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