Special Article
Effects of Restrictive Licensing of Handguns on Homicide and Suicide in the District of Columbia
N Engl J Med 1991; 325:1615-1620December 5, 1991DOI: 10.1056/NEJM199112053252305
- Abstract
- Abstract
Background
Whether restricting access to handguns will reduce firearm-related homicides and suicides is currently a matter of intense debate. In 1976 the District of Columbia adopted a law that banned the purchase, sale, transfer, or possession of handguns by civilians. We evaluated the effect of implementing this law on the frequency of homicides and suicides.
Methods
Homicides and suicides committed from 1968 through 1987 were classified according to place of occurrence (within the District of Columbia or in adjacent metropolitan areas where the law did not apply), cause (homicide or suicide), mechanism of death (firearms or other means), and time of occurrence (before or after the implementation of the law). The number of suicides and homicides was calculated for each month during the study period, and differences between the mean monthly totals before and after the law went into effect were estimated.
Results
In Washington, D.C., the adoption of the gun-licensing law coincided with an abrupt decline in homicides by firearms (a reduction of 3.3 per month, or 25 percent) and suicides by firearms (reduction, 0.6 per month, or 23 percent). No similar reductions were observed in the number of homicides or suicides committed by other means, nor were there similar reductions in the adjacent metropolitan areas in Maryland and Virginia. There were also no increases in homicides or suicides by other methods, as would be expected if equally lethal means were substituted for handguns.
Conclusions
Restrictive licensing of handguns was associated with a prompt decline in homicides and suicides by firearms in the District of Columbia. No such decline was observed for homicides or suicides in which guns were not used, and no decline was seen in adjacent metropolitan areas where restrictive licensing did not apply. Our data suggest that restrictions on access to guns in the District of Columbia prevented an average of 47 deaths each year after the law was implemented. (N Engl J Med 1991;325:1615–20.)
Media in This Article
Figure 1
Number of Homicides by Firearms per Month in Washington, D.C.Figure 2
Number of Suicides by Firearms per Month in Washington, D.C.Article Activity
- Article
BY any measure, firearms — especially handguns — are a leading instrument of violent injury. In 1987, firearms accounted for 32,919 fatalities in the United States: 18,144 suicides, 12,665 homicides, and 2110 unintentional fatalities, legal interventions (killings by law-enforcement officials), or deaths of undetermined type.1 Sixty percent of all homicides and suicides during this year were committed with guns,1 and handguns accounted for three fourths of the homicides by firearms.2
A central question in research on the prevention of gunrelated mortality is whether restricting access to handguns would reduce deaths by firearms.3 One approach to the issue is to examine patterns of mortality associated with changes in local, state, or national regulations. In 1976 the District of Columbia adopted one of the most restrictive handgun policies in the nation. The law prohibited the purchase, sale, transfer, and possession of handguns by civilians in Washington, D.C., unless a citizen already owned the handgun and had registered it under an existing system.4 We conducted an interrupted time-series study to determine whether the implementation of the law reduced gunrelated homicides and suicides.
Methods
The Law
The District of Columbia's Firearms Control Regulations Act was signed by the mayor on July 23, 1976, and went into effect on September 24, 1976. A restraining order issued on December 9, 1976, interrupted its enforcement for 49 days, but the Appeals Court of the District of Columbia reinstated the law, and its provisions became fully effective again on February 21, 1977.5
The law restricts the possession of firearms to persons who hold registration certificates. Persons who owned firearms at the time the law was implemented and who had registered them under the provisions of the 1968 code were given 60 days to reregister them. After the initial reregistration period, handguns became "unregisterable" and therefore illegal. Newly acquired rifles and shotguns can be registered if they are obtained in person from a licensed dealer in the district and if the owner meets specified requirements relating to age, criminal record, physical fitness, and knowledge of firearms laws and safe use. Finally, the law requires that registrants keep firearms unloaded and disassembled or locked up except while they are being used for lawful recreational purposes or when they are kept at a place of business. The penalty originally specified for violation of the law was 10 days in jail and a $$300 fine. It was increased to one year in jail and a $$1,000 fine in March 1981.
Study Design
We undertook a longitudinal study, comparing the mean monthly numbers of gunrelated homicides and suicides in the District of Columbia before the law was implemented with the numbers after its implementation. Comparisons with other areas and other types of deaths were used to determine whether the observed differences were specific to the District of Columbia. For comparison we used suicides and homicides committed in the district without firearms, homicides and suicides committed with firearms in adjacent metropolitan areas in Maryland and Virginia, and homicides and suicides committed without firearms in the adjacent metropolitan areas.
