The Future of Firearm Violence Prevention: Title and subTitle BreakBuilding on Success

Through the late 1980s and early 1990s, a true epidemic of firearm-related interpersonal violence developed in the United States. Commentators noted that the concurrent decline in motor vehicle–related injuries had resulted from a comprehensive intervention strategy rooted in the principles of public health and disease prevention. They proposed similar strategies for preventing firearm-related violence.^{1 - 2}

Since 1993, rates of firearm-related violence have been declining. The decrease is substantial: in 1997, the firearm homicide rate in the United States was 4.6 per 100,000 persons per year,³ comparable to rates seen last in the mid-1960s and briefly in the mid-1980s. Preliminary Federal Bureau of Investigation data for 1998 show a further 8% decrease in homicides overall.⁴

What exactly has been accomplished, and how has it been done? Since the early 1970s the nation's firearm homicide rate has shown no long-term trend but has both risen and fallen. Is its decline since 1993 simply another fluctuation? I would argue that it is not. The decline results, at least in part, from synergy between effective interventions of many types that are coming to be seen as an evidence-based comprehensive strategy to prevent violence. This article briefly reviews several important interventions that have addressed firearm-related violence directly, discusses the evidence on which they are based, and proposes additional measures to help build on these successes.

The steady increase in the homicide rate from 1985 to 1993 was largely confined to persons aged 15 to 34 years and was specific to firearms. The impact on teenagers and young adults was staggering. For both black and white males aged 15 to 24 years, the firearm homicide rate roughly doubled just from 1987 to 1993, even as the nonfirearm homicide rate decreased.⁵ By 1993, 53.9% of all deaths among black males aged 15-24 years were firearm homicides.⁶ The risk of sustaining a firearm injury was greatest for young males who were already involved in the criminal justice system, and most perpetrators were drawn from that same group.^{7 - 8} Firearm-related violence was highly concentrated geographically: half of all homicides occurred in 63 cities with 16% of the nation's population; within those cities, homicides were largely clustered in certain neighborhoods.⁹ These findings suggested that a mixture of behavioral interventions targeting high-risk people and environments and interventions targeting the distribution and design of firearms was likely to produce significant benefits.

Behavioral interventions have played a substantial role in reducing firearm-related violence. In 1 controlled trial, high-visibility police patrols with a mission to identify and confiscate illegal street firearms were associated with a 49% decrease in firearm-related crime, an effect achieved not so much by the confiscation of firearms per se, as by an increased police presence in known firearm crime hot spots.¹⁰ "Gun-oriented policing," beginning with increased hot spot patrols and expanding to include aggressive enforcement of other gun laws, has been linked to a 60% decrease in firearm homicide in New York City between 1991 and 1996.¹¹

Complementary interventions have focused on suppliers of firearms used in crime. In an ever-increasing number of cities, comprehensive tracing by the Bureau of Alcohol, Tobacco and Firearms (ATF) of all guns used in crime or illegally possessed has made it much easier to identify illegal surrogate or "straw" purchasers and firearms traffickers.^{12 - 13} Prosecutions are often pursued under federal laws, which carry stiffer penalties.

Tougher licensure requirements have decreased the number of federally licensed firearms dealers from 244,000 in 1993, when the nation had more licensed firearms dealers than gas stations,¹⁴ to fewer than 90,000 in 1998.¹⁵ This has eliminated many "kitchen table" dealers, a number of whom had been implicated in gun trafficking investigations.¹⁶

Handguns purchased as part of large-volume transactions appear to be at increased risk for use in crime. Virginia, long a major source state for guns used in crime in the more restrictive New England states, limited handgun sales to no more than 1 per month per person in 1993. The percentage of guns used in crimes in New England that were purchased in Virginia dropped from 35% before the law took effect to 16% thereafter.¹⁷

Background checks conducted under the Brady Handgun Violence Prevention Act and related state statutes prevent the purchase of firearms by 70,000 to 80,000 felons and other prohibited persons each year.¹⁸ Such denials work; felons whose handgun purchases are denied are less likely to be charged with new crimes than are persons who have felony arrests, but no felony convictions, and who purchase handguns legally.¹⁹

