Editor’s note: This commentary is by Paul D. Manganiello, MD, MPH, of Norwich, a emeritus professor of obstetrics and gynecology at the Geisel School of Medicine at Dartmouth College. He is president of the GunSense Vermont Education Fund.
[T]his is #MyLane! This is everyoneโs lane! The National Rifle Association rightly received a lot of blow back when they criticized the medical profession for speaking out about the public health crisis resulting from inadequate firearm regulations. Who hasnโt lost a friend, colleague, family member or child to gun violence? We need to get beyond the usual talking points and statistics to realize that it affects all of us. Our children in school are reminded of this on an almost daily basis; you think twice about going to a movie theater, a concert, nightclub, church, or for some individuals, their own home. This is domestic terrorism at its worst.
The NRA attempted to obstruct the Centers for Disease Control and Preventionโs ability to carry out research on gun violence by legislatively supporting the passage of the Dickey Amendment in 1996. In 2018 Congress allowed the CDC to research the causes of gun violence, but not to make recommendations that would limit gun ownership. Republicans in Congress continue to refuse to appropriate funding for gun violence research.
This is unfortunate since it hampers a public health approach to addressing preventable deaths and injuries caused by the epidemic of gun violence. The public health approach defines the problem, identifies the risk and protective factors, develops and tests preventive strategies, and, finally, assures widespread public adoption of these strategies. A public health approach has been shown to be effective in reducing auto deaths and smoking. Recently, the American Medical Association, the American College of Surgeons and the American College of Physicians have all called for a public health approach to the epidemic of firearm violence, and its resulting injuries and death.
Suicide is the leading cause of death by gun in Vermont. According to the most recent statistics, December 2017, from the Vermont Department of Health, suicide is the eighth leading cause of death in Vermont, with approximately 14 per 100,000 people as compared with the rest of the U.S., which is 13 per 100,000 people.
There are many risk factors which might lead an individual to attempt to take his or her life: mental health disorders, substance abuse disorders, prior suicide attempt, family history of suicide, domestic violence, bullying, access to firearms in the home, or purchasing a firearm when having an acute suicidal crisis.
Males in Vermont are five times more likely to die of suicide than females (29 vs. 6 in 100,000). The leading cause of death by suicide in Vermont was firearms (52 percent), and of these, males were twice as likely to die by firearms than females (58 percent vs. 24 percent). The highest rate occurs in those males over 65 (44 per 100,000) as compared to females (3 per 100,000). From ages 15 to 64, the rate for males gradually increases from 33 to 36 per 100,000, while for females from 3 to 9 per 100,000.
But death as an endpoint is only part of the story. In 2014 there were 114 deaths by suicide in Vermont, but there were approximately 1,500 injuries, 326 hospitalizations and 1,183 emergency room visits for attempted suicides. These injuries included: poisoning (53 percent); cutting (30 percent); unspecified (15 percent); suffocation (2 percent); burns (1 percent); and although firearms were responsible for only (1 percent) of the reported injuries they were the principal cause of suicide death because of their inherent lethality. In a 2018 article by Knopov et al., which appeared in the American Journal of Preventive Medicine, the association between gun ownership and overall suicide death rates is well established.
From a public health standpoint, what might be done to reduce self-inflicted or accidental firearm related deaths or injuries? For those individuals under the age of 21, a study by Hamilton et al. in 2018 reported in the Journal of Trauma Acute Care Surgery that 27 states have passed Child Access Prevention (CAP) laws; 14 states had โstrong CAP lawsโ; defined as a law imposing criminal liability on the gun owner when a child gains access to a firearm as a result of negligent storage. Among states with strong CAP laws, the incident rate of self-inflicted pediatric firearm injuries decreased by 54 percent (Incidence Rate Ratio (IRR), 0.46; 95 percent Confidence Interval (CI), 0.26โ0.79; p = 0.005) and the incident rate of unintentional firearm injuries was decreased by 44 percent (IRR, 0.56; 95 percent CI, 0.43โ0.74; p < 0.001) as compared with states with no CAP law. Furthermore, more than 75 percent of the guns used in suicide attempts and unintentional injuries were obtained from the residence of the victim, a relative or a friend. These findings support strong CAP laws that require safe storage of firearms.
For those individuals over the age of 21, in a 2017 article by Luca et al. reported in the Proceedings of the National Academy of Sciences, 44 states (including the District of Columbia) have had a waiting period for at least some time between 1970 and 2014. They found that waiting periods are not only associated with a 17 percent reduction in gun homicides, an equivalent to ๏ฝ36 fewer gun homicides per year for a state with an average number of gun deaths; but waiting periods also lead to a 7โ11 percent reduction in gun deaths by suicide, which is equivalent to 22โ35 fewer gun suicides per year for the average state.
If we hope to have any impact on self-inflicted firearm injuries or deaths we need to reduce access to lethal means. Please contact your state representatives and senators asking them to support a waiting period of 72 hours before being able to purchase a firearm; and to support a Child Access Prevention law, which would impose criminal liability for the gun owner who as a result of improperly secured firearms, an individual suffers an intentional or unintentional injury or death.
