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State Gun Laws, Gun Ownership, and Mass Shootings in the US: Cross Sectional Time Series BMJ: First Published As 10.1136/Bmj.L542 on 6 March 2019

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State Gun Laws, Gun Ownership, and Mass Shootings in the US: Cross Sectional Time Series BMJ: First Published As 10.1136/Bmj.L542 on 6 March 2019 RESEARCH State gun laws, gun ownership, and mass shootings in the US: BMJ: first published as 10.1136/bmj.l542 on 6 March 2019. Downloaded from cross sectional time series Paul M Reeping,1 Magdalena Cerdá,2 Bindu Kalesan,3 Douglas J Wiebe,4 Sandro Galea,5 Charles C Branas1 1Department of Epidemiology, ABSTRACT a growing divide appears to be emerging between Columbia University, Mailman OBJECTIVE restrictive and permissive states. School of Public Health, 722 To determine whether restrictiveness-permissiveness West 168th Street, New York, of state gun laws or gun ownership are associated NY 10032, USA Introduction 2 with mass shootings in the US. Department of Population Despite an increasing frequency of mass shootings in Health, New York University, DESIGN Langone School of Medicine, the US and the seemingly disproportionate occurrence New York, NY, USA Cross sectional time series. of mass shootings in some states and not others, little 3Department of Community SETTING AND POPULATION research has been carried out to understand state level Health Sciences, Boston US gun owners from 1998-2015. factors that could influence mass shootings.1 A 2018 University School of Public Health, Boston, MA, USA EXPOSURE report pointed to only three studies that had examined 4Department of Biostatistics, An annual rating between 0 (completely restrictive) associations between gun laws and mass shooting Epidemiology & Informatics, and 100 (completely permissive) for the gun laws events.2-5 However, testing the effects of state gun University of Pennsylvania, of all 50 states taken from a reference guide for laws on the occurrence of mass shootings was not the Perelman School of Medicine, Philadelphia, PA, USA gun owners traveling between states from 1998 to primary objective of at least one of these studies and 5Boston University School of 2015. Gun ownership was estimated annually as the the body of evidence they represent was inconclusive Public Health, Boston, MA, USA percentage of suicides committed with firearms in in terms of determining the effects of specific state gun Correspondence to: P Reeping each state. laws on mass shootings. [email protected] Gun laws have the potential to influence the (or @PaulReeping on Twitter MAIN OUTCOME MEASURE ORCID 0000-0003-1703-6379) Mass shootings were defined as independent events occurrence of mass shootings. There are limited Additional material is published in which four or more people were killed by a firearm. national gun laws in the US, so the variety of state online only. To view please visit Data from the Federal Bureau of Investigation’s gun laws that have evolved provides an excellent the journal online. Uniform Crime Reporting System from 1998-2015 opportunity for study. Previous studies have found that http://www.bmj.com/ Cite this as: BMJ 2019;364:l542 more permissive statewide gun laws are associated http://dx.doi.org/10.1136/bmj.l542 were used to calculate annual rates of mass shootings in each state. Mass shooting events and rates were with higher levels of gun homicide and gun suicide,6-10 Accepted: 28 January 2019 further separated into those where the victims were although none of these studies considered whether immediate family members or partners (domestic) and state gun laws in general were associated with mass those where the victims had other relationships with shootings. Gun ownership is also a potentially key the perpetrator (non-domestic). variable to be examined in conjunction with gun laws, RESULTS given that statewide gun ownership can lead to the on 2 October 2021 by guest. Protected copyright. Fully adjusted regression analyses showed that a 10 implementation of laws, and the implementation of unit increase in state gun law permissiveness was laws can result in changes to statewide gun ownership. associated with a significant 11.5% (95% confidence Previous studies have found that gun ownership is interval 4.2% to 19.3%, P=0.002) higher rate of mass associated with higher levels of gun assault and gun shootings. A 10% increase in state gun ownership was homicide, although none of these studies considered associated with a significant 35.1% (12.7% to 62.7%, whether state gun ownership in general was associated P=0.001) higher rate of mass shootings. Partially with mass shootings.11-15 adjusted regression analyses produced similar How gun laws and gun ownership influence mass results, as did analyses restricted to domestic and shooting events in the US is not fully understood. non-domestic mass shootings. Therefore, we conducted a cross sectional, time series CONCLUSIONS analysis to broadly examine whether restrictiveness States with more permissive gun laws and greater gun or permissiveness of state gun laws and state gun ownership had higher rates of mass shootings, and ownership were associated with mass shootings. Methods WHAT IS ALREADY KNOWN ON THIS TOPIC Independent variables More permissive state gun laws