Definition and Classification of Cases
Monthly totals of homicides and suicides in the District of Columbia and suburban Maryland and Virginia during the period 1968 through 1987 (the last year for which data were available) were obtained from tapes produced by the National Center for Health Statistics (NCHS).1 The cases were classified according to place of occurrence (within the District of Columbia or in an adjacent metropolitan area), cause of death (homicide or suicide), mode of death (firearms or other means), and month of occurrence. The adjacent metropolitan areas were the parts of the Washington, D.C.—Maryland—Virginia Standard Metropolitan Statistical Area (SMSA) as constituted in 1967,6 exclusive of the District of Columbia. Specifically, this area included the cities of Alexandria, Fairfax, and Falls Church, Virginia; Arlington, Fairfax, Loudoun, and Prince William counties in Virginia; and Montgomery and Prince George's counties in Maryland.
The cause and mechanism of death in each case were classified according to the codes in the International Classification of Diseases, 8th Revision (ICD-8) and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).7 , 8 Four groups were defined: homicide by firearms (codes E965 in ICD-8 and E965.0 through E965.4 in ICD-9-CM); homicide by other means (E960 through E964 and E966 through E969 in ICD-8, and E960 through E964 and E965.5 through E969 in ICD-9-CM); suicide by firearms (E955 in ICD-8 and E955.0 through E955.4 in ICD-9-CM); and suicide by other means (E950 through E954 and E956 through E959 in ICD-8, and E950 through E954 and E955.5 through E959 in ICD-9-CM). Unintentional deaths (E922) and deaths caused by firearms in which the intent was unknown (E980 through E989) were excluded because the monthly frequencies were too low for meaningful analysis. A further refinement that would have classified deaths as caused by specific types of firearms, such as handguns, was not possible because the ICD-8 codes did not distinguish handguns from other firearms. In all, eight separate 240-month time series (105 months before the implementation of the law and 135 months thereafter) were analyzed. The first month after the law went into effect was October 1976.
As a check against possible effects of changes in the population, we conducted a similar analysis using annual mortality rates. For the District of Columbia, which is treated as a state for reporting purposes, annual population estimates from 1968 through 1987 for five age groups (<5, 5 through 19, 20 through 44, 45 through 64, and 3≥65 years) were taken from NCHS vital-statistics records.9 For the adjacent metropolitan areas, population estimates according to age were not available, but total population estimates for 1968 through 1987 were obtained from the Census Bureau's Current Population Reports (the values for 1969, 1978, and 1979 were interpolated, because county-level estimates were not generated by the Census Bureau for those years).10 , 11 For the District of Columbia, age-standardized rates were calculated by the direct method, with the population of the district enumerated in the 1970 census as the standard.12 Crude rates were calculated for the surrounding metropolitan areas. The first year after the law was implemented that is included in the annual analysis is 1977.
Statistical Analysis
Statistical inferences were based on two approaches. First, the observations were assumed to be independently sampled from the populations in the District of Columbia before and after the implementation of the law. According to this model, the difference between the mean monthly rates of fatalities is an estimate of the magnitude of the intervention (i.e., the effect of the law), and the statistical significance of the differences can be assessed with the usual t-test. 13 Second, because observations in a time series are often not independent (that is, they are serially correlated), we also applied Box and Tiao's methods14 for intervention analysis. Box-Tiao methods are based on the autoregressive, integrated, moving-average time-series models proposed by Box and Jenkins.15 Following a strategy recommended by Box and Jenkins, we used the data to identify and estimate appropriate models for within-series correlation. Components representing the effect of the intervention (the law) were then added. For each series, we considered models in which change was abrupt and permanent, gradual and permanent, or abrupt and temporary.16 All these analyses were conducted with use of algorithms in the SCA Statistical System software. 17
For the analysis of the data on monthly frequency, serial correlation was minimal; therefore, the simple t-test statistics are presented. For some of the annual mortality rates, there was evidence of a relatively strong serial correlation among the observations. For these series, statistical inferences are based on the more complex Box—Tiao models. Details about the Box—Tiao estimates are available elsewhere.* All P values are two-tailed.
