Dr. Amy Thompson Associate Professor of Public Health The University of Toledo

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Deadly Shooting in

 This combination image of three file photos shows Jared Lee Loughner, the gunman accused of trying to assassinate Arizona Rep. Gabrielle Giffords and killing six others.

West Haven Deaths Ruled

 January 20, 2010|By The Hartford Courant WEST HAVEN — — The deaths of Selami Ozdemir and Shengyl Rasim, who were fatally shot in their Blohm Street home on Sunday, were officially ruled a murder-suicide by the office of the state medical examiner on Tuesday.

Ozdemir shot his 25-year-old wife multiple times on Sunday morning, then he shot himself in the chest, authorities said Tuesday.

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Presentation Objectives

After attending the presentation those in attendance will be able to:  Discuss firearms as a leading cause of injury in the U.S.

Explain the impact that firearms have in schools and communities.

Identify barriers of implementation for firearm control polices.

Discuss considerations for firearm injury prevention programs

Our Recent Research

  Price, J., Thompson, A., Khubchandani, J.& Wiblishauser, M. Psychiatric Residency Directors’ “Perceptions of Firearm Access by the Mentally Ill”. Manuscript under review Academic Psychiatry.  Thompson, A., Price, J., Dake, J. & Teeple, K et al. “College Students Perceptions Regarding the Carrying of Concealed Handguns on College Campuses”. Manuscript under review American Journal of College Health.

 Price, J., Thompson, A. Payton, E et al., (2013). “Historically Black University Presidents Perceptions of Firearms on College Campuses”. Manuscript under review the Journal of

the National Medical Association.

 Price, J., Thompson, A., Khubchandani, J, Wiblishauser, M. & Dowling, J. (2013) .“Perceived Roles of Emergency Department Physicians Regarding Anticipatory Guidance on Firearm Safety” . Journal of Emergency Medicine. S0736 4679(12):01448-5.

 Thompson, A., Price, J., Dake, J. & Teeple, K. (2012).“Faculty Perceptions Regarding the Carrying of Concealed Handguns on College Campuses”. Journal of Community Health DOI 10.1007/s10900-012-9626-0

 Teeple, K., Thompson, A. & Price, J. (2012). “Armed Campuses: The Current Status Of Concealed Guns On College Campuses”. The Monograph of Eta Sigma Gamma. 29

(2):57-64..

 Thompson, A., Khubchandani, J., Price, J. & Dowling, J. (2011). “Sheriffs Perceptions of Firearm Policies”. Journal of Community Health. 36 (5): 715-720.

 Price JH, Thompson A, Khubchandani J, Mrdjenovich AJ, Price JA. (2010). Firearm anticipatory guidance training in psychiatric residency programs. Academic Psychiatry, 34:417 423.

 Thompson A, Price J, Mrdjenovich A, Khubchandani J. (2009). “Reducing Firearm-Related Violence on College Campuses- Police Chiefs' Perceptions and Practices”. Journal of American College Health 58:(3):247-254  Dowling J. Thompson A, Price J. (2009). “Campus Communities and Firearm Violence: Fighting Crime by Arming our Students and Faculty?” The Monograph of Eta Sigma Gamma 26:(2) 23-27  Price J, Mrdjenovich A, Thompson A, Dake J. (2009). “College Counselors’ Perceptions and Practices Regarding Anticipatory Guidance on Firearms”. American Journal of College Health

58:(2) 133-139.

 Price J, Kinnison A, Dake J, Thompson A, Price J. (2007). “Psychiatrists’ Practices and Perceptions Regarding Anticipatory Guidance on Firearms”. American Journal of Preventive Medicine 33(5):370-373.

Introduction

 Firearm use and ownership have a significant impact on individual communities in 3 ways: 1.

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Loss of human life.

Health care costs from firearm injury.

High economic cost associated with lost productivity

Did You Know Most States Do Not Have Laws that…….

  Ban assault weapons  Ban high capacity ammunition clips  Restrict child access  Require a minimum age to possess a firearm  Restrict the number of guns or volume of ammunition purchased

Did You Know Most States Do Not Have

  Require safety mechanisms on guns  Require registration  Require a back ground check on all sales  Prohibit open carrying or concealed carrying  Allow cities to have their own firearm laws  Allow you to sue gun manufacturers and dealers

Introduction

 In the year 2010 there were 31,672 deaths -11,078 firearm homicide victims -19,392 firearm suicide victims -606 unintentional firearm injury deaths -344 legal intervention

 In 2010, there were 1,076 people killed by firearms in Michigan.

 In addition to the 31,672 people killed by firearms 73,883 individuals were non-fatally wounded by firearms

The Impact of Firearms on Youth

 The danger of firearm violence to American youth is a realistic one; one youth is killed with a firearm every three hours.

