Alcohol restrictions and firearm prohibitions based on mental illness: Effects on fatal and nonfatal firearm injuries

项目总结/摘要 枪支暴力是美国一个紧迫的公共卫生问题，造成近4万人死亡。 每年死亡人数;估计每年另有70，000人入院或 急诊室处理与枪支有关的伤害多种因素导致枪支暴力的风险， 这些危险因素可能因受伤类型、受伤严重程度或社区环境而异。酒精滥用 某些形式的精神疾病与自杀和暴力受害风险密切相关。的 酗酒和心理健康问题对枪支暴力的影响还不太清楚， 我们有有限的证据来说明针对这些风险因素的政策是否可以在人口水平上 产生有意义的减少火器伤害和死亡率。 该项目利用了非致命性和致命性火器伤害率的巨大差异 跨越州和时间。这项研究估计了具体的国家政策在多大程度上与 随后枪支死亡率和发病率的变化，以及这些影响是否更明显 对于某些人群或类型的火器伤害。具体来说，它使用了一个新构建的国家级面板 火器伤住院数据集，结合现有的火器死亡率数据，以评估酒精如何 限制和基于精神疾病的火器禁令影响火器伤害和死亡率。我们认为 显示出减少酒精使用或滥用流行率的几项酒精政策，包括经验证的复合材料 衡量一个州的酒精政策环境的整体实力的指标。精神疾病枪支 禁止，我们认为国家政策，（a）扩大个人的范围，禁止枪支 （B）提高国家执行此类禁令的能力，或（c）授权 暂时从有伤害自己或他人的严重危险的个人手中拿走火器。使用 贝叶斯统计方法和模型更适合于枪支40年的面板数据 死亡率，我们估计这些政策对致命和非致命火器伤害的因果影响。我们也 评估这些政策的影响是否因受害者性别、伤害意图（例如，自杀与杀人）， 以及社区枪支可用性（以一个州拥有枪支的家庭百分比衡量）。 研究结果可以告知严重火器伤害的发生率如何受到减少使用火器的策略的影响。 酒精或防止枪支接触的个人精神疾病或确定是一个危险， 自己或他人。这项研究有助于确定有效降低枪支使用率的具体国家政策 暴力，并提供深入了解新的政策或计划，可能进一步减少火器伤害， 死亡

PROJECT SUMMARY/ABSTRACT Firearm violence is a pressing public health problem in the United States, resulting in nearly 40,000 deaths annually; it is estimated an additional 70,000 individuals each year are admitted to hospitals or emergency departments for firearm-related injuries. A variety of factors contribute to risk of firearm violence, and these risk factors may differ across injury types, injury severity, or community contexts. Alcohol misuse and some forms of mental illness are strongly associated with suicide and risk of violence victimization. The contribution of alcohol use and mental health problems to firearm-specific violence is less well-understood, and we have limited evidence to inform whether policies targeting these risk factors at the population level can generate meaningful reductions in rates of firearm injury and deaths. This project takes advantage of the substantial variability in rates of nonfatal and fatal firearm injury across states and over time. The research estimates the extent to which specific state policies are associated with subsequent changes in firearm mortality and morbidity, and whether those effects are more pronounced for certain populations or types of firearm injury. Specifically, it uses a newly constructed state-level panel dataset of firearm injury hospitalizations, combined with existing firearm mortality data, to assess how alcohol restrictions and mental illness-based firearm prohibitions affect firearm injury and mortality. We consider several alcohol policies shown to reduce prevalence of alcohol use or misuse, including a validated composite metric that measures the overall strength of a state’s alcohol policy environment. For mental illness firearm prohibitions, we consider state policies that (a) expand the scope of individuals prohibited from firearm possession based on mental illness, (b) improve states’ abilities to enforce such prohibitions, or (c) authorize the temporary removal of firearms from individuals at acute risk of harming themselves or others. Using Bayesian statistical methods and models shown to be more appropriate for the 40-year panel data of firearm mortality, we estimate the causal effects of these policies on both fatal and nonfatal firearm injuries. We also assess whether the effects of these policies vary by victim gender, injury intent (e.g., suicide versus homicide), and community firearm availability (measured by the percent of households in a state that own firearms). Findings can inform how the prevalence of serious firearm injuries is affected by strategies to reduce use of alcohol or to prevent firearms access by individuals with mental illness or determined to be a danger to themselves or others. This research helps to identify specific state policies effective at reducing rates of firearm violence and provides insight into novel policies or programs that may further reduce firearm injuries and deaths.