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Gun violence

Firearm safety interventions: you get what you pay for?

2 Aug, 17 | by Angy El-Khatib

I work in a Level 1 Trauma Center in the state of Ohio in the United States. I am tasked with decreasing injury before it occurs by providing culturally-relevant injury prevention in my community. One thing you should know: Ohioans. Love. Guns. Many rely on it for game hunting, protection, sport, etc. Another thing you should know: a solid number of the trauma patients that come into my hospital present with a firearm injury. So how do we stop that?

As injury prevention researchers, we have a body of research which suggests that the safe storage of guns can significantly reduce unintentional firearm injuries in the home. However, a lacking body of research related to the safe storage of firearm injuries means we don’t have a conclusive answer.

In the latest issue of Injury Prevention, researchers at the University of Washington published a preliminary evaluation of a community-based firearm safety intervention. The intervention provided a free, participant-selected locking device designed for safe firearm storage. Additionally, participants were assessed for device preferences, as well as their level of comfort with firearm safety counselors.

What the study found was participants are more likely to lock all firearms in their household (+13.7%) and more likely to unload their firearms (+8.5%). Although not statistically significant, +6.3% reported that all their ammunition was safely stored away. The majority of participants also reported being comfortable in discussing firearms safety with a safety counselor.

This new research is great as it adds to the body of research suggesting that participants are, in fact, willing to employ safe firearm storage practices and willing to receive safety education. The kicker is that an increase in safe firearm storage was only observed if participants received a free firearm storage device. In a systematic review published by the same researchers, they discovered that out of 7 community-based interventions centered around safe firearm storage, only the 3 studies which offered free firearm storage devices observed increases in firearm storage rates.

With this in mind, how do we – as injury prevention practitioners – translate these findings into everyday practice? How do we aim to enhance the adoption of these best practices in the community with cost-effectiveness in mind?

In the United States, federal firearms dealers are required to provide with each gun that is sold with a storage or locking device. This law does not apply to private sales… except in the state of California, which requires all guns which are sold and transferred to be locked. The only state to criminalize the storage of unlocked firearms is the state of Massachusetts. In 2015, the Department of Justice awarded the National Shooting Sports Foundation a $2.4 million grant to distribute gun-safety kits (which included steel cable locks) to gun owners.

Hopefully, as the body of research in data relating to firearm storage increases, the answer to increasing the adoption of firearm safety best practices becomes more clearer.


Treating firearm violence like a contagious disease

12 Aug, 15 | by jsantaella


Following up on a previous post by aelkhatib.

When I first heard about the 1996 amendment prohibiting the Center for Disease Control and Prevention from conducting research on firearm violence prevention I was very surprised. I could not believe that there was a legal mechanism that would prevent researchers from studying the causes of something impacting so heavily the health of populations. The amendment, authored by former U.S. House Representative Jay Dickey, stated “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control”; the language did not explicitly ban research on gun violence, but along with the cuts to CDC’s budget, there was a clear message against researchers trying to study this topic. Later, in the next decades, funding for firearm injury prevention dropped by 96%, while the annual rate of 10 firearm related deaths per 100,000, was relatively immutable.

Amazingly, even after the occurrence of recent absurd events in which citizens have lost their lives at the hands of armed individuals, the US House of Representatives Appropriations Committee rejected an amendment that would have allowed the CDC to conduct research on the causes of firearm violence. The message: CDC should not be studying this topic! As put by one House Speaker “I’m sorry, but a gun is not a disease. Guns don’t kill people – people do.”

However, even if a gun is not a disease, can’t the firearm violence problem be tackled using an evidence-based approach? This strategy has been used in the past to confront non-infectious problems such as the incidence of fatal motor-vehicle crashes or the harms associated with second hand smoking. What if we could treat, not guns, but firearm violence like a contagious disease? This angle, endorsed by many, and clearly presented by physician Gary Slutkin in his TED talk, has lead to important reductions in firearm homicides in many neighborhoods across the US, as he describes. Interestingly, the call for more research on this topic has also been adopted by former representative Jay Dickey as shown in a 2012 co-authored Washington Post op-ed with Mark Rosenberg: “…we are in strong agreement now that scientific research should be conducted into preventing firearm injuries and that ways to prevent firearm deaths can be found without encroaching on the rights of legitimate gun owners.”

Yes, more research is needed! Time and resources must be used to rigorously study the causes of firearm violence in order to come with appropriate solutions; otherwise, answers to confront this problem might just serve as innocuous palliatives.




Concern for prehospital care/ambulance services

10 Aug, 15 | by jmagoola

I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.