Results
In the District of Columbia, the mean frequency of both suicides and homicides by firearms declined by about one quarter in the period after the law went into effect (Table 1Table 1
Mean Numbers of Homicides and Suicides per Month, According to Jurisdiction and Method, before and after the Implementation of the District of Columbia Law.). Gunrelated homicides, with a mean of 13.0 per month before the law was implemented, declined to a mean of 9.7 per month thereafter (Fig. 1Figure 1Number of Homicides by Firearms per Month in Washington, D.C.). Similarly, suicides in which guns were used declined from a mean of 2.6 per month to 2.0 per month (Fig. 2Figure 2Number of Suicides by Firearms per Month in Washington, D.C.). When we used both a sampling model that assumed independent observations (Table 1) and one that assumed serial dependence of observations,* these differences between the means before and after the law went into effect were statistically significant (P<0.001 for homicides and P = 0.005 for suicides). Accordingly, the data are consistent with a model in which there was a decrease in the number of deaths by firearms after the law was implemented.In contrast, none of the comparison time series showed declines of similar magnitude during the same period. Non-gunrelated homicides (Fig. 3Figure 3
Number of Homicides by Means Other than Firearms per Month in Washington, D.C.) and non-gunrelated suicides (Fig. 4Figure 4
Number of Suicides by Means Other than Firearms per Month in Washington, D.C.) in the District of Columbia declined only slightly (by 0.3 per month, or 4 percent, for homicides, and by 0.4 per month, or 9 percent, for suicides). Neither of these differences was statistically significant.The adjacent areas in Maryland and Virginia, which were not subject to the change in gun regulations, did not have declines in gunrelated homicides and suicides similar to those observed in the District of Columbia. The mean for gunrelated homicides in these adjacent areas after the District of Columbia law was implemented was lower by 0.4 homicide per month (a decline of 7 percent), but the rate of suicides in which guns were used was higher by 1.1 per month (an increase of 12 percent). Neither difference represents a statistically significant decline.
The series of cases in Maryland and Virginia provide additional evidence that the decline in fatalities was specific to suicides and homicides by firearms in the District of Columbia. Homicides committed with other weapons in Maryland and Virginia increased by 23 percent, or 0.7 homicide per month, whereas the frequency of suicides by other methods changed very little: there was a decrease of 0.2 suicide per month, or 2 percent.
The analysis of annual mortality rates gave results similar in general pattern to those of the analysis of the monthly data. The Box—Tiao estimates are available elsewhere.* In the District of Columbia the rates of both homicides and suicides by firearms declined in the period after the law went into effect (P<0.001 and P = 0.085, respectively); at the same time, the rate of homicides committed by other means increased (P = 0.082) and that of suicides by other means did not change (P = 0.653). In the surrounding metropolitan area there were no significant changes in the annual mortality rates.
In summary, there was an abrupt decline in both suicides and homicides by firearms that coincided with the implementation of the restrictive licensing law. The reductions were specific to fatalities involving guns in the District of Columbia. No similar reduction was observed in homicides or suicides committed without guns, nor were there reductions in the adjacent areas of Maryland and Virginia, where the provisions of the law were not in effect.
Discussion
The strongest argument for attributing the reductions in homicides and suicides by firearms in the District of Columbia to the restrictive licensing law is the relative implausibility of alternative explanations. Earlier studies of the District of Columbia law, which were published a few years after the law was implemented,18 , 19 were limited by a paucity of data and by the investigators' failure to compare deaths by firearms and deaths by other means. These studies demonstrated declines in violent crime but did not successfully show that the declines were limited to the District of Columbia or to violence involving guns. Accordingly, critics noted that the declines were probably due to confounding demographic trends or to unrelated criminal-justice policies.20 , 21
In the light of our study, alternative explanations appear implausible. The pattern of change in mortality rates that would be predicted from the effects of the gun law is specific and is unlikely to be simulated by coincidental changes in demographic, economic, cultural, or social factors. For example, economic factors might alter the homicide rate or the suicide rate, but it is unlikely that they would affect only deaths involving guns and that the changes would be limited to the District of Columbia. Similarly, improvements in the medical treatment of gunshot wounds since the Vietnam War or marked changes in the activities of the drug underworld might have reduced gunrelated fatalities, but the expected pattern of changes would not be those that we observed. Improved medical treatment would be available in both the city and the suburbs, and changes in the drug underworld would not influence both homicides and suicides. Furthermore, the analysis of mortality rates indicates that the declines in homicides and suicides by firearms were not due to changes in characteristics of the resident population. The population estimates are, of course, subject to error, and complex changes in high-risk groups are also possible. Nevertheless, the population at risk was the same for both gunrelated and non-gunrelated mortality. Therefore, the differences between the rate of mortality by firearms and that of mortality due to other causes cannot be attributed to a failure to study the appropriate population.
The best explanation for the District of Columbia data is the weapon-choice theory developed by Zimring,22 Cook,23 and others.24 , 25 According to this view, assaults, whether against others or self-directed, vary with respect to intent to kill. Some are characterized by a sustained, single-minded determination, whereas in others the intention is more episodic and ambivalently motivated. If the resolve is weak or short-lived, the relative frequency with which a particular type of weapon is used will be influenced by its availability.23 The key element in the theory is that firearms are more likely to cause death than are other weapons that are likely to be substituted. It follows that even if there is no change in the number of assaults or suicide attempts, a reduction in the availability of guns will result in a reduction in the number of deaths. The theory recognizes that people with more deadly intent may tend to select guns rather than other means, but it assumes that the association is less than perfect. Some people select guns because they are determined to kill, but others do so only because a gun is readily available.
