UNC-Chapel Hill Researchers Offer a Public Health Perspective on Gun Violence
Institute for Global Health and Infectious Diseases
When doctor of nursing practice student Brittany Alexander sat down to pen an assigned op-ed for her political advocacy class, she tried to write about a topic from her work treating patients at the University of North Carolina at Chapel Hill’s Infectious Diseases Clinic. But as she began to type, the fears she faced each morning dropping her two daughters off at school flooded the page.
“I really worry about a shooting at their school,” Alexander said. “I should not be scared to send my children to school, but I am. I just wrote from my heart.”
Alexander’s fears are supported by research that counted school shootings from 2013-2015, which totaled 160 incidents, or nearly one shooting a week.
But mass shootings don’t paint the full picture of how a gun is used when it falls into the wrong hands. Adam Goldstein is a professor in UNC-Chapel Hill’s Department of Family Medicine. He led the first study to survey clinicians about whether or not they talked with patients about guns in the home, especially those who exhibited symptoms of depression. Firearms are used in 50 percent of suicides.
UNC-Chapel Hill epidemiology doctoral student Josie Caves researches intimate partner violence. She said 60 percent of female homicides involve an intimate partner, and 50 percent of those murders are committed using a firearm.
Andres Villaveces, adjunct professor of epidemiology, looks at gun violence from a global perspective. He was a part of a team that explored 130 studies in 10 countries that looked at gun regulations and the subsequent impact on homicides, suicides and unintentional deaths.
Exploring the findings of all three researchers is important for gaining a clearer picture of the effect of guns on public health. Gun laws are a polarizing issue in the United States. To be clear, none of the investigators in this article are advocating for the abolishment of the Second Amendment. Their research looks at how additional training and effective implementation of existing laws can reduce gun deaths.
The Physician’s Role
Goldstein remembers feeling uncomfortable when patients would ask him to certify that they were competent to carry a concealed weapon.
“I tried to think of an analogous situation, like assessing whether a person was healthy enough to drive,” Goldstein said. “But it really isn’t the same question. Under what conditions is this person competent to carry a gun? How do I know they know how to use this weapon? What if they develop Parkinson’s disease? It really got me thinking about a physician’s role. As providers, we have little training about guns, and we don’t have a set list of competency criteria.”
Goldstein decided to reach out to his colleagues for answers. He led a team that surveyed 223 psychiatrists, family medicine doctors and primary care providers in North Carolina. The survey results revealed that only 25 percent of clinicians reported having conversations with patients about firearms and firearm safety often or very often. And nearly 50 percent said they had not asked depressed patients about firearms in the home.
“We uncovered something really simple – we don’t do something we’re uncomfortable with,” Goldstein said. “But while we don’t do something, patients are dying, and that’s a disgrace.”
And his colleagues agree. Eighty percent of the survey’s respondents said that gun violence is a serious public health issue that should be included in medical training. And those providers who had undergone continuing medical education on gun safety were three times more likely to engage in counseling patients on firearm injury prevention.
“This is just a function of training,” Goldstein says. “If we make the training available, providers will feel more comfortable having a discussion about firearms with their patients. And we’re not saying, ‘don’t have a gun.’ We’re just counseling on risk reduction and firearm safety.”
Intimate Partner Violence
Caves most recent study is funded by a grant established in honor of a victim of the very research Caves seeks to better understand – intimate partner violence. She is the first recipient of IntraHealth International’s Raluca Iosif Intimate Partner Violence Research Award. Raluca Iosif, who worked at IntraHealth, was shot and killed by a former boyfriend in Durham in the fall of 2015.
“She lived near my cousin, so it really brought my research home for me,” Caves said. “I am honored to be the first recipient of this award, and I feel tremendous pressure to do meaningful research through this grant in her name and for IntraHealth.”
Sadly, the incident involving Iosif is not a rare occurrence. Intimate partner violence involving a firearm is a major public health problem. Every 16 hours, an American woman is shot dead by a current or former partner, according to an Associated Press analysis of FBI and state crime data. Yet, if a partner has a violent past, there are laws in place that aim to reduce gun access. It’s these regulations Caves studies.
The 1996 Lautenberg Amendment prohibits people convicted of assault of their spouse or child from owning or purchasing a gun. It also bans firearm ownership by people under a permanent protective order. Yet flaws in this amendment exist, as people do not always turn over the guns they already own.
“Enforcing existing laws around firearm surrender is very challenging for police,” Caves said. “That may be why research shows that laws mandating confiscation of firearms typically are not associated with lower rates of intimate partner homicides, while laws restricting an offender’s ability to purchase and possess firearms are.”
That’s why research from the intimate partner violence field suggests that closing the “boyfriend loophole” may be impactful. Currently, an offender has to be married to or have a child with the person they have assaulted in order to lose their gun rights. Changing this federal amendment to include a ban on the ability to purchase a gun by anyone convicted of committing a violent act against a dating partner would help save lives and keep firearms out of the hands of more people with violent tendencies.
Some states have enacted their own laws to close the “boyfriend loophole.” In fact, a study by researchers at Michigan State University showed a 10 percent lower rate of intimate partner homicide when firearm restrictions that cover all dating partners were enforced.
Four states have taken the Lautenberg Amendment even further, prohibiting firearm possession and purchases by anyone convicted of a violent misdemeanor, regardless of their relationship to the victim. These four states saw a 23 percent lower rate of intimate partner homicides as compared to states without violent misdemeanor legislation.
“Broadening the definition of domestic violence may help,” Caves said. “My research goal is to flesh out the circumstances where regulations can lower rates of violence and where regulations are unnecessary.”
Villaveces first began studying the impact of gun regulations on homicides while working in Colombia in the 1990s. To combat violence, two cities implemented a ban on carrying concealed guns during high risk times, which were from 6 p.m. to 6 a.m. on weekends and holidays. The restrictions led to a 14 percent drop in homicides.
“This law had a powerful effect on public health as it saved hundreds if not thousands of lives in Colombia,” Villaveces said.
Fast forward to 2016 and Villaveces was part of a team that conducted the first study of how gun laws affect violence around the world. He and his colleagues combed through 130 studies in 10 countries, including the U.S. They wanted to know if firearm regulations had any effect on homicides, suicides and unintentional injuries.
“We found different firearm legislative approaches were more effective than others in decreasing mortality,” said Villaveces.
For example, laws requiring background checks reduced the rates of intimate partner homicides. And laws dictating how a firearm should be stored led to lower rates of unintentional deaths in children.
In 1997, Austria not only passed a firearm law that required background checks and safe storage, but also limited access to certain guns, like semiautomatic rifles. Firearm homicides dropped by nearly five percent, and suicides decreased by nearly 10 percent.
Looking toward the future, Villaveces said he would like to study how technology can be harnessed to make gun ownership safer.
“There could be technological changes or solutions we could develop that allow only the gun’s owner to be able to use the firearm,” said Villaveces. “This would be especially helpful for preventing a child who finds a gun from using it.”
Finding a Middle Ground
Gun ownership is a right in the United States. But so, too, is the right to live without the fear of being shot at a concert, at a school or at home. Keeping firearms out of the hands of people who are depressed, partners who have a history of violence and children saves lives.
Alexander is hopeful more trainings and regulations aimed at these three at-risk populations will one day allay her fears at school drop-off.
“As a society, we need to be comfortable saying that not everyone should have access to a gun,” she said. “We need to value human life first.”
January 23, 2023