Matthew Miller, MD, ScD; Lisa Hepburn, PhD; Deborah Azrael, PhD
Acknowledgment: The authors thank their Northeastern University colleagues Carmel Salhi, ScD, for generously running and thoughtfully conceiving and operationalizing their imputation strategy, and Justin Manjourides, ScD, for helping them think about their imputation approach.
Financial Support: Fund for a Safer Future and the Joyce Foundation.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1590.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See the . Statistical code: Available from Dr. Miller (e-mail, firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Matthew Miller, MD, ScD, Northeastern University, Bouvï¿½ College of Health Sciences, Department of Health Sciences, Room 316, Robinson Hall, 360 Huntington Avenue, Boston, MA 02115; e-mail, email@example.com.
Current Author Addresses: Dr. Miller: Northeastern University, Bouv College of Health Sciences, Department of Health Sciences, Room 316, Robinson Hall, 360 Huntington Avenue, Boston, MA 02115.
Drs. Hepburn and Azrael: Harvard Injury Control Research Center, 677 Huntington Avenue, Kresge 310, Boston, MA 02115.
Author Contributions: Conception and design: M. Miller, L. Hepburn, D. Azrael.
Analysis and interpretation of the data: M. Miller, L. Hepburn, D. Azrael.
Drafting of the article: M. Miller, L. Hepburn.
Critical revision for important intellectual content: M. Miller, L. Hepburn, D. Azrael.
Final approval of the article: M. Miller, L. Hepburn, D. Azrael.
Statistical expertise: M. Miller, L. Hepburn, D. Azrael.
Obtaining of funding: M. Miller, D. Azrael.
Administrative, technical, or logistic support: M. Miller.
Collection and assembly of data: M. Miller, D. Azrael.
In 1994, 40% of U.S. gun owners who had recently acquired a firearm did so without a background check. No contemporary estimates exist.
To estimate the proportion of current U.S. gun owners who acquired their most recent firearm without a background check, by time since and manner of acquisition, for the nation as a whole and separately in states with and without legislation regulating private sales.
Probability-based online survey.
United States, 2015.
1613 adult gun owners.
Current gun owners were asked where and when they acquired their last firearm; if they purchased the firearm; and whether, as part of that acquisition, they had a background check (or were asked to show a firearm license or permit).
22% (95% CI, 16% to 27%) of gun owners who reported obtaining their most recent firearm within the previous 2 years reported doing so without a background check. For firearms purchased privately within the previous 2 years (that is, other than from a store or pawnshop, including sales between individuals in person, online, or at gun shows), 50% (CI, 35% to 65%) were obtained without a background check. This percentage was 26% (CI, 5% to 47%) for owners residing in states regulating private firearm sales and 57% (CI, 40% to 75%) for those living in states without regulations on private firearm sales.
Potential inaccuracies due to recall and social desirability bias.
22% of current U.S. gun owners who acquired a firearm within the past 2 years did so without a background check. Although this represents a smaller proportion of gun owners obtaining firearms without background checks than in the past, millions of U.S. adults continue to acquire guns without background checks, especially in states that do not regulate private firearm sales.
Fund for a Safer Future and the Joyce Foundation.
Recruitment and participation of panel members.
KP = KnowledgePanel.
Table 1. State Laws for Secondary Sales*
Table 2. Characteristics of U.S. Adults Who Own Guns
Table 3. Summary of Most Recent Firearm Transfer, by Type of Acquisition*
Table 4. Percentage of Current Firearm Owners Whose Most Recent Private-Sale Firearm Acquisition Occurred Without a BC or the Equivalent, by State Law Status and Time of Transfer*
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Richard W Egan, PhD
February 23, 2018
Challenge you background assumptions
Whenever you have a study that claims 90% agreement you must be highly suspicious. There are many definitions of background checks but Universal is generally considered to be a check required for any transfer from person to another, including family and loans to friends. This type of check is abhorrent to many if not most firearms owners. Also Police chiefs are usually political appointments it is usually better to ask the regular level policeman not political appointees.
Contractor Department of Defense
February 28, 2018
I read with great interest your statistic concerning gun owners who reported buying a gun within the last two years without a background check. Please tell me how they were able to accomplish this since I have bought 10 guns in the last two years (online, at gun shows and in person at a local store), have intimate knowledge of how to do so and yet I still had to complete a background check/screening in EVERY instance. Gun show personnel use two forms of picture ID – which could include a military ID card, a driver’s license or a card (concealed carry, FOID etc.) issued by the state of residence also with a picture. The seller then runs pertinent information from those two forms of picture ID through the National Instant Criminal Background Check System (NICS – located at the FBI’s Criminal Justice Information Services in Clarksburg, West Virginia). That online service is ALWAYS present at these shows. If there is ANY discrepancy, the gun sale ends immediately. If not, the sale proceeds and the now vetted customer must then fill out ATF Form 4473 which is kept on file for not less than 20 years by the seller. The personnel at any gun show must have a Federal Firearms License (FFL) to sell guns. An FFL is a license granted to a business only after very intense and in-depth ATF investigation procedures are completed. Online gun stores send guns through the mail (FedEx, UPS etc.) – and ALL guns purchased online are sent to a “Brick and Mortar” store which must have that FFL license. This store will have already been investigated and vetted by ATF personnel for gun sales. Online stores NEVER send any weapon to a buyer, always to an FFL designated by the buyer. Failure to follow these steps would result in them being out of business and being prosecuted INSTANTLY. All “Brick and Mortar” stores run the same NICS check with the same two required forms of picture ID and have any potential buyer again fill out ATF form 4473 before receiving any gun. There is the buying process in a nutshell. I do not have any idea how someone would get around these requirements based on your criteria within the “22% of gun owners who reported obtaining their most recent firearm within the previous 2 years reported doing so without a background check”. Please let me know if you have additional information, thank you.
Miller M, Hepburn L, Azrael D. Firearm Acquisition Without Background Checks: Results of a National Survey. Ann Intern Med. ;166:233–239. doi: 10.7326/M16-1590
Download citation file:
Published: Ann Intern Med. 2017;166(4):233-239.
Published at www.annals.org on 3 January 2017
Results provided by:
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use