gun violence

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Etiology

  • substance use is a risk factor for adolescent firearm homicide[7]
  • gun violence may be propagated through networks of people by social interaction[7]
  • exposure to gun use in movies, television, & other forms of media may influence how children interact with guns whenthey find them[8]
    • watching gun use associated with significantly more gun holding & trigger pulls[8]

Epidemiology

  • Surgeon general declares firearm violence a public health crisis in US[39]
  • firearm deaths now leading cause of death from trauma is U.S. exceeding deaths from motor vehicle accidents[33]
  • firearm fatality rates in the United States reached a 28-year high in 2021[35]
  • in 2013, more than 33,000 people in the United States died from gunshot injuries[3]
  • in the United States, the National Rifle Association (NRA), the legislators it has funded, & a certain breed of gun owners have stood in the way of research to determine what policies might help[3]
  • very few existing state-specific firearm laws are associated with reduced firearm mortality[4]
    • of 25 state firearm laws, 9 associated with reduced firearm mortality, 9 were associated with increased firearm mortality, & 7 had an inconclusive association
    • 3 state laws most strongly associated with reduced overall firearm mortality included:
  • Australia has had no mass fatal shootings since it banned semi-automatic weapons in 1996[6]
    • the ban included guns already owned by citizens & mandated government buyback of all prohibited firearms[6]
    • from 1979-1996 in Australia, there were 13 mass fatal shootings, with 104 deaths, none afterwards[6]
    • total firearm deaths in Australia also declined after the ban, from 3.6 per 100,000 population to 1.2 per 100,000
  • 37,000 deaths from firearms in U.S. in 2016, 2/3 being suicides[27]
  • 6 countries accounted for half the global firearm deaths in 2016, Brazil, U.S., Mexico, Colombia, Venezuela, & Guatemala[27]
  • death rate from gun violence was 12.0 per 100,000 population in 1st quarter of 2017, higher prior year (11.4 per 100,000)[16]
  • firearm homicide in 2020 at highest in 25 years[34]
  • young adult males from zip codes with the most violence in Chicago & Philadelphia in 2020-2021 had a higher risk of firearm-related death than US military personnel who served during the wars in Afghanistan & Iraq[36]
  • from 2014 to 2020, mortality from firearm homicides increased by 7% annually[38]
  • from 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, & homicide due to firearms & all other injuries[38]

Management

  • SaFETy score predicts risk for firearm violence in youth with substance abuse
  • evidence-based laws compliant with the 2nd amendment work[26]
    • prohibit dangerous individuals from purchasing firearms
    • enforce prohibited purchase laws
    • safe storage, smart guns, & child protection
    • ban hazardous weapons
    • permissive right-to-carry laws significantly increase violent crime, including homicides
    • crime detection[26]
    • stricter state gun laws are associated with safer schools[30]

Clinical trials

  • of 43 pairs of children who found a planted (disabled) handgun, 22 (51%) handled it, & 14 (33%) alerted researchers to its presence[8]
    • children who watched gun scenes held the handgun longer (53.1 vs 11.1 seconds) & pulled the trigger more times (2.80 vs 0.01)
    • children watching gun scenes played more aggressively, shot at their play partners & people passing by outdoors[8]

Notes

  • research on gun violence has been underfunded compared with research on other major cause of death[7]
  • with background checks for firearm purchases, firearm- related mortality would decline from 10.35 per 100,000 to 4.46; with ammunition background checks to 1.99; with firearm identification* to 1.81
  • 22% of current U.S. gun owners who acquired a firearm in 2014-2015 did so without a background check[21]
  • unregulated gun shows (i.e. in Nevada) may increase gun violence in neighboring states (i.e. in California)[15]
  • large increases in handgun purchases may occur after mass shootings (40-50%)[20][24]
  • exposure to violence increases likelihood of carrying a firearm[22]
  • Supreme Court allows for firearms regulation within the context of the second ammendment[25]
  • assessment of Mass Attacks in Public Spaces[37]

* microstamping or ballistic fingerprinting given as examples of firearm identification

  • general engagement guidelines for physicians[14]
    • educate yourself & regularly contact their elected officials about this public health threat
    • meet with your institution's leaders to find ways to work with the government at all levels
    • ask patients about guns in the home
    • not be silent