 Additionally, for every child who dies from firearm injury another four are wounded by firearms.

Years of Potential Life Loss

  In the United States in 2010 there were 782, 750 years of potential life loss from firearms.

 While these seem like numbers remember these are brother, sisters, parents, friends, and loved ones .

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Christina Green Age 9

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Benny Doran

" On the night of March 31, 2003, my Ben, almost sixteen and full of life, was brutally beaten to death by two complete strangers that were adult gang members."

Brooke Suzanne McDonald

On October 4, 2008, 17 year old Brooke Suzanne McDonald,was shot and killed by a 20 year old man. He said he thought he had taken all the bullets out of his .44 magnum handgun, before he pointed it at her head and pulled the trigger hitting her in the temple and killing her instantly. She was at a small gathering of about 8 other people

Ricky

  Ricky committed suicide on February 6th 2008 with a shot gun he purchased. Ricky was an amazing and educated person however, never should have been able to pass a background check to purchase a legal gun due to his mental illness.

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Firearms in the U.S.

 More than 40% of all U.S. households contain at least one firearm.  1:4 homes has a handgun .

 According to a National Institute of Justice Report approximately 4.5 million firearms are sold each year in the U.S., including 2 million handguns.

 In addition, estimates of secondhand sales range from 2 million to 4.5 million.

Firearm Availability and Its Impact

  Availability of firearms have increased rates of violent acts across the United states whether it be shootings or robberies.

 Webster et al., (1993) found that individuals who were more likely to carry guns were more likely to be arrested for violence, victims of violence, initiators of fights, and were willing to justify shooting someone.

Firearms & Homicide

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Having a gun in your home makes you nearly 3 times more likely that you or someone you know will be shot (Kellerman, 1993).

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Firearms & Homicide

 For homicides in which the weapon could be identified, 53% of female victims were killed with guns-more than 63% were shot by male intimates  The number of females shot by their intimates was 4 times higher than the total number murdered by male strangers (FBI Supplemental Crime reports).

 THE PERSON MOST LIKLEY TO KILL YOU ALREADY HAS THE KEYS TO YOUR HOME.

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Firearms & Homicide

 In 2008, according to the FBI’s Uniform Crime Report, there were only 404 justifiable homicides committed with a firearm by private citizens compared with a total 12,623 murders.

 A gun in the home is actually used for home protection in fewer than 2% of home invasion crimes

Firearms and Homicide

  In a study by Price, Thompson, and Dake (2003) state level data was examined and it was found that firearm prevalence had a significant effect on firearm homicide, suicide, and unintentional injury.

 In states where there were higher rates of gun ownership there were higher rates of firearm related death.

Firearms & Suicide

  On an average day in the U.S., 84 people die from suicide, 50 of these are with a firearm.

 In the U.S. more people kill themselves with a firearm than with all other methods combined.

 For every firearm homicide there is 1.5 firearm suicides.

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The Problem

Firearms account for more completed suicide than any other means, not only among men but women and children.

 This should not be surprisingly considering the lethality of firearms compared to other methods.  For example, a study conducted by Chapdelaine et al., (1991) found that 92% of gun attempts resulted in death compared to 78% of attempts using carbon dioxide or hanging, 67% of drowning attempts and 23% of intentional drug overdose.

Firearms in the Home & Suicide

 Moreover, further research indicates that a gun in the home is 43 times more likely to be used for suicide or murder than self-defense.

 For every case of self-protective homicide involving a firearm kept in the home, 37 suicides, 4.6 criminal homicides and 1.3 unintentional deaths occur (Kellermen and Reay, 1986).

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Firearms and

 A gun is 22 more times more likely to be used in an unintentional shooting than for self-defense  Unintentional injury significantly impact youth. In 72% of children who are injured with a firearm, the gun was obtained from home

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Firearms and

 Unintentional shootings commonly occur when children find a gun in a hidden place. 40% of homes with children have guns (Peter Hart Research, 1999.

 The unintentional firearm-related death rate for children 0-9 years of age is 9 times higher than in 25 other industrialized countries combined (CDC, 1997).

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Guns and Youth Facts

 Each Year almost 3,000 youths die from guns whether it be accidental, suicide, or murder.

 Every day 8 children die as a result of guns. This means that nationally a classroom full of kids is lost every 2-3 days.

 5.6% of 9-12 graders report bringing a gun to school in the last 30 days.

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Preventing Gun Injury and

 Enforce zero tolerance weapons policies  Reduce ready access to guns      Utilize bullying prevention programs Dispel misperceptions about guns Identify and refer youth who are depressed or have mental health problems.

Increase after school programs that reduce gang activity Incorporate gun injury and violence prevention education into the classroom.

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Preventing Gun Injury and

 Educate on changing social norms about the acceptability of violence  Help develop problem-solving skills (for example, parenting, conflict resolution, coping)  Currently there is limited research on effective gun violence and injury prevention curricula.