In this scenario, all the ambulance is manned by only a driver (no paramedic, no nurse) whose role is to pick you up and drop you at the nearest health facility. One of 2 ambulanes currently used by the district to transport patients during emergencies.No triage, no first aid, no prehospital care until arrival. This could contribute to the trauma mortality rates, which are already higher in rural areas before victims reach the hospital. It is known that travel time is a predictor of the outcome of an injury and as such many fatal injuries or their severity may be reduced by adequate prehospital trauma care. A previous study in Uganda found that fewer than 5% of injured patients are transported by ambulance to hospital  most of which ambulances are privately run and expensive. In neighboring Tanzania, a study evaluating access to prehospital care found there was no prehospital care in the region.

The interior of the ambulance, lacking paramedic supplies for first aid.

The interior of the ambulance, lacking paramedic supplies for first aid.

This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?


A Gap in Gun Violence Injury Prevention Data in the United States

17 Jul, 15 | by Angy El-Khatib

Do guns make people safer? Do comprehensive back ground checks limit gun violence in the United States? Which gun violence or firearm safety interventions work in our states? What effect do right-to-carry laws have on our communities?

Nine years ago, the Centers for Disease Control and Prevention (CDC) was on the forefront of trying to answer these questions to make meaningful changes and enact policies to prevent injury related to firearms and gun violence.

Last month, the United States House of Representatives Appropriations Committee voted to reject amendment (19-32) from Congresswoman Nita Lowey that would have allowed the CDC to study whether there was an association between firearm ownership and gun violence.  This isn’t something new. This ban has been enacted since 1996, when the National Rifle Association (NRA) accused the CDC of lobbying gun control. The NRA then helped a Representative to lobby Congress to cut funding from the CDC budget in the exact amount it had dedicated to gun violence and firearm safety research the previous year ($2.6 million).

Although the funding was eventually restored (although continually decreased), research as to the effect of firearm safety and gun violence on public health has essentially been eliminated. Researchers are discouraged from specializing in firearm safety or gun violence due to the fact there isn’t enough funding to support research.

Databases, such as the National Violent Death Reporting System (NVDRS), record the causes of all violent deaths; including firearm-related injury and death. However, there are some limitations: this data is voluntarily reported by only 32 states within the United States; incidents which contained missing data elements (i.e. – lacking information on demographics, weapon type, or circumstances regarding the incident) are omitted from the database; and only incidents which have been reported to the police are reflected in this database.

Needless to say, there is a general lack of data and information regarding injury prevention from firearms and gun violence in the United States. Unfortunately, I don’t have an answer, but I thought I might reflect on this.

Feel free to share your comments!

More background on our blogging team

19 Jun, 15 | by Bridie Scott-Parker

Blog 3: So today I wanted to share some more background on our blogging team. As an applied social psychologist, I find this information very interesting indeed!

What excites you about being part of the Injury Prevention social media editorial team?  

Sheree Bekker: The invaluable conversation that has sprung up around scholarly work through the collaborative power of social media and blogs inspires me to no end. I tend to find more relevant scholarly content through Twitter than through traditional platforms, and Injury Prevention has played a big part in that. As researchers, I believe that we should own our voice on social media, and constructively add value to this conversation.

David Bui: Through my studies in medical school I have seen the costs of injuries to society and individuals worldwide.  This is a great opportunity to harness the underutilised power of Social Media in health promotion and Injury Prevention, across multiple disciplines and multiple borders.

Angy El-Khatib: Being a part of the Injury Prevention social media editorial team is a great opportunity personally and collectively. By being a part of the social media editorial team, I am able to stay up to date on various topics within the realm of Injury Prevention while acquiring different perspectives from individuals from different backgrounds, disciplines, and locations. I’m also excited to be able to potentially increase readership and engage readers to create a conversation around the latest Injury Prevention research and ideas.

Klara Johansson: I am very interested to explore ways to share and disseminate knowledge and research results, outside the “old-school”, regular channels. I look forward to learning from my new co-editors, who all seem to be great communicators.

Joseph Magoola: The opportunity to work and collaborate with a variety of scholars on the injury prevention platform is nothing short of exciting. It also excites and inspires me to have an opportunity to represent Africa since low and medium income countries bear the brunt of the injury burden.

Julian Santaella-Tenorio: It is really exciting to be part of this team and to have a space to communicate and express ideas on ways to improve injury prevention, and to discuss about new studies and topics relevant to this field. I am very motivated to learn more and continue growing as a researcher as I walk through this experience.

What are you passionate about?

Sheree Bekker: Intersectional issues drive my life’s work, and my aim is that my research is, and always will be, an extension of that.

David Bui: Passionate about bringing people and ideas together.

Angy El-Khatib: I am passionate about translating scientific evidence and research into public health action. My goal is to improve the health and wellbeing of myself as well as my community. Outside of my work, I am passionate about health, fitness, and wellness.