More general terms

Additional terms

References

  1. ↑ Kapp MB Geriatric Patients, Firearms, and Physicians. Ann Intern Med. Published online 9 July 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23836076 <Internet> http://annals.org/article.aspx?articleid=1707739
  2. ↑ Fisher CE and Lieberman JA Getting the Facts Straight About Gun Violence and Mental Illness: Putting Compassion Before Fear. Ann Intern Med. Published online 9 July 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23836046 <Internet> http://annals.org/article.aspx?articleid=1707738
  3. ↑ 3.0 3.1 3.2 Malina D, Morrissey S, Campion EW Rooting Out Gun Violence. N Engl J Med. December 16, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26672390 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1515975
  4. ↑ 4.0 4.1 4.2 Kalesan B et al Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. The Lancet. March 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26972843 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901026-0/abstract
    Hemenway D Firearm legislation and mortality in the USA. The Lancet. March 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26972841 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2900206-3/abstract
  5. ↑ AMA News Room. June 14, 2016 AMA Calls Gun Violence "A Public Health Crisis;" Will Actively Lobby Congress to Lift Ban on CDC Gun Violence Research. http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-gun-violence-lobby-congress.page
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Chapman S, Alpers P, Jones M Association Between Gun Law Reforms and Intentional Firearm Deaths in Australia, 1979-2013. JAMA. Published online June 22, 2016. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27332876 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2530362
    Webster DW Lessons From Australia's National Firearms Agreement. JAMA. Published online June 22, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27332736 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2530361
    Sacks CA, Malina D, Morrissey S In the Wake of Orlando - Taking Steps against Gun Violence. N Engl J Med. June 22, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27376581 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1608173
  7. ↑ 7.0 7.1 7.2 7.3 Hohl BC, Wiley Wiebe DJ et al Association of Drug and Alcohol Use With Adolescent Firearm Homicide at Individual, Family, and Neighborhood Levels. JAMA Intern Med. Published online January 3, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28055064 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2594803
    McGinty EE, Webster DW The Roles of Alcohol and Drugs in Firearm Violence. JAMA Intern Med. Published online January 3, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28055044 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2594799
    Green B, Horel T, Papachristos AV et al Modeling Contagion Through Social Networks to Explain and Predict Gunshot Violence in Chicago, 2006 to 2014. JAMA Intern Med. Published online January 3, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28055070 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2594804
    Branas CC, Jacoby S, Andreyeva E Firearm Violence as a Disease - "Hot People" or "Hot Spots". JAMA Intern Med. Published online January 3, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28055043 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2594800
    Stark DE, Shah NH Funding and Publication of Research on Gun Violence and Other Leading Causes of Death. JAMA. 2017;317(1):84-85 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28030692 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2595514
    Steinbrook R Responding to Firearm Homicide in Urban Areas. JAMA Intern Med. Published online January 3, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28055039 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2594796
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Dillon KP, Bushman BJ. Effects of exposure to gun violence in movies on children's interest in real guns. JAMA Pediatr 2017 Sep 25; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973535 <Internet> http://jamanetwork.com/journals/jamapediatrics/fullarticle/2654597
  9. ↑ Campion EW, Morrissey S, Malina D. After the Mass Shooting in Las Vegas - Finding Common Ground on Gun Control. N Eng J Med. October 4, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28976811 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1713203
