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Impact on Nonfirearm Deaths of Firearm Laws Affecting Firearm Deaths: A Systematic Review and Meta-Analysis.

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Title: Impact on Nonfirearm Deaths of Firearm Laws Affecting Firearm Deaths: A Systematic Review and Meta-Analysis.
Authors: Smart, Rosanna (AUTHOR), Schell, Terry L. (AUTHOR), Cefalu, Matthew (AUTHOR), Morral, Andrew R. (AUTHOR)
Source: American Journal of Public Health. Oct2020, Vol. 110 Issue 10, pe1-e9. 9p.
Subjects: Gun laws, Suicide & psychology, Books, Homicide, Legal databases, MEDLINE, Meta-analysis, Online information services, Systematic reviews
Abstract: Background. There is debate whether policies that reduce firearm suicides or homicides are offset by increases in non–firearm-related deaths. Objectives. To assess the extent to which changes in firearm homicides and suicides following implementation of various gun laws affect nonfirearm homicides and suicides. Search Methods. We performed a literature search on 13 databases for studies published between 1995 and October 31, 2018 (PROSPERO CRD42019120105). Selection Criteria. We included studies if they (1) estimated an effect of 1 of 18 included classes of gun policy on firearm homicides or suicides, (2) included a control group or comparison group and evaluated time series data to establish that policies preceded their purported effects, and (3) provided estimated effects of the policy and inferential statistics for either total or nonfirearm homicides or suicides. Data Collection and Analysis. We extracted data from each study, including study timeframe, population, and statistical methods, as well as point estimates and inferential statistics for the effects of firearm policies on firearm deaths as well as either nonfirearm or overall deaths. We assessed quality at the estimate (study–policy–outcome) level by using prespecified criteria to evaluate the validity of inference and causal identification. For each estimate, we derived the mortality multiplier (i.e., the ratio of the policy's effect on total homicides or suicides; expressed as a change in the number of deaths) as a proportion of its effect on firearm homicides or suicides. Finally, we performed a meta-analysis to estimate overall mortality multipliers for suicide and homicide that account for both within- and between-study heterogeneity. Main Results. We identified 16 eligible studies (study timeframes spanning 1977–2015). All examined state-level policies in the United States, with most estimating effects of multiple policies, yielding 60 separate estimates of the mortality multiplier. From these, we estimated that a firearm law's effect on homicide, expressed as a change in the number of total homicide deaths, is 0.99 (95% confidence interval = 0.76, 1.22) times its effect on the number of firearm homicides. Thus, on average, changes in the number of firearm homicides caused by gun policies are neither offset nor compounded by second-order effects on nonfirearm homicides. There is insufficient evidence in the existing literature on suicide to indicate the extent to which the effects of gun policy changes on firearm suicides are offset or compounded by their effects on nonfirearm suicides. Authors' Conclusions. State gun policies that reduce firearm homicides are likely to reduce overall homicides in the state by approximately the same number. It is currently unknown whether the same holds for state gun policies that significantly reduce firearm suicides. The small number of studies meeting our inclusion criteria, issues of methodological quality within those studies, and the possibility of reporting bias are potential limitations of this review. Public Health Implications. Policies that reduce firearm homicides likely have large benefits for public health as there is little evidence to support a strong substitution effect between firearm and nonfirearm homicides at the population level. Further research is needed to determine whether policies that produce population-level reductions in firearm suicides will translate to overall declines in suicide rates. [ABSTRACT FROM AUTHOR]
Copyright of American Journal of Public Health is the property of American Public Health Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Impact on Nonfirearm Deaths of Firearm Laws Affecting Firearm Deaths: A Systematic Review and Meta-Analysis.
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  Data: <searchLink fieldCode="AR" term="%22Smart%2C+Rosanna%22">Smart, Rosanna</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schell%2C+Terry+L%2E%22">Schell, Terry L.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cefalu%2C+Matthew%22">Cefalu, Matthew</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Morral%2C+Andrew+R%2E%22">Morral, Andrew R.</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22American+Journal+of+Public+Health%22">American Journal of Public Health</searchLink>. Oct2020, Vol. 110 Issue 10, pe1-e9. 9p.