The observations in the District of Columbia fit the predictions of the Zimring—Cook theory well. Especially interesting is the fact that in the District of Columbia there were no compensating increases in homicides or suicides by methods other than guns, as has been suggested in other studies.26 , 27 The effects of the law were apparently truly preventive, in the sense that there was an overall reduction in the number of deaths. There may have been an increase in nonlethal injuries from weapons other than guns, but surveillance data on nonfatal injuries are not available.
The most surprising feature of the District of Columbia experience is the magnitude and suddenness of the effect. Observers expected the gun-licensing law to have limited or gradual effects because it "grandfathered" previously registered handguns and did not directly remove existing guns from their owners. In addition, observers argued that social conditions, including high levels of criminal violence and fear of victimization, were not affected and that there would
thus continue to be a high level of demand for illegal guns that could easily be supplied from neighboring jurisdictions.23 , 28 In spite of these limitations, the law reduced gunrelated suicides and homicides substantially and abruptly. Because people voluntarily disposed of guns or altered their patterns of storage and use, or because it was more difficult to obtain a new gun, the District of Columbia had about 47 fewer gun deaths each year after the restrictive licensing law was implemented.
The facts that the frequency of gunrelated homicides remained high in the District of Columbia after the gun law went into effect and that there have been dramatic increases in homicides very recently are not incompatible with the argument that the restrictive licensing law had a preventive effect on homicides. The number of homicides is determined by many factors other than legal restrictions on access to guns. Since the economic and social conditions in the district are similar to those associated with high rates of homicide in other cities, it is not surprising that the frequency of homicide remained high in the District of Columbia or that in the district, as in many other cities in the late 1980s, there were dramatic increases in homicides attributable to the spread of "crack" cocaine.23 , 29 , 30 It is reasonable to assume that the restrictions on access to guns in the district continued to exert a preventive effect even as homicide rates were driven up by conflict over drugs and other factors.
The data from the District of Columbia provide strong evidence that restrictive licensing of handguns reduced gunrelated homicides and suicides, but they have limited usefulness in generalizing to other jurisdictions or to other policies designed to limit access to handguns. Comparative studies of other gun-licensing laws would provide information on which to base wider generalizations and increase our understanding of the factors that influence the preventive effect of licensing laws.
Source Information
From the Violence Research Group, Institute of Criminal Justice and Criminology, University of Maryland at College Park, 2220 Lefrak Hall, College Park, MD 20742–8235, where reprint requests should be addressed to Dr. Loftin.
- References
References
*
NAPS document no. 04909 for four pages of supplementary material. Order from NAPS c/o Microfiche Publications, P.O. Box 3513, Grand Central Station, New York, NY 10163–3513. Remit in advance (in U.S. funds only) $7.75 for photocopies or $5 for microfiche. Outside the U.S. and Canada add postage of $4.50 ($1.75 for microfiche postage). There is a $15 invoicing charge on all orders filled before payment.
*
NAPS document no. 04909 for four pages of supplementary material. Order from NAPS c/o Microfiche Publications, P.O. Box 3513, Grand Central Station, New York, NY 10163–3513. Remit in advance (in U.S. funds only) $7.75 for photocopies or $5 for microfiche. Outside the U.S. and Canada add postage of $4.50 ($1.75 for microfiche postage). There is a $15 invoicing charge on all orders filled before payment.
1
Department of Health and Human Services, National Center for Health Statistics. Mortality detail files, 1968 to 1987. Ann Arbor, Mich.: Inter-university Consortium for Political and Social Research [distributor], 1990 (computer files).
2
Federal Bureau of Investigation. Crime in the United States, 1987. Washington, D.C.: Federal Bureau of Investigation, 1988.
3
Mercy
Full Text | Web of Science | Medline4
District of Columbia Firearms Control Regulations Act (D.C. Law 1–85), D.C. Code Ann. §6–2301, et seq. (1990). Charlottesville, Va.: Michie, 1990.
5
Wentworth 6
Bureau of the Budget. Standard metropolitan statistical areas. Washington, D.C.: Government Printing Office, 1967.
7
National Center for Health Statistics. International classification of diseases, adapted for use in the United States. 8th rev. Washington, D.C.: Government Printing Office, 1967. (PHS publication no. 1693.)
8
Department of Health and Human Services. ICD-9-CM: international classification of diseases, clinical modification. 3rd ed., 9th rev. Vol. 1. Washington, D.C.: Government Printing Office, 1989. (DHHS publication no. (PHS) 89–1260.)
9
National Center for Health Statistics. Vital statistics of the United States. Vol. 2. Mortality, part A. 1968 to 1987. Washington, D.C.: Government Printing Office, 1972–1990.
10
Bureau of the Census. Current population reports 1968 to 1974. Series P-25. Nos. 432, 517, 537, 629, 688, 694. Washington, D.C.: Government Printing Office, 1969–1977.