  10. ↑ Rivara FP, Kellermann AL Silencing the science on gun research. JAMA. 2013 Feb 13;309(6):549-50. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23262635 <Internet> http://jamanetwork.com/journals/jama/fullarticle/1487470
  11. ↑ Kassirer JP Weapons of mass destruction. JAMA Intern Med. 2013;173(3):182-183 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23262523 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1487516
  12. ↑ Frieden J, Walker M Calls Grow for CDC to Resume Gun Violence Research. But little expectation of repealing Dickey Amendment MedPage Today. October 03, 2017
  13. ↑ Bauchner H, Rivara FP, Bonow RO et al Death by Gun Violence - A Public Health Crisis. JAMA Intern Med. Published online October 9, 2017. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29052733 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2657425
  14. ↑ 14.0 14.1 Taichman DB, Bauchner H, Drazen JM, Laine C, Peiper L. Firearm-Related Injury and Death - A U.S. Health Care Crisis in Need of Health Care Professionals. N Engl J Med. October 9, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28991510 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1713355
  15. ↑ 15.0 15.1 Matthay EC, Galin J, Rudolph KE et al In-State and Interstate Associations Between Gun Shows and Firearm Deaths and Injuries: A Quasi-experimental Study. Ann Intern Med. 2017. Oct 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29059689 <Internet> http://annals.org/aim/article/2659346/state-interstate-associations-between-gun-shows-firearm-deaths-injuries-quasi
    Conner A, Azrael D, Miller M. Public Opinion About the Relationship Between Firearm Availability and Suicide: Results From a National Survey. Ann Intern Med. 2017. Oct 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29059684 <Internet> http://annals.org/aim/article/2659603/public-opinion-about-relationship-between-firearm-availability-suicide-results-from
    Rowhani-Rahbar A, Rivara FP Firearm Injury After Gun Shows: Evidence to Gauge the Potential Impact of Regulatory Interventions. Ann Intern Med. 2017. Oct 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29059686 <Internet> http://annals.org/aim/article/2659347/firearm-injury-after-gun-shows-evidence-gauge-potential-impact-regulatory
  16. ↑ 16.0 16.1 Ahmad FB, Bastian B. Quarterly provisional estimates for selected indicators of mortality, 2016-Quarter 2, 2017. National Center for Health Statistics. National Vital Statistics System, Vital Statistics Rapid Release Program. 2017. https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm
  17. ↑ Wintemute GJ, Betz ME, Ranney ML. Yes, You Can: Physicians, Patients, and Firearms. Ann Intern Med. 2016;165(3):205-213 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27183181 <Internet> http://annals.org/aim/fullarticle/2522436/yes-you-can-physicians-patients-firearms
    Betz ME, Ranney ML, Wintemute GJ. Physicians, Patients, and Firearms: The Courts Say "Yes" Ann Intern Med. 2017 May 16;166(10):745-746. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28265644
    Wintemute GJ, Betz ME, Ranney ML. Physicians, Patients, and Firearms. Ann Intern Med. 2016 Dec 20;165(12):893. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27992910
  18. ↑ Wintemute GJ What You Can Do to Stop Firearm Violence. Ann Intern Med. 2017;167(12):886-887 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29049506 <Internet> http://annals.org/aim/fullarticle/2658284/what-you-can-do-stop-firearm-violence
  19. ↑ Butkus R, Doherty R, Daniel H et al Reducing firearm-related injuries and deaths in the United States: executive summary of a policy position paper from the American College of Physicians. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24722815 <Internet> http://annals.org/aim/fullarticle/1860325/reducing-firearm-related-injuries-deaths-united-states-executive-summary-policy
  20. ↑ 20.0 20.1 Studdert DM, Zhang Y, Rodden JA, Hyndman RJ, Wintemute GJ. Handgun Acquisitions in California After Two Mass Shootings. Ann Intern Med. 2017 May 16;166(10):698-706. Epub 2017 May 2. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28462425 <Internet> http://annals.org/aim/fullarticle/2624284/handgun-acquisitions-california-after-two-mass-shootings