Klara Johansson: Open discussions and innovative research in collaborative teams with high scientific ambition + high levels of tolerance and kindness; I also enjoy making difficult subjects understandable to students and the general population. Passions on my free time: nature, gardening, books, movies, writing fiction, playing music (clarinet, harmonium, piano, accordion).

Joseph Magoola: Writing on my social media accounts (facebook, twitter and my blog) as a way of reaching out to the masses. I am also interested travelling a lot, especially by road and as such, ensuring road safety is part and parcel of my aims to contribute towards reducing the carnage of our roads.

Julian Santaella-Tenorio: I am passionate about things that can make people have a better, healthier and happier life. I am inspired by ideas challenging previous knowledge, creative thinking finding answers from different angles, and the power of multidisciplinary groups. That is why I am passionate about public health research.


I hope you are looking forward to hearing from our bloggers, starting next month!

Hope for future gun control

28 Dec, 14 | by Barry Pless

Last week was the anniversary of the horrific Newtown shootings. That was when I saw an item on Mother Jones that prompted this posting. That item described the work of Moms Demand Action for Gun Sense in America (MDA). This group was founded after the Newtown massacre and it has had several important victories, largely by following the example of Mothers Against Drunk Driving (MADD). It aims to change the gun culture in America, just as MADD did in the 1980s when driving while intoxicated was still taken for granted. Thirty years ago most Americans saw drunk-driving deaths as “a problem you had to live with.” MADD helped to redefine them as crimes. It put pressure not on political leaders and on the liquor industry by “turning a spotlight on kids who had been killed.”


Some years ago I served on the National Board of MADD Canada. Today I am convinced that the strategies MADD used are equally well suited for MDA’s vital mission to bring to bring some sanity to the gun scene in the US. Largely, those strategies focus heavily on the wise use of the media, and nowadays, the web, combining human interest stories with solid statistics. In each case the major focus is politicians and all successes are brought to the attention of the media. MDA now has over 200,00o members, a sizeable war chest, and has joined forces with other influential groups such as Bloomberg’s ‘Mayors Against Illegal Guns.’


 So far MDA has persuaded some restaurant chains, internet companies, and retailers to oppose lax gun laws. They must be on the right track because they have elicited strong responses from many gun rights activists. MDA members and leaders have been called “Bloomberg’s whores,” “thugs with jugs,” and far worse. They get menacing phone calls and see violent images posted online.


 When Sandy Hook failed to bring about substantial changes in gun laws MDA focused on corporations like Starbucks where guns were being ‘openly carried’. Moms response was to urge members to “#SkipStarbucks” and post pictures of themselves having coffee elsewhere. Starbucks changed its policy after Facebook posts resulted in a petition with over 40,000 signatures. Other similar successes offer hope that large-scale changes in attitude will come before the next massacre.


 One experienced Washington lobbyist stated, “Changes to the culture are more important than legal changes in some ways. This sends a message that having guns everywhere makes people uncomfortable, which goes directly against the gun lobby’s agenda—to normalize having them everywhere.”





Gangs, Violence, and a Flood of Migrant Children

11 Jul, 14 | by gtung

There has been a tremendous amount of media attention in the United States on what is described as a flood of migrant children illegally crossing the US-Mexico border. Statistics referenced in a recent NPR article estimate that more than 50,000 unaccompanied children have been detained by US border patrol in the last eight months.

Much of the US media coverage has also emphasized a belief of migrant children and their families that they can receive political asylum or that there are other mechanisms in place that will allow them to stay in the US once they cross. What is also starting to get more media attention are the factors pushing migrant children to take the risk of traveling long distances alone in hopes of making it into the US. A recent New York Times article does a nice job of describing the fear of gangs and violence in some Central American cities and the role it plays as a driver of the recent flood of migrant children to the US border.

The severity of the gang and violence problem portrayed in some Central American cities in the NYT article is shocking with some city blocks described as empty and other significant internal displacement because of gangs. I can understand taking the risks of trying to make it into the US if faced with these issues. What is less clear to me is what should be done to address the gang issues that are pushing so many children to leave their homes. And then there is the heated and ongoing debate in the US about what steps if any the US should take in responding to the issue.


Guns on Campus in Idaho

28 Feb, 14 | by gtung

Today, the Idaho House of Representatives will be discussing legislation that has already passed the state senate that would allow individuals who have a concealed weapon’s permit to carry a gun on college and university campuses in the state.  One of the arguments in favor of this legislation is that someone who is considering carrying out a mass shooting will be less likely to attempt to do so if students and others on campus are packing heat.  And if for some reason they decide to give it a shot anyway, there will be a unit of armed citizens on campus to take them out.  This and other arguments in favor of this legislation seem insane to me but apparently they are persuasive to many others as this legislation has already passed the state senate.

In response to all of this, Greg Hampikian, a professor at Boise State (located in Idaho) published a biting and satirical opinion piece in the New York Times titled “When May I Shoot a Student?”  For me, it captures the insanity and ridiculousness of this proposed legislation.  It is a good read.

