) of victims and 97.2% (95% CI 96.3 to 98.3) of shooters were males. When compared with incidents involving weapons labelled ‘handguns’, those involving a weapon labelled AR-15 or AK-47 were six times more likely to be associated with case-fatality rates greater than the median (OR=6.1, 95% CI 2.3 to 15.8, p<0.00001). MS incidents were significantly more likely to occur on weekends and during summer months. US counties in states without AWB had consistently higher MS rates throughout the study period (p<0.0001), and the slope for increase over time was significantly lower in counties with AWB (beta=–0.11, p=0.01). In a multivariable negative binomial model, counties in states with AWB were associated with a 41% lower incidence of MS fatalities (OR=0.58, 95% CI 0.37 to 0.97, p=0.02).

Conclusions

Counties located in states with AWB were associated with fewer MS fatalities between 2014 and 2022.

Extreme risk protection order use in six US states

Extreme Risk Protection Orders (ERPOs) are civil court orders that temporarily prohibit firearm purchase and possession by someone (“respondent”) at imminent risk of harming themselves or others. Despite ERPOs…

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.

Principles of Effective Gun Policy

Reduction of gun misuse by legitimate private owners and criminals can be accomplished without eliminating private ownership of firearms, including using gun possession as a criminal liability to criminals and supply-side regulations on gun transfers.