The future of firearm violence prevention: building on success.

THROUGH THE LATE 1980S AND EARLY 1990S, A TRUE epidemic of firearm-related interpersonal violence developed in the United States. Commentators noted that the concurrent decline in motor vehicle– related injuries had resulted from a comprehensive intervention strategy rooted in the principles of public health and disease prevention. They proposed similar strategies for preventing firearm-related violence. Since 1993, rates of firearm-related violence have been declining. The decrease is substantial: in 1997, the firearm homicide rate in the United States was 4.6 per 100 000 persons per year, comparable to rates seen last in the mid1960s and briefly in the mid-1980s. Preliminary Federal Bureau of Investigation data for 1998 show a further 8% decrease in homicides overall. What exactly has been accomplished, and how has it been done? Since the early 1970s the nation’s firearm homicide rate has shown no long-term trend but has both risen and fallen. Is its decline since 1993 simply another fluctuation? I would argue that it is not. The decline results, at least in part, from synergy between effective interventions of many types that are coming to be seen as an evidence-based comprehensive strategy to prevent violence. This article briefly reviews several important interventions that have addressed firearm-related violence directly, discusses the evidence on which they are based, and proposes additional measures to help build on these successes. The steady increase in the homicide rate from 1985 to 1993 was largely confined to persons aged 15 to 34 years and was specific to firearms. The impact on teenagers and young adults was staggering. For both black and white males aged 15 to 24 years, the firearm homicide rate roughly doubled just from 1987 to 1993, even as the nonfirearm homicide rate decreased. By 1993, 53.9% of all deaths among black males aged 15-24 years were firearm homicides. The risk of sustaining a firearm injury was greatest for young males who were already involved in the criminal justice system, and most perpetrators were drawn from that same group. Firearm-related violence was highly concentrated geographically: half of all homicides occurred in 63 cities with 16% of the nation’s population; within those cities, homicides were largely clustered in certain neighborhoods. These findings suggested that a mixture of behavioral interventions targeting high-risk people and environments and interventions targeting the distribution and design of firearms was likely to produce significant benefits. Behavioral interventions have played a substantial role in reducing firearm-related violence. In 1 controlled trial, highvisibility police patrols with a mission to identify and confiscate illegal street firearms were associated with a 49% decrease in firearm-related crime, an effect achieved not so much by the confiscation of firearms per se, as by an increased police presence in known firearm crime hot spots. “Gun-oriented policing,” beginning with increased hot spot patrols and expanding to include aggressive enforcement of other gun laws, has been linked to a 60% decrease in firearm homicide in New York City between 1991 and 1996. Complementary interventions have focused on suppliers of firearms used in crime. In an ever-increasing number of cities, comprehensive tracing by the Bureau of Alcohol, Tobacco and Firearms (ATF) of all guns used in crime or illegally possessed has made it much easier to identify illegal surrogate or “straw” purchasers and firearms traffickers. Prosecutions are often pursued under federal laws, which carry stiffer penalties. Tougher licensure requirements have decreased the number of federally licensed firearms dealers from 244 000 in 1993, when the nation had more licensed firearms dealers than gas stations, to fewer than 90 000 in 1998. This has eliminated many “kitchen table” dealers, a number of whom had been implicated in gun trafficking investigations. Handguns purchased as part of large-volume transactions appear to be at increased risk for use in crime. Virginia, long a major source state for guns used in crime in the more restrictive New England states, limited handgun sales to no more than 1 per month per person in 1993. The percentage of guns used in crimes in New England that were purchased in Virginia dropped from 35% before the law took effect to 16% thereafter. Background checks conducted under the Brady Handgun Violence Prevention Act and related state statutes prevent the purchase of firearms by 70 000 to 80 000 felons and other prohibited persons each year. Such denials work; fel-