11
Idem. Current population reports 1974 to 1987. Series P-26. Nos. 75–46, 76–20, 76–46, 77–20, 77–46, 78–20, 78–46, 85-MD-C, 85-VA-C, 88-B. Washington, D.C.: Government Printing Office, 1976–1990.
12
Idem. Census of the population, 1970, characteristics of the population, District of Columbia. Vol. 1. Part 10. Washington, D.C.: Government Printing Office, 1973.
13
Cochran WG. Planning and analysis of observational studies. New York: John Wiley, 1983.
14
Box
CrossRef | Web of Science15
Box GEP, Jenkins GM. Time-series analysis: forecasting and control. Rev. ed. San Francisco: Holden-Day, 1976.
16
McDowall D, McCleary R, Meidinger EE, Hay RA. Interrupted time series analysis. Beverly Hills, Calif.: Sage, 1980.
17
Liu LM, Hudak GB, Box GEP, Muller ME, Tiao GC. The SCA statistical system: reference manual for forecasting and time series analysis. Version III for MSDOS. DeKalb, I11.: Scientific Computing Associates, 1986 (computer software program).
18
Nicholson R, Gamer A. The analysis of the Firearms Control Act of 1975: handgun control in the District of Columbia. Washington, D.C.: United States Conference of Mayors, 1980.
19
Jones
CrossRef | Web of Science20
Wright JD, Rossi PH, Daly K. Under the gun: weapons, crime, and violence in America. New York: Aldine, 1983.
21
Valentine 22
Zimring
CrossRef23
Cook PJ. The technology of personal violence. In: Tonry M, ed. Crime and justice: an annual review of research. Vol. 14. Chicago: University of Chicago Press, 1991:1–71.
24
Baker
CrossRef | Web of Science | Medline25
Sloan
Full Text | Web of Science | Medline26
Rich
Web of Science | Medline27
Sloan
Free Full Text | Web of Science | Medline28
Zimring
CrossRef | Web of Science29
Office of Criminal Justice Plans and Analysis, Statistical Analysis Center. Homicide in the District of Columbia. Washington, D.C.: Office of Criminal Justice Plans and Analysis, 1988.
30
Morin
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J. R. CUTCLIFFE, C. STEVENSON. (2008) Commentary. Journal of Psychiatric and Mental Health Nursing 15:10.1111/jpm.2008.15.issue-2, 154-160
CrossRef39
Brendan G. Carr, C William Schwab, Charles C. Branas, Mara Killen, Douglas J. Wiebe. (2008) Outcomes Related to the Number and Anatomic Placement of Gunshot Wounds. The Journal of Trauma: Injury, Infection, and Critical Care 64, 197-203
CrossRef40
Young People and Violence. 2008:, 675-684.
CrossRef41
D Gunnell, R Fernando, M Hewagama, W D D Priyangika, F Konradsen, M Eddleston. (2007) The impact of pesticide regulations on suicide in Sri Lanka. International Journal of Epidemiology 36, 1235-1242
CrossRef42
Philip J. Cook, Jens Ludwig. (2007) Aiming for evidence-based gun policy. Journal of Policy Analysis and Management 25:10.1002/pam.v25:3, 691-735
CrossRef43
M. Humeau, N. Papet, N. Jaafari, L. Gotzamanis, N. Lafay, J.-L. Senon. (2007) Disponibilité des armes à feu et risque suicidaire: revue de la littérature. Annales Médico-psychologiques, revue psychiatrique 165, 269-275
CrossRef44
H. Oyama, M. Fujita, M. Goto, H. Shibuya, T. Sakashita. (2006) Outcomes of Community-Based Screening for Depression and Suicide Prevention Among Japanese Elders. The Gerontologist 46, 821-826
CrossRef45
Elmar Etzersdorfer, Nestor D. Kapusta, Gernot Sonneck. (2006) Suicide by shooting is correlated to rate of gun licenses in Austrian counties. Wiener klinische Wochenschrift 118, 464-468
CrossRef46
SHAWN D. BUSHWAY, DAVID MCDOWALL. (2006) HERE WE GO AGAIN?CAN WE LEARN ANYTHING FROM AGGREGATE-LEVEL STUDIES OF POLICY INTERVENTIONS?. Criminology <html_ent glyph="@amp;" ascii="&"/> Public Policy 5:10.1111/cpp.2006.5.issue-3, 461-470
CrossRef47
A. L. Beautrais, D. M. Fergusson, L. J. Horwood. (2006) Firearms legislation and reductions in firearm-related suicide deaths in New Zealand. Australian and New Zealand Journal of Psychiatry 40:10.1111/anp.2006.40.issue-3, 253-259
CrossRef48
Jeffrey A. Bridge, Tina R. Goldstein, David A. Brent. (2006) Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry 47:10.1111/jcpp.2006.47.issue-3-4, 372-394