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  Data: <searchLink fieldCode="DE" term="%22Gun+laws%22">Gun laws</searchLink><br /><searchLink fieldCode="DE" term="%22Suicide+%26+psychology%22">Suicide & psychology</searchLink><br /><searchLink fieldCode="DE" term="%22Books%22">Books</searchLink><br /><searchLink fieldCode="DE" term="%22Homicide%22">Homicide</searchLink><br /><searchLink fieldCode="DE" term="%22Legal+databases%22">Legal databases</searchLink><br /><searchLink fieldCode="DE" term="%22MEDLINE%22">MEDLINE</searchLink><br /><searchLink fieldCode="DE" term="%22Meta-analysis%22">Meta-analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Online+information+services%22">Online information services</searchLink><br /><searchLink fieldCode="DE" term="%22Systematic+reviews%22">Systematic reviews</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Background. There is debate whether policies that reduce firearm suicides or homicides are offset by increases in non–firearm-related deaths. Objectives. To assess the extent to which changes in firearm homicides and suicides following implementation of various gun laws affect nonfirearm homicides and suicides. Search Methods. We performed a literature search on 13 databases for studies published between 1995 and October 31, 2018 (PROSPERO CRD42019120105). Selection Criteria. We included studies if they (1) estimated an effect of 1 of 18 included classes of gun policy on firearm homicides or suicides, (2) included a control group or comparison group and evaluated time series data to establish that policies preceded their purported effects, and (3) provided estimated effects of the policy and inferential statistics for either total or nonfirearm homicides or suicides. Data Collection and Analysis. We extracted data from each study, including study timeframe, population, and statistical methods, as well as point estimates and inferential statistics for the effects of firearm policies on firearm deaths as well as either nonfirearm or overall deaths. We assessed quality at the estimate (study–policy–outcome) level by using prespecified criteria to evaluate the validity of inference and causal identification. For each estimate, we derived the mortality multiplier (i.e., the ratio of the policy's effect on total homicides or suicides; expressed as a change in the number of deaths) as a proportion of its effect on firearm homicides or suicides. Finally, we performed a meta-analysis to estimate overall mortality multipliers for suicide and homicide that account for both within- and between-study heterogeneity. Main Results. We identified 16 eligible studies (study timeframes spanning 1977–2015). All examined state-level policies in the United States, with most estimating effects of multiple policies, yielding 60 separate estimates of the mortality multiplier. From these, we estimated that a firearm law's effect on homicide, expressed as a change in the number of total homicide deaths, is 0.99 (95% confidence interval = 0.76, 1.22) times its effect on the number of firearm homicides. Thus, on average, changes in the number of firearm homicides caused by gun policies are neither offset nor compounded by second-order effects on nonfirearm homicides. There is insufficient evidence in the existing literature on suicide to indicate the extent to which the effects of gun policy changes on firearm suicides are offset or compounded by their effects on nonfirearm suicides. Authors' Conclusions. State gun policies that reduce firearm homicides are likely to reduce overall homicides in the state by approximately the same number. It is currently unknown whether the same holds for state gun policies that significantly reduce firearm suicides. The small number of studies meeting our inclusion criteria, issues of methodological quality within those studies, and the possibility of reporting bias are potential limitations of this review. Public Health Implications. Policies that reduce firearm homicides likely have large benefits for public health as there is little evidence to support a strong substitution effect between firearm and nonfirearm homicides at the population level. Further research is needed to determine whether policies that produce population-level reductions in firearm suicides will translate to overall declines in suicide rates. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of American Journal of Public Health is the property of American Public Health Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.2105/AJPH.2020.305808
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      – Code: eng
        Text: English
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        PageCount: 9
        StartPage: e1
    Subjects:
      – SubjectFull: Gun laws
        Type: general
      – SubjectFull: Suicide & psychology
        Type: general
      – SubjectFull: Books
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      – SubjectFull: Homicide
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      – SubjectFull: MEDLINE
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      – SubjectFull: Meta-analysis
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      – SubjectFull: Online information services
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      – SubjectFull: Systematic reviews
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      – TitleFull: Impact on Nonfirearm Deaths of Firearm Laws Affecting Firearm Deaths: A Systematic Review and Meta-Analysis.
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              Text: Oct2020
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