Comprehensive local interventions have combined the principle of focusing resources where they will do the most good with that of intervening on multiple risk factors simultaneously. In Boston, gang membership and a desire for personal protection were major determinants of firearm carrying and use among young males, and a small number of high-rate offenders were disproportionately responsible for violence involving juveniles and youth.²⁰ A combination of gang-based interventions, identification and prosecution of firearms traffickers, and other measures has been associated in a preliminary evaluation with a more than 60% decrease in juvenile and youth homicide and a reduction in weapon carrying.^{20 - 21}

Other behavior-based interventions are largely of symbolic value. Gun buy-backs or exchanges do not reduce violent crime rates. The surrendered firearms are not like those used in crime, and many are broken.^{22 - 23} Child access prevention laws, which create criminal liability for owners of firearms used by children to cause death or injury, may be of benefit if felony prosecution is permitted; in most states with such laws, violations are misdemeanors.²⁴ A controlled evaluation of the National Rifle Association's "Eddie Eagle" firearm safety program for children was presented in May by a television news magazine.²⁵ Of 20 children who received training, 17 found firearms 4 days later in a test situation. Only 3 reacted as they had been trained to do: "Stop. Don't touch. Leave the area. Tell an adult." Laws requiring concealed weapon permits to be issued essentially on demand were associated with a modest decrease in violent crime in 1 study,²⁶ but substantial flaws in that work have been identified.^{27 - 28} Other studies have found opposite effects.^{29 - 30}

What has been the impact of changes in firearm design? There have been few successes. It appears that the lethality of firearms used in violence has increased since the mid-1980s.³¹ A strong case has been made that manufacturers have deliberately increased the lethality of firearms to maximize sales volume.³²

The semiautomatic pistol has emerged as the firearm of choice for criminal use.^{12 ,31 ,33 - 34} Pistols have roughly double the ammunition capacity of the revolvers they replaced. In the early 1990s, refinements in design and technology led to the introduction of new "pocket rocket" pistols that combine maximum permissible ammunition capacity and larger caliber with light weight and small size to facilitate concealed carrying.^{31 - 32} As rates of firearm violence increased, so did reports of increases in the mean number of wounds per person injured,³³ in the average caliber of bullets recovered during surgery or at autopsy,³⁵ and in at-scene mortality.³⁴ In 3 major cities with sophisticated trauma systems, 57% of persons with fatal firearm injuries died where they were shot, before receiving any emergency care.³⁶ From 1993 to 1995, the number of firearm-related deaths decreased, but the case-fatality rate for firearm injuries increased.³⁷

Some progress has been made. In 1994, the production and sale of new assault-type firearms and high-capacity ammunition magazines were banned. Assault-type firearms were never frequently involved in firearm-related violence, and the ban's effect has been modest.³⁸ No information is available on the impact of the high-capacity ammunition magazine ban; millions of magazines produced before the law took effect remain on the market. Six states have banned the production and sale of unreliable, inexpensive "junk" handguns. In Maryland this has reduced the frequency with which the banned handguns are used in crime³⁹ ; effects on rates of firearm-related violence are unclear.⁴⁰

Integrated safety devices such as loaded-chamber indicators and magazine-disconnect devices might help prevent shootings of the "I-didn't-know-it-was-loaded" variety.⁴¹ Absent any requirement that firearms be equipped with these devices, manufacturers differ on whether to use them. Some manufacturers provide trigger locks, but there are no standards for these locks—a few can be broken simply by stepping on them—and they are likely to be less effective than safety devices that are integral to the gun and work automatically.

What can we who seek to prevent violence do to help ensure that firearm-related violence continues to decline? We can encourage widespread adoption of new law enforcement practices that increase disincentives for the criminal use of firearms and disrupt gun trafficking. A dissemination effort is already under way at the Departments of Justice and the Treasury.^{12 - 13 ,42} In March President Clinton gave priority to developing a national firearm violence prevention strategy based on these successes; the administration's fiscal year 2000 budget proposal includes funding for additional federal prosecutors and ATF agents to help implement such a strategy. In the aftermath of the shootings in Littleton, Colo, and Conyers, Ga, the Senate adopted new restrictions on firearm sales and ownership, but the future of such measures in the House of Representatives is in doubt. If new interventions are adopted, rigorous evaluation will be important; such work has been seriously hampered by congressional restrictions on firearm violence research.⁴³

