Rocco Pallin, MPH; Sarabeth A. Spitzer, BA; Megan L. Ranney, MD, MPH; Marian E. Betz, MD, MPH; Garen J. Wintemute, MD, MPH
CME Objective: To review current evidence for epidemiology; health benefits, harms, and risk groups; screening; prevention; and practice improvement of preventing firearm-related death and injury.
Funding Source: American College of Physicians.
Disclosures: Dr. Ranney, ACP Contributing Author, reports grants from the National Institute of Child Health and Human Development during the conduct of the study and grants from the National Institute of Mental Health outside the submitted work and is a pro bono officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM). Dr. Wintemute, ACP Contributing Author, reports grants from the Heising-Simons Foundation and The California Wellness Foundation during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0333.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive 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. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
With the assistance of additional physician writers, the editors of Annals of Internal Medicine develop In the Clinic using MKSAP and other resources of the American College of Physicians.
In the Clinic does not necessarily represent official ACP clinical policy. For ACP clinical guidelines, please go to https://www.acponline.org/clinical_information/guidelines/.
Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.
Firearm suicide and homicide rates, by age, 2017.
Data from reference 1.
Ranking for firearm-related suicide and homicide among all causes of death, by age, 2017.
From reference 1. Causes of death were calculated by separating homicides by firearm from homicides by all other mechanisms and suicides by firearm from suicides by all other mechanisms.
Firearm mortality rate in males, by type and race, 2017.
Age-adjusted firearm suicide and homicide rates, by state, 2017.
Data from reference 1. Hawaii, New Hampshire, North Dakota, Vermont, and Wyoming have suppressed firearm homicide rates.
* Unstable value for rate of firearm homicide.
Odds of suicide and homicide in the context of firearm access.
From reference 17.
Appendix Table 1. Characteristics of Studies of Suicide and Homicide Victimization
Appendix Table 2. Literature Review of the Effectiveness of Clinician Intervention Regarding Firearm Safety
Four common devices for safe firearm storage.
A. Cable lock. Cable locks are among the least expensive options for safer storage, and some local police departments distribute them for free. A cable placed through the magazine well and out the ejection port renders the weapon incapable of being fired. B. Trigger lock. Trigger locks are also inexpensive. The cylinder of the lock is placed behind the trigger so that it cannot be pulled; the other half of the device is attached and locked into place. C. Lock box. Lock boxes come in various sizes for different-sized firearms. They can have combination locks or fingerprint-style locks for quick access, and may be most useful for those who own firearms for personal protection. Some lock boxes come with a cable to allow users to attach the box to a secure fixture. D. Firearm safe. Firearm safes may have locks that use combinations, keys, keypads, or biometric technology. They can be expensive to purchase and install; however, they can often accommodate multiple firearms and firearms of different sizes.
Misuse alcohol or other substances
Have a history of violent behavior
Have dementia or another form of poor mental function
Have serious and poorly controlled mental illness
Have an abusive partner
Young black and Hispanic men are at higher risk for homicide by gun.
Middle-aged or older non-Hispanic white men are at higher risk for suicide by gun.
Children who visit or reside in a home with a gun are at higher risk for injury or death by gun.
Should I be concerned about firearm safety?
What should I do to protect my family from injury if I own a gun?
Why is proper gun storage so important?
How can I safely store my firearms?
How can I get help if I am feeling suicidal or violent?
How can I help a friend or family member who has access to guns and is suicidal or violent?
Pallin R, Spitzer SA, Ranney ML, et al. Preventing Firearm-Related Death and Injury. Ann Intern Med. 2019;170:ITC81–ITC96. doi: https://doi.org/10.7326/AITC201906040
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Published: Ann Intern Med. 2019;170(11):ITC81-ITC96.
Emergency Medicine, Prevention/Screening.
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