  21. ↑ 21.0 21.1 Miller M, Hepburn L, Azrael D Firearm Acquisition Without Background Checks: Results of a National Survey. Ann Intern Med. 2017 Feb 21;166(4):233-239. Epub 2017 Jan 3. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28055050 <Internet> http://annals.org/aim/fullarticle/2595892/firearm-acquisition-without-background-checks-results-national-survey
    Cook PJ At Last, a Good Estimate of the Magnitude of the Private- Sale Loophole for Firearms. Ann Intern Med. 2017;166(4):301-302. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28055051 <Internet> http://annals.org/aim/fullarticle/2595893/last-good-estimate-magnitude-private-sale-loophole-firearms
  22. ↑ 22.0 22.1 Reid JA, Richards TN, Loughran TA, Mulvey EP. The Relationships Among Exposure to Violence, Psychological Distress, and Gun Carrying Among Male Adolescents Found Guilty of Serious Legal Offenses: A Longitudinal Cohort Study. Ann Intern Med. 2017 Mar 21;166(6):412-418. Epub 2017 Jan 31. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28135726 <Internet> http://annals.org/aim/fullarticle/2599282/relationships-among-exposure-violence-psychological-distress-gun-carrying-among-male
  23. ↑ Taichman DB, Bauchner H, Drazen JM, Laine C, Peiperl L. Firearm-Related Injury and Death: A U.S. Health Care Crisis in Need of Health Care Professionals. Ann Intern Med. 2017 Dec 5;167(11):824-825. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29052714 <Internet> http://annals.org/aim/fullarticle/2657344/firearm-related-injury-death-u-s-health-care-crisis-need
    Laine C, Taichman DB. The Health Care Professional's Pledge: Protecting Our Patients From Firearm Injury. Ann Intern Med. 2017 Dec 19;167(12):892-893. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29049687 <Internet> http://annals.org/aim/fullarticle/2658283/health-care-professional-s-pledge-protecting-our-patients-from-firearm
    Taichman DB, Bauchner H, Drazen JM, Laine C, Peiperl L. Firearm-Related Injury and Death: A US Health Care Crisis in Need of Health Care Professionals. JAMA. 2017 Nov 21;318(19):1875. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29049471
    Taichman DB, Bauchner H, Drazen JM, Laine C, Peiperl L. Firearm-Related Injury and Death: A U.S. Health Care Crisis in Need of Health Care Professionals. PLoS Med. 2017 Oct 9;14(10):e1002430. eCollection 2017 Oct. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29016601 Free PMC Article
    Taichman DB, Bauchner H, Drazen JM, Laine C, Peiperl L. Firearm-Related Injury and Death - A U.S. Health Care Crisis in Need of Health Care Professionals. N Engl J Med. 2017 Nov 23;377(21):2090-2091. Epub 2017 Oct 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28991510 Free Article
  24. ↑ 24.0 24.1 Webster DW. The True Effect of Mass Shootings on Americans. Ann Intern Med. 2017 May 16;166(10):749-750. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28462426 <Internet> http://annals.org/aim/fullarticle/2624992/true-effect-mass-shootings-americans
  25. ↑ 25.0 25.1 Gostin LO, Duranske S. The Second Amendment and a Well-Regulated Firearms Environment. JAMA. Published online March 23, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29570755 https://jamanetwork.com/journals/jama/fullarticle/2676544
  26. ↑ 26.0 26.1 26.2 Gostin LO, Duranske S. The Second Amendment and a Well-Regulated Firearms Environment. JAMA. 2018;319(17):1763-1764. May 1, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29570755 https://jamanetwork.com/journals/jama/fullarticle/2676544
  27. ↑ 27.0 27.1 27.2 The Global Burden of Disease 2016 Injury Collaborators Global Mortality From Firearms, 1990-2016 JAMA. 2018;320(8):792-814. Aug 28, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30167700 https://jamanetwork.com/journals/jama/fullarticle/2698492
    Rivara FP, Studdert DM, Wintemute GJ. Firearm-Related Mortality. A Global Public Health Problem. JAMA. 2018;320(8):764-765 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30167677 https://jamanetwork.com/journals/jama/fullarticle/2698467
  28. ↑ Butkus R, Doherty R, Bornstein SS et al Reducing Firearm Injuries and Deaths in the United States: A Position Paper From the American College of Physicians. Ann Intern Med. 2018. Oct 30. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30383132 <Internet> http://annals.org/aim/fullarticle/2709820/reducing-firearm-injuries-deaths-united-states-position-paper-from-american