 Existing programs include, Eddie Eagle, STAR, The Pledge and the “Ask Campaign”.

Preventing Firearm

  Introduce and support Child Access Prevention Laws (Webster, 2004)  Sentence enhancements for those found guilty of assaults and robbery. (Teret et al 1993)  Introduce policy that supports safety mechanisms for firearms (Teret et al 1993)

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Preventing Firearm

 Introduce legislation that bans large capacity ammunition and assault weapons (Teret et al 1993)  Regulation of retail sales and background checks. (Teret et al 1993)  Introduce system to help restrict sales to those who are mentally unstable. (Teret et al 1993)

Public Health Departments

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Almost half (49.7%) of respondents in a national study said that their health departments had not seriously thought about being involved in activities to reduce firearm injuries.

Public Health Departments

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Fewer than one in five (17.8%) are involved in firearm injury prevention.

The most significant barriers:

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limited financial resources lack of expertise not enough time

To Summarize Prevention

  Modifications of the environment  Improvements in product safety  Legislation and enforcement  Education and behavior change  Technology and engineering 7

President Obama’s Plan

1.Closing background check loopholes to keep guns out of dangerous hands; 2. Banning military-style assault weapons and high capacity magazines, and taking other common-sense steps to reduce gun violence; 3. Making schools safer; and 4. Increasing access to mental health services

Considerations for Programming on Firearms

 Be prepared for opposition.

 Programs should emphasize the public health and injury prevention perspective.

 Focus of program should be aimed at youth intervention, community empowerment, and policy implementation (remember to evaluate).

 Try to mobilize health departments and schools to enact programming.

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References

 Nat’l Ctr. for Injury Prevention & Control, Centers for Disease Control & Prevention, Web-Based Injury Statistics Query & Reporting System (WISQARS) Nonfatal Injury Reports. Available at http://webappa.cdc.gov/sasweb/ncipc/nfirates2001.html

Accessed January 3, 2011.

Nat’l Ctr. for Injury Prevention & Control, Centers for Disease Control & Prevention, Web-Based Injury Statistics Query & Reporting System (WISQARS) Nonfatal Injury Reports. Available at http://webappa.cdc.gov/sasweb/ncipc/nfirates2001.html

Accessed January 3, 2011.

Wintemute GJ, Braga AA, Kennedy DM. Private-party gun sales, regulation, and public safety. New Engl J Med. 2010; 363(6): 508-511. Federal Bureau of Investigation. Crime in the United States: Expanded Homicide Table 8. (2010) Available at: http://www2.fbi.gov/ucr/cius2009/offenses/expanded_information/data/shrtable_ 08.html

. Assessed on January 3, 2011.

Corso PS, Mercy JA, Simon TR, Finkelstein EA, Miller TR. Medical costs and productivity losses due to interpersonal and self-directed violence in the United States. Am J Prev Med. 2007; 32(6): 474-482.e2.

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References

 Centers for Disease Control and Prevention. National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary, table 13. Available at: http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf. Accessed on January 3, 2011 Hepburn L, Miller M, Azrael D, Hemenway D. The US gun stock: results from the 2004 national firearms survey. Inj Prev. 2007; 13:15-19. Miller M, Azrael D, Hemenway D. Firearm availability and unintentional firearm deaths. Accident Anal Prev. 2001; 33: 477-484.

Dahlberg LL, Ikeda RM, Kresnow MJ. (2004). Guns in the home and risk of a violent death in the home: Findings from a national study. Am J Epidemiol. 2004; 160(10): 929-936.

Wiebe DJ. Homicide and suicide risks Associated with firearms in the home: A national case-control study. Ann Emerg Med. 2003; 41(6): 771-782.

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References

 Price JH, Thompson AH, Dake JA. Factors associated with state variations in homicide, suicide, and unintentional firearm deaths. J Commun Health. 2004; 29(4): 271-283.

Miller M. One third of households in the USA own firearms which are often stored unsafely. Evidence-Based Healthcare & Public Health. 2005; 9: 23-25.

Children’s Defense Fund. Protect Children Not Guns 2004. (2004). Available at: report-2004.pdf

http://www.childrensdefense.org/child research-data-publications/data/protect-children-not-guns . Accessed on January 3, 2011. Eber GB, Annest JL, Mercy, JA, Ryan, GW. Nonfatal and fatal firearm-related injuries among children aged 14 years and younger: United States, 1993–2000. Pediatrics 2004; 113(6): 1686 1692.

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References

 Webster et al. (2004). “References Association Between Youth-Focused Firearm Laws and Youth”.

JAMA 292:594-601.

 S P Teret and G J Wintemute (1993). Policies to prevent firearm injuries Health Affairs, 12, no.4 :96-108