Other initiatives should complement these efforts. Among guns used in crimes and traced by ATF, those on which an attempt has been made to obliterate the serial number (a clear demonstration of criminal intent) are particularly likely to have been purchased in multiple-sale transactions.¹² A national 1-handgun-a-month policy is worthy of serious consideration and is supported by a majority of both gun owners and the general public.⁴⁴

Commerce in firearms deserves more attention. Less than 1% of firearms dealers sell the majority of crime guns traced by ATF.⁴⁵ Perhaps this is simply because these dealers sell large numbers of firearms. Perhaps other less defensible practices are involved; Chicago police have compiled chilling documentation of the readiness of some dealers to participate in illegal transactions.⁴⁶ Scofflaws in the industry should be prosecuted more vigorously. More information is needed about business practices that facilitate the diversion of firearms into the illicit market.

Much more can be done to prevent prohibited persons from acquiring firearms. By 1 estimate, 40% of all sales of firearms do not occur at gun stores.⁴⁷ Federal law exempts firearm sales by private parties, whether at gun shows or elsewhere, from criminal records background checks. A federal initiative to require that all transfers of firearms involve a background check is supported by 72% of gun owners and 77% of the general public.⁴⁴

We should consider expanding the statutory definition of prohibited persons. Among persons who purchase handguns legally, those with prior misdemeanor convictions are more than 6 times as likely as those with no prior criminal record to be charged later with firearm-related or violent crimes.⁴⁸ Majorities of both gun owners and the general public believe that persons convicted of selected misdemeanors should be prohibited from purchasing firearms,⁴⁴ and some 19 states have taken limited steps to do so.

One vital step, largely ignored until recently, will be to require the firearm industry's involvement in reducing the harm done by the widespread availability and misuse of its products. This tactic was a critical element of efforts to reduce motor vehicle injuries, but it faces an additional challenge here. Lower crash rates do not lessen demand for motor vehicles, but lower crime rates are strongly associated with decreasing demand for firearms.⁴⁹ Although they would almost certainly deny it, firearms manufacturers have an economic interest in the incidence of crime—or at least the fear of crime—remaining at a high level. Just from 1993 to 1997, declining crime rates were accompanied by a 50% decrease in domestic handgun production.

Fear continues to drive firearm sales. In the spring of 1999, wholesalers were reporting sales increases of up to 20% "as a direct result of consumer concerns about Y2K"; 1 wholesaler promised that "we're going to sell the heck out of it."⁵⁰ Among the most sought-after products are high-capacity ammunition magazines and SKS and AK-47 semiautomatic rifles.⁵¹

But decreasing crime rates, generally poor sales, lawsuits charging that the industry is accountable for the costs of firearm violence, and public outrage over such events as the shootings in Littleton and Conyers are causing the firearm industry to circle its wagons. In February the industry announced a multimillion-dollar advertising campaign to promote the sporting, rather than the defensive, use of firearms at its Shooting, Hunting, and Outdoor Trade (SHOT) show⁵² ; even this campaign was suspended by May. After staff at the American Shooting Sports Council, the industry's moderate trade organization, worked to require background checks for sales at gun shows, the group was voted out of existence by its own board of directors.

Firearms themselves remain unaddressed. Design and performance standards should be adopted for firearms produced in the United States; currently, firearms are largely exempt from such regulation. More than 93% of gun owners and 94% of the general population favor this proposal.⁴⁴ New standards should seek to minimize the potential for criminal use and unintentional misuse of firearms but impair their legitimate sporting use as little as possible. Particular attention should be given to a requirement that new firearms be personalized—capable of operation only by their legitimate owners.

At the same time, it must be acknowledged that there is such a thing as responsible gun ownership. Most gun owners and guns are at low risk for involvement in crime, and firearm violence prevention measures should be targeted on the high-risk elements of both populations when possible. Most gun owners support much of what is characterized as an antigun policy agenda⁴⁴ ; the grounds for collaboration between gun owners and others interested in preventing gun violence are greater than is commonly realized.

In 1993, I predicted that firearms would replace motor vehicles as the leading cause of injury death in the United States by 2004 and probably sooner.⁵³ The intervening 6 years have made a critical difference. If current trends continue, rates of firearm-related violence shortly into the new millennium will be at their lowest point since the 1950s. This is a goal worth working hard to achieve.