Gun violence in movies

13 Jan, 14 | by gtung

More on guns…  There was a really interesting paper titled “Gun Violence Trends in Movies” recently published in Pediatrics.

This study examined the presence of gun related violence in top grossing major motion pictures and concluded that gun violence in films has grown substantially.  Not a huge surprise but what was interesting is that the rate of growth in PG-13 (age 13+) films outpaced both PG (Parental Guidance Suggested) and R (age 17+) rated films.  So much so, that in recent years the study found that there is actually more gun violence in PG-13 then in R rated movies.  Why is this important?

The article also does a nice job of summarizing relevant research that outlines why this might be bad.  The authors drew two conclusions from this research that can be outlined to some extant with these statements: 1. exposure to violence can lead to increased aggressive attitudes and behavior and 2. exposure to guns independent of violent behavior can lead to increased aggression.  The authors went on to describe the combined gun violence in PG-13 movies as a “double whammy” that may be contributing to increased aggressive behavior in youth.  I’ll confess that increased aggressive behavior due to simply being exposed to a gun (the “weapons effect”) was news to me.

Other research has shown that exposure to things like smoking and drinking in movies increases engagement in those activities among youth and at least for smoking there is a push by some public health advocates to assign an R rating to movies when smoking is present.  Maybe an R rating should also be considered for movies that contain some lower threshold level of gun violence?

When the Right to Bear Arms Includes the Mentally Ill

31 Dec, 13 | by Barry Pless

Also in the New York Times a short while ago was a piece describing what advocates of gun control have to contend with when even mental health checks are challenged. This is an edited version of that article:

Last April, workers at Middlesex Hospital in Connecticut called the police to report that a psychiatric patient named Mark Russo had threatened to shoot his mother if officers tried to take the 18 rifles and shotguns he kept at her house. Mr. Russo, who was off his medication for paranoid schizophrenia, also talked about the recent elementary school massacre in Newtown. The police seized the firearms, as well as seven high-capacity magazines, but Mr. Russo, 55, was eventually allowed to return to the trailer where he lives alone. As for his guns, Mr. Russo is scheduled to get them back in the spring, as mandated by Connecticut law.

The Russo case highlights a central, unresolved issue in the debate over balancing public safety and the Second Amendment right to bear arms: just how powerless law enforcement can be when it comes to keeping firearms out of the hands of people who are mentally ill. Connecticut’s law giving the police broad leeway to seize and hold guns for up to a year is actually relatively strict. Most states only ban gun possession after someone is involuntarily committed to a psychiatric facility or designated as mentally ill or incompetent after a court proceeding or other formal legal process. As a result, the police often find themselves grappling with legal ambiguities when they encounter mentally unstable people with guns, unsure how far they can go in searching for and seizing firearms and then, in particular, how they should respond when the owners want them back.

In each of three recent shootings the gunman had been recognized as mentally disturbed but had not been barred from owning a firearm. After the Newtown killings a year ago, state legislatures across the country debated measures that would have more strictly limited the gun rights of those with mental illness. But most of the bills failed amid resistance from both the gun lobby and mental health advocates concerned about unfairly stigmatizing people. The New York Times obtained records from more than 1,000 cases in which guns were seized in mental-health-related episodes. A systematic review of these cases underscores how easy it is for people with serious mental health problems to have guns. Moreover, in many of the cases examined, the authorities said they had no choice under the law but to return the guns after an initial seizure for safekeeping. And nothing prevents the mentally ill from buying new guns. Adding to the uncertainty for law enforcement, federal courts have ruled that an emergency involuntary psychiatric evaluation is not grounds to bar someone from possessing firearms. Following the Newtown shooting the mental health debate in state legislatures focused largely on two areas: requiring mental health professionals to report dangerous people to the authorities and expanding the mental health criteria for revoking gun rights.

 As for Mark Russo, the Middletown man who is looking forward to reclaiming his 18 guns in April, he acknowledged that public records indicated that he had made threats of violence, but he said they were untrue. He said he had had difficulty getting doctors to understand the real nature of his problem, which is not mental illness but paranormal activities that have afflicted him since his youth, including objects disappearing from his home and a bird once flying out of his forehead. “I’ve offered to take a lie-detector test to prove what I’m saying is true,” he said. “But psychiatrists, they don’t want to hear about God and demons and all that.”

Editors note: I have removed many, many examples of what appear to me to be incredibly bizarre behavior protected by the gun lobby. How unbelievably disturbing all this is. On a lighter note, and harking back to an editorial I wrote many years ago, you should now go to YouTube and see the 3 episodes from the Daily Show in which John Oliver compares Australia’s gun control laws with those of the U.S. The link is: (John Oliver Australia Gun Control)

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