CrossRef49
Thomas Reisch, Konrad Michel. (2005) Securing a Suicide Hot Spot: Effects of a Safety Net at the Bern Muenster Terrace. Suicide and Life-Threatening Behavior 35:10.1521/suli.2005.35.issue-4, 460-467
CrossRef50
Linda L Dahlberg, Alexander Butchart. (2005) State of the science: violence prevention efforts in developing and developed countries. International Journal of Injury Control and Safety Promotion 12, 93-104
CrossRef51
Beth E. Molnar, Andrea L. Roberts, Angela Browne, Hannah Gardener, Stephen L. Buka. (2005) What girls need: recommendations for preventing violence among urban girls in the US. Social Science & Medicine 60, 2191-2204
CrossRef52
ELIZABETH GRIFFITHS, JORGE M. CHAVEZ. (2004) COMMUNITIES, STREET GUNS AND HOMICIDE TRAJECTORIES IN CHICAGO, 1980-1995: MERGING METHODS FOR EXAMINING HOMICIDE TRENDS ACROSS SPACE AND TIME*. Criminology 42:10.1111/crim.2004.42.issue-4, 941-978
CrossRef53
Kenneth R. Conner. (2004) A Call for Research on Planned vs. Unplanned Suicidal Behavior. Suicide and Life-Threatening Behavior 34:10.1521/suli.2004.34.issue-2, 89-98
CrossRef54
Sarah P. Kennedy, Larry J. Baraff, Robert L. Suddath, Joan R. Asarnow. (2004) Emergency department management of suicidal adolescents. Annals of Emergency Medicine 43, 452-460
CrossRef55
Thomas M. Wickizer, Branko Kopjar, Gary Franklin, Jutta Joesch. (2004) Do Drug-Free Workplace Programs Prevent Occupational Injuries? Evidence from Washington State. Health Services Research 39:10.1111/hesr.2004.39.issue-1, 91-110
CrossRef56
Kenneth R Conner, Yueying Zhong. (2003) State firearm laws and rates of suicide in men and women. American Journal of Preventive Medicine 25, 320-324
CrossRef57
TOMISLAV V. KOVANDZIC, THOMAS B. MARVELL. (2003) RIGHT-TO-CARRY CONCEALED HANDGUNS AND VIOLENT CRIME: CRIME CONTROL THROUGH GUN DECONTROL?*. Criminology <html_ent glyph="@amp;" ascii="&"/> Public Policy 2:10.1111/cpp.2003.2.issue-3, 363-396
CrossRef58
Douglas J. Wiebe. (2003) Homicide and suicide risks associated with firearms in the home: A national case-control study. Annals of Emergency Medicine 41, 771-782
CrossRef59
MADELYN S. GOULD, TED GREENBERG, DREW M. VELTING, DAVID SHAFFER. (2003) Youth Suicide Risk and Preventive Interventions: A Review of the Past 10 Years. Journal of the American Academy of Child & Adolescent Psychiatry 42, 386-405
CrossRef60
Yeates Conwell, Paul R. Duberstein, Kenneth Connor, Shirley Eberly, Christopher Cox, Eric D. Caine. (2002) Access to Firearms and Risk for Suicide in Middle-Aged and Older Adults. The American Journal of Geriatric Psychiatry 10, 407-416
CrossRef61
Pamela Wilcox. (2002) Self-Help? Examining the Anti-Crime Effectiveness of Citizen Weapon Possession. Sociological Focus 35, 145-167
CrossRef62
David Shaffer, Cynthia R. Pfeffer. (2001) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior. Journal of the American Academy of Child & Adolescent Psychiatry 40, 24S-51S
CrossRef63
David A. Brent. (2001) Firearms and Suicide. Annals of the New York Academy of Sciences 932, 225-240
CrossRef64
Madelyn S. Gould, Rachel A. Kramer. (2001) Youth Suicide Prevention. Suicide and Life-Threatening Behavior 31:10.1521/suli.2001.31.issue-supplement_to_is, 6-31
CrossRef65
Rosa Gofin, Malka Avitzour, Ziona Haklai, Navah Jellin. (2000) Intentional injuries among the young: presentation to emergency rooms, hospitalization, and death in Israel. Journal of Adolescent Health 27, 434-442
CrossRef66
(2000) Suicide acts in 8 states: incidence and case fatality rates by demographics and method. American Journal of Public Health 90, 1885-1891
CrossRef67
Peter Cummings. (2000) Should Your Neighbor Buy a Gun?. Epidemiology 11, 617-619
CrossRef68
DAVID A. BRENT, MARIANNE BAUGHER, BORIS BIRMAHER, DAVID J. KOLKO, JEFF BRIDGE. (2000) Compliance With Recommendations to Remove Firearms in Families Participating in a Clinical Trial for Adolescent Depression. Journal of the American Academy of Child & Adolescent Psychiatry 39, 1220-1226
CrossRef69