    Morgan ER, Rowhani-Rahbar A, Azrael D et al Public Perceptions of Firearm- and Non-Firearm-Related Violent Death in the United States: A National Study. Ann Intern Med. 2018. Oct 30. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30383115 <Internet> http://annals.org/aim/fullarticle/2711392/public-perceptions-firearm-non-firearm-related-violent-death-united-states
    Kahn JS What Can I Do as a Physician to Prevent Firearm Injury?? Ann Intern Med. 2018. Oct 30. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30383121 <Internet> http://annals.org/aim/fullarticle/2709821/what-can-i-do-physician-prevent-firearm-injury
    Cook PJ Expanding the Public Health Approach to Gun Violence Prevention. Ann Intern Med. 2018. Oct 30. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30383127 <Internet> http://annals.org/aim/fullarticle/2711393/expanding-public-health-approach-gun-violence-prevention
  29. ↑ Kegler SR, Dahlberg LL, Mercy JA. Firearm Homicides and Suicides in Major Metropolitan Areas- United States, 2012-2013 and 2015-2016. MMWR Morb Mortal Wkly Rep 2018;67:1233-1237 https://www.cdc.gov/mmwr/volumes/67/wr/mm6744a3.htm
  30. ↑ 30.0 30.1 Ghiani M, Hawkins SS, Baum CF Gun laws and school safety J Epidemiol Commun Health. March 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30898852 https://jech.bmj.com/content/early/2019/02/25/jech-2018-211246
  31. ↑ McLean RM, Harris P, Cullen J Firearm-Related Injury and Death in the United States: A Call to Action From the Nation's Leading Physician and Public Health Professional Organizations. Ann Intern Med. 2019. Aug 7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31390463 https://annals.org/aim/fullarticle/2748085/firearm-related-injury-death-united-states-call-action-from-nation
  32. ↑ Firth S Preventing Gun Violence in Patients With Dementia. Gun safety advocate Emmy Betz, MD, MPH, offers advice. MedPage Today September 23, 2021 https://www.medpagetoday.com/geriatrics/dementia/94663
  33. ↑ 33.0 33.1 AMA Morning Rounds. Feb 24, 2022 American Medical Association
    Klein J, Prabhakaran K, Latifi R, Rhee P. Firearms: the leading cause of years of potential life lost Trauma Surgery & Acute Care Open 2022. 7(1):e000766 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35141422 PMCID: PMC8819782 Free PMC article https://tsaco.bmj.com/content/7/1/e000766
  34. ↑ 34.0 34.1 AMA Morning Rounds. May 11, 2022 2020 surge in gun violence pushed firearm homicide rate to highest level in quarter-century, CDC finds. American Medical Association
    Kegler SR, Simon TR, Zwald ML, et al. Vital Signs: Changes in Firearm Homicide and Suicide Rates - United States, 2019-2020. MMWR Morb Mortal Wkly Rep. May 13;71(19):656-663. ePub: 10 May 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35550497 https://www.cdc.gov/mmwr/volumes/71/wr/mm7119e1.htm
  35. ↑ 35.0 35.1 Rees CA, Monuteaux MC, Steidley I et al Trends and Disparities in Firearm Fatalities in the United States, 1990-2021. JAMA Netw Open. 2022;5(11):e2244221. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36445703 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799021
  36. ↑ 36.0 36.1 del Pozo B, Knorre A, Mello MJ et al Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected US Cities With Wartime Service in Iraq and Afghanistan. JAMA Netw Open. 2022;5(12):e2248132. Dec 22. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36547982 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799859
  37. ↑ 37.0 37.1 Alathar L et al Mass Attacks in Public Spaces: 2016-2020 United States Secret Service. National Threat Assessment Center U.S. Department of Homeland Security. Jam 2023 https://www.secretservice.gov/sites/default/files/reports/2023-01/usss-ntac-maps-2016-2020.pdf
  38. ↑ 38.0 38.1 38.2 Lawrence WR, Freedman ND, McGee-Avila JK et al Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020. JAMA Intern Med. 2023;183(8):849-856 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37399025 PMCID: PMC10318548 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2806958
  39. ↑ 39.0 39.1 Rhoades A, DiBerardino CL Surgeon general declares firearm violence a public health crisis in US. Helio. June 25, 2024 https://www.healio.com/news/primary-care/20240625/surgeon-general-declares-firearm-violence-a-public-health-crisis-in-us
  40. ↑ 40.0 40.1 Laine C, Bornstein SS Firearm Injury: An Escalating Health Crisis Ann Intern Med. 2023 Mar;176(3):398-399. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36645887 Free article
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