ACPM Statement: Firearm Violence Prevention Requires a Public Health Strategy

Preventive medicine physicians have long been aware of the tragic scale of firearm violence in the United States. Each year, more than 40 thousand Americans die from firearm violence – more than 100 per day.¹ The violence of these past months is a painful reminder of the work yet to be done to prevent violent deaths in America – and the intersection of related complex upstream factors that must be addressed to do so. 

Every year, there are: 

• More than 20 thousand firearm related suicides² 

• More than 19 thousand firearm related homicides³ 

• More than 600 accidental firearm deaths⁴ 

Historically excluded and marginalized populations bear a disproportionate burden of firearm violence in America.^5,6 That includes the more than 200 mass shootings that have occurred so far this year, the thousands of other gun deaths that never make the news and also the more than 50% of gun deaths that occur by suicide. Preventive medicine physicians, who understand the need for equity-focused public health practices in areas such as chronic and infectious diseases, must also bring forward solutions to violence prevention that incorporate anti-racism, equity and inclusion.^7,8   

ACPM has long supported science and evidence-based measures to prevent gun violence. This ranges from universal background checks and mandatory waiting periods, to increased support for the essential research and surveillance that leads to effective violence prevention policy and interventions. There is much still to be learned about effective strategies for the prevention of firearm violence. However, there is a growing body of evidence supporting primary, secondary and tertiary prevention strategies for firearm violence prevention: 

• Prohibitions on firearm ownership among those with domestic violence restraining orders has been shown to reduce incidence of intimate partner homicide.⁹ 

• Evidence supports universal dealer background checks reduces the incidence of firearm homicide.¹⁰

• Evidence supports permitting and license requirements to reduce the incidence of firearm suicide.¹¹ 

• Waiting period requirements appear associated with significant reduction in firearm suicide and homicide.¹² 

• Evidence supports efforts to provide free, safe firearm storage, both increases safe storage usage, and concurrently decreases the incidence of firearm self-injury among adults.¹³  

• Trauma informed care approaches for patients who have experienced violence has been shown to lead to better patient outcomes and increased referrals to trauma-related services.¹⁴ 

• Improved physician training has been shown to increase physician comfort and confidence discussing topics related to firearm injury and violence prevention with their patients.^15,16  

Lastly, providing the appropriate mental health resources and access will be a critical component of violence prevention. This goes beyond access to counseling and mental health professionals. We must apply a public health lens – identifying communities struggling with violence and deaths of despair and then not just treating the symptoms, but identifying and addressing the underlying causes. 

Every shooting death is preventable! Focused efforts on implementing violence prevention initiatives with a key focus on anti-racism and equity, can prevent them. 

1. https://www.cdc.gov/violenceprevention/firearms/fastfact.html

2. https://www.pewresearch.org/fact-tank/2022/02/03/what-the-data-says-about-gun-deaths-in-the-u-s/

3. https://www.pewresearch.org/fact-tank/2022/02/03/what-the-data-says-about-gun-deaths-in-the-u-s/

4. https://www.pewresearch.org/fact-tank/2022/02/03/what-the-data-says-about-gun-deaths-in-the-u-s/

5. Formica MK. An eye on disparities, health equity, and racism—the case of firearm injuries in urban youth in the United States and globally. Pediatric Clinics of North America. 2021;68(2):389-399. doi:10.1016/j.pcl.2020.12.009

6. Mattson C, Kaylor R, Koehler T, Ydenberg M, Grill J, Stork B. Gun violence and firearm injuries in West Michigan: Targeting prevention. Western Journal of Emergency Medicine. 2021;22(3). doi:10.5811/westjem.2021.3.49255

7. Johnson BT, Sisti A, Bernstein M, et al. Community-level factors and incidence of gun violence in the United States, 2014–2017. Social Science & Medicine. 2021;280:113969. doi:10.1016/j.socscimed.2021.113969

8. Martin R, Rajan S, Shareef F, et al. Racial disparities in child exposure to firearm violence before and during covid-19. American Journal of Preventive Medicine. 2022;63(2):204-212. doi:10.1016/j.amepre.2022.02.007

9. Zeoli, April M., Alexander McCourt, Shani Buggs, Shannon Frattaroli, David Lilley, and Daniel W. Webster, “Analysis of the Strength of Legal Firearms Restrictions for Perpetrators of Domestic Violence and Their Associations with Intimate Partner Homicide,” American Journal of Epidemiology, Vol. 187, No. 11, 2018, pp. 2365–2371.

10. Gius, Mark, “The Effects of State and Federal Background Checks on State-Level Gun-Related Murder Rates,” Applied Economics, Vol. 47, No. 38, 2015a, pp. 4090–4101.

11. Luca, Michael, Deepak Malhotra, and Christopher Poliquin, The Impact of Mass Shootings on Gun Policy, working paper, Boston, Mass.: Harvard Business School, 2016. ———, “Handgun Waiting Periods Reduce Gun Deaths,” Proceedings of the National Academy of Sciences, Vol. 114, No. 46, 2017, pp. 12162–12165.

12. Edwards, Griffin, Erik Nesson, Joshua J. Robinson, and Fredrick Vars, “Looking Down the Barrel of a Loaded Gun: The Effect of Mandatory Handgun Purchase Delays on Homicide and Suicide,” Economic Journal, Vol. 128, No. 616, 2018, pp. 3117–3140.

13. Ali Rowhani-Rahbar, Ali, Simonetti, Joseph, Rivara, Frederick. Effectiveness of Interventions to Promote Safe Firearm Storage. Epidemiologic Reviews. Vol. 38, 2016 DOI: 10.1093/epirev/mxv006

14.  McNamara M, Cane R, Hoffman Y, et al. Training hospital personnel in trauma-informed care. Acad Pediatr. 2021;21(1):158-164.

15. Thai JN, Saghir HA, Pokhrel P, Post RE. Perceptions and experiences of family physicians regarding firearm safety counseling. Fam Med. 2021;53(3):181-188.

16. David-Ferdon C, Vivolo-Kantor AM, Dahlberg LL, et al. A comprehensive technical package for the prevention of youth violence and associated risk behaviors. Accessed April 26, 2022. https://www.cdc.gov/violenceprevention/ communicationresources/pub/technical-packages.html