Jane M. Burns, George C. Patton. (2000) Preventive interventions for youth suicide: a risk factor-based approach. Australian and New Zealand Journal of Psychiatry 34, 388-407
CrossRef70
Kim M. Blankenship, Sarah J. Bray, Michael H. Merson. (2000) Structural interventions in public health. AIDS 14, S11-S21
CrossRef71
James F. Anderson, Laronistine Dyson, Elizabeth B. Perkins. (2000) Confronting paralyzing crime. The Justice Professional 12, 327-341
CrossRef72
Wintemute , Garen J. , Parham , Carrie A. , Beaumont , James Jay , Wright , Mona , Drake , Christiana , . (1999) Mortality among Recent Purchasers of Handguns. New England Journal of Medicine 341:21, 1583-1589
Free Full Text73
Kelli A. Komro. (1999) Adolescents' Access to Firearms: Epidemiology and Prevention. Journal of Health Education 30, 290-296
CrossRef74
Louis E Christie. (1999) Australian gun controls: Should more be done?. Emergency Medicine Australasia 11, 94-100
CrossRef75
Matthew Miller, David Hemenway. (1999) The relationship between firearms and suicide. Aggression and Violent Behavior 4, 59-75
CrossRef76
Teret , Stephen P. , Webster , Daniel W. , Vernick , Jon S. , Smith , Tom W. , Leff , Deborah , Wintemute , Garen J. , Cook , Philip J. , Hawkins , Darnell F. , Kellermann , Arthur L. , Sorenson , Susan B. , DeFrancesco , Susan , . (1998) Support for New Policies to Regulate Firearms — Results of Two National Surveys. New England Journal of Medicine 339:12, 813-818
Free Full Text77
Darci Cherry, Joseph L Annest, James A Mercy, Marcie-jo Kresnow, Daniel A Pollock. (1998) Trends in Nonfatal and Fatal Firearm-Related Injury Rates in the United States, 1985–1995. Annals of Emergency Medicine 32, 51-59
CrossRef78
Mark S. Kaplan, Olga Geling. (1998) Firearm suicides and homicides in the United States: regional variations and patterns of gun ownership. Social Science & Medicine 46, 1227-1233
CrossRef79
Carl C. Bell, David C. Clark. (1998) ADOLESCENT SUICIDE. Pediatric Clinics of North America 45, 365-380
CrossRef80
Lorraine H. Freed, Jon S. Vernick, Stephen W. Hargarten. (1998) PREVENTION OF FIREARM-RELATED INJURIES AND DEATHS AMONG YOUTH. Pediatric Clinics of North America 45, 427-438
CrossRef81
Yoshitomo Takahashi, Hideto Hirasawa, Keiko Koyama. (1998) Restriction of suicide methods: A japanese perspective. Archives of Suicide Research 4, 101-107
CrossRef82
Firearms Task Force. (1998) Consensus statement on youth suicide by firearms. Archives of Suicide Research 4, 89-94
CrossRef83
Steven Stack. (1998) Research on controlling suicide: Methodological issues. Archives of Suicide Research 4, 95-99
CrossRef84
Yeates Conwell. (1997) MANAGEMENT OF SUICIDAL BEHAVIOR IN THE ELDERLY. Psychiatric Clinics of North America 20, 667-683
CrossRef85
Rivara , Frederick P. , Grossman , David C. , Cummings , Peter , . (1997) Injury Prevention. New England Journal of Medicine 337:9, 613-618
Full Text86
Bonita Stanton, Robert M. Baldwin, Laura Rachuba. (1997) A QUARTER CENTURY OF VIOLENCE IN THE UNITED STATES. Psychiatric Clinics of North America 20, 269-282
CrossRef87
H Morgenstern. (1997) Gun availability and violent death.. American Journal of Public Health 87, 899-901
CrossRef88
Ted R. Miller, Mark A. Cohen. (1997) Costs of gunshot and cut/stab wounds in the United States, with some Canadian comparisons. Accident Analysis & Prevention 29, 329-341
CrossRef89
Cameron Crandall, Lenora Olson, Lynne Fullerton, David Sklar, Ross Zumwalt. (1997) Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978-1993. Academic Emergency Medicine 4:10.1111/acem.1997.4.issue-4, 263-267
CrossRef90
David A. Brent. (1997) Practitioner Review: Practitioner Review: The Aftercare of Adolescents with Deliberate Self-harm. Journal of Child Psychology and Psychiatry 38:10.1111/jcpp.1997.38.issue-3, 277-286
CrossRef91
Jukka Hintikka, Johannes Lehtonen, Heimo Viinamäki. (1997) Hunting guns in homes and suicides in 15--24--year-old males in Eastern Finland. Australian and New Zealand Journal of Psychiatry 31, 858-861
CrossRef92