and higher levels of gun ownership are We used the 1998-2015 edition of the Traveler’s associated with higher levels of gun homicide and gun suicide in the US Guide to the Firearms Laws of the Fifty States to obtain WHAT THIS STUDY ADDS the independent variable of interest, an annual restrictiveness-permissiveness scale of US gun laws States with more permissive gun laws and greater gun ownership have higher for each state.16 This report is published annually rates of mass shootings by legal professionals as a reference guide for gun There is a growing divergence in recent years as rates of mass shootings in owners traveling between states and gives a rating restrictive states have decreased and those in permissive states have increased between 0 (completely restrictive) and 100 (completely the bmj | BMJ 2019;364:l542 | doi: 10.1136/bmj.l542 1 RESEARCH permissive) for the firearm laws of all 50 states. The Descriptive and unadjusted analyses report considers more than 13 factors in developing To understand how state gun law restrictiveness- the score, including: standard firearms ownership permissiveness scores changed over the study BMJ: first published as 10.1136/bmj.l542 on 6 March 2019. Downloaded from and permit requirements; if semi-automatic, high period, we first estimated an ordinary least squares capacity magazines, machine guns, and suppressors regression with year as the independent variable are permitted or restricted; if the firearms laws across and permissiveness score as the dependent variable. the state vary widely; if the state employs a right to We also calculated boxplots of the distribution of self-defense, ability to conceal, ability to open and restrictiveness-permissiveness scores per state across vehicle carry, ability to conceal carry in state parks, all years. We stratified states with restrictiveness- or whether a gun permittee can carry in a restaurant permissiveness scores ≤50 (labeling them restrictive) serving alcohol; whether there is a duty to notify law and >50 (labeling them permissive). For comparative enforcement of permit status; and if one can keep a gun purposes, we also used a second stratification that in their vehicle at colleges and K-12 schools (primary separated states by the median restrictiveness- and secondary schools). permissiveness score of ≤79 (restrictive) and >79 Gun ownership is not directly surveyed across all (permissive). We compared both stratifications with 50 states each year in the US. A review of over 24 gun changes in mass shootings per million people over ownership indicators found that the percentage of time. Average state restrictiveness-permissiveness suicides committed with a firearm was the best measure scores and average state gun ownership percentages for estimating gun ownership by state.17 This has also were calculated across all years of available data. been verified in several other studies across different We calculated Pearson correlation coefficients and regions,18-22 in which the percentage of suicides scatterplots between these state restrictiveness- committed with a firearm was shown to be highly permissiveness scores and gun ownership percentages, correlated with the proportion of households reporting as well as the population-based rates of mass shootings gun ownership (across 21 US states r=0.90,23 across across all states in all years. nine census regions r=0.9324). Therefore, we chose to use the percentage of suicides committed with a firearm Regression analyses as a proxy measurement for gun ownership per state per Data were analyzed by using generalized estimating year, which we obtained through the Centers for Disease equations with a negative binomial distribution and Control and Prevention’s online database, WONDER.25 natural log link to determine the association between We included the following annual measures of state- state gun laws and annual mass shootings. We chose http://www.bmj.com/ level characteristics in our analyses: median household this regression specification because of estimated income, percent high school graduation, percent variances exceeding conditional means. Repeated female headed households, percent in poverty, percent cross-sectional time-series measures were calculated unemployment, incarceration rate, and percent white. as state-per-year. We used an offset of state population We took all covariates from the American Community and, in the fully adjusted model, median household Survey at the United States Census Bureau,26 except income, percent high school graduation, percent incarceration rate, which was obtained from the female headed households, percent in poverty, percent on 2 October 2021 by guest. Protected copyright. Bureau of Justice Statistics.27 We included year in all unemployment, incarceration rate, and percent white analyses as a fixed effect to account for other time were included as covariates. These variables were varying factors. chosen according to suggestions in the Supplementary Homicide Reports documentation,28 as well as other Outcome variables studies that examined state laws with different firearm We used the Supplementary Homicide Reports from outcomes.6-10 32 We included year as an indicator the Federal Bureau of Investigation’s Uniform Crime variable in all analyses.
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