Paul Fornes, Laurent Druilhe, Dominique Lecomte. (1996) Homicide Among Youth and Young Adults, 15 Through 29 Years of Age. A Report of 138 Cases from Paris and Its Suburbs, 1991–1993. Journal of Forensic Sciences 41, 14006J
CrossRef93
Alexander W. Gotta. (1996) TRAUMA. Anesthesiology Clinics of North America 14, 1-12
CrossRef94
ANNAKATRI OHBERG, JOUKO LONNQVIST, SEPPO SARNA, ERKKI VUORI. (1996) Violent Methods Associated with High Suicide Mortality among the Young. Journal of the American Academy of Child & Adolescent Psychiatry 35, 144-153
CrossRef95
Michael Dudley, Chris Cantor, Greg de Moore. (1996) Jumping the gun: firearms and the mental health of Australians. Australian and New Zealand Journal of Psychiatry 30, 370-381
CrossRef96
Gary Kleck. (1995) Using speculation to meet evidence: Reply to alba and messner. Journal of Quantitative Criminology 11, 411-424
CrossRef97
Lawrence W. Sherman, Dennis P. Rogan. (1995) Effects of gun seizures on gun violence: “Hot spots” patrol in Kansas city. Justice Quarterly 12, 673-693
CrossRef98
Abraham N. Tennenbaum, Edward L. Fink. (1994) Temporal regularities in homicide: Cycles, seasons, and autoregression. Journal of Quantitative Criminology 10, 317-342
CrossRef99
A. J. Flisher, C. D. H. Parry. (1994) Suicide in South Africa.. Acta Psychiatrica Scandinavica 90:10.1111/acp.1994.90.issue-5, 348-353
CrossRef100
(1994) Guns in the Home. New England Journal of Medicine 330:16, 1157-1159
Free Full Text101
E Y Deykin, S L Buka. (1994) Suicidal ideation and attempts among chemically dependent adolescents.. American Journal of Public Health 84, 634-639
CrossRef102
Gregg A Pane, Ellen H Taliaferro. (1994) Health care cost containment: An overview of policy options. Annals of Emergency Medicine 23, 103-108
CrossRef103
Thore Karlsson, Bosse Isaksson, Kari Ormstad. (1993) Gunshot Fatalities in Stockholm, Sweden with Special Reference to the Use of Illegal Weapons. Journal of Forensic Sciences 38, 13545J
CrossRef104
Kellermann , Arthur L. Rivara , Frederick P. Rushforth , Norman B. Banton , Joyce G. Reay , Donald T. Francisco , Jerry T. Locci , Ana B. Prodzinski , Janice Hackman , Bela B. Somes , Grant (1993) Gun Ownership as a Risk Factor for Homicide in the Home. New England Journal of Medicine 329:15, 1084-1091
Free Full Text105
Gary Kleck, E. Britt Patterson. (1993) The impact of gun control and gun ownership levels on violence rates. Journal of Quantitative Criminology 9, 249-287
CrossRef106
Beverly P. Giordano. (1993) The next generation deserves a gun-free world. AORN Journal 58, 13-15
CrossRef107
David C Clark. (1993) Suicidal Behavior in Childhood and Adolescence: Recent Studies and Clinical Implications. Psychiatric Annals 23, 271-283
CrossRef108
Mary Fran Hazinski, Louis Hugo Francescutti, Garry D Lapidus, Sylvia Micik, Frederick P Rivara. (1993) Pediatric injury prevention. Annals of Emergency Medicine 22, 456-467
CrossRef109
Kellermann , Arthur L. , Rivara , Frederick P. , Somes , Grant , Reay , Donald T. , Francisco , Jerry , Banton , Joyce Gillentine , Prodzinski , Janice , Fligner , Corinne , Hackman , Bela B. , . (1992) Suicide in the Home in Relation to Gun Ownership. New England Journal of Medicine 327:7, 467-472
Free Full Text110
Leonard B Lerer. (1992) Women, homicide and alcohol in cape town, south africa. Forensic Science International 55, 93-99
CrossRef111
Katherine Kaufer Christoffel. (1992) Pediatric Firearm Injuries: Time to Target a Growing Population. Pediatric Annals 21, 430-436
CrossRef112
Robert B. Lufkin. (1992) Why we should speak out for restriction of handguns. Journal of Magnetic Resonance Imaging 2:10.1002/jmri.v2:4, 489-489
CrossRef113
(1992) Effects of Restrictive Handgun Laws. New England Journal of Medicine 326:17, 1157-1161
Free Full Text114
Trudy A. Karlson. (1992) Injury control and public policy. Critical Reviews in Environmental Control 22, 195-241
CrossRef115
Kassirer , Jerome P. , . (1991) Firearms and the Killing Threshold. New England Journal of Medicine 325:23, 1647-1650
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