Public Perceptions of Firearm- and Non–Firearm-Related Violent Death in the United States: A National Study
Authors: Erin R. Morgan, Ali Rowhani-Rahbar, Deborah Azrael, Matthew Miller
Journal: Annals of Internal Medicine (2018)

Letters20 November 2018Public Perceptions of Firearm- and Non–Firearm-Related Violent Death in the United States: A National StudyFREEErin R. Morgan, MS, Ali Rowhani-Rahbar, MD, PhD, Deborah Azrael, PhD, and Matthew Miller, MD, ScDErin R. Morgan, MSSchool of Public Health and Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington (E.R.M., A.R.), Ali Rowhani-Rahbar, MD, PhDSchool of Public Health and Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington (E.R.M., A.R.), Deborah Azrael, PhDHarvard T.H. Chan School of Public Health and Harvard Injury Control Research Center, Harvard University, Boston, Massachusetts (D.A.), and Matthew Miller, MD, ScDBouvé College of Health Sciences, Northeastern University, and Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts (M.M.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1533 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Persons tend to estimate the likelihood of events, such as the risk for homicide versus suicide, in proportion to the ease with which they can retrieve examples of these incidents from memory (1). Because the recency of personal experience and media coverage can influence this retrieval (1–3), misperceptions about the relative frequency of suicide versus homicide—the leading causes of intentionally inflicted (that is, violent) death from external causes (such as firearms)—may be common. In the United States, suicide is twice as common as homicide, and suicide by firearm is more common than homicide by firearm (4). However, no nationally representative study has assessed public perceptions of the relative frequency of these leading causes of violent death. This study addresses this subject. We hope that identifying the scope of actuarial misperceptions among the U.S. population in general and among those who own or live with firearm owners in particular might facilitate discussions about firearm ownership and storage.Objective: To describe public misperceptions about the relative frequency of violent death by intent (homicide vs. suicide) and means (firearm vs. nonfirearm) at the national level.Methods and Findings: We used data from the National Firearms Survey, a nationally representative Web-based survey of U.S. adults conducted by Growth for Knowledge in April 2015. Details are described elsewhere (5). A total of 3949 participants were presented with 4 options on the intent and means of violent death (homicide with a gun, homicide with a weapon other than a gun, suicide with a gun, and suicide by a method other than a gun) and asked to rank order the frequency of these outcomes in their state in an average year (Supplement).We used the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System to rank these 4 options in each state between 2014 and 2015 (the year before the survey was conducted and the year that it was conducted, respectively) (4). Survey respondents were characterized by their ability to correctly rank the frequency of violent death in their state by intent and means.Between 2014 and 2015, more suicides than homicides occurred in every state. Suicide by firearm was the most frequent cause of violent death in 29 states (Figure). A total of 3811 respondents answered the question on the relative frequency of the intent and means of violent death in their state. Only 13.5% (95% CI, 11.5% to 15.8%) of U.S. adults correctly identified the most frequent cause of violent death (Table). Furthermore, 20.0% (CI, 10.3% to 35.4%) of health care professionals among the 1880 respondents who reported their occupation and 12.4% (CI, 8.3% to 18.2%) of U.S. adults with a history of mental illness answered correctly. For violent deaths involving firearms, 25.9% (CI, 23.2% to 28.8%) correctly identified the most frequent intent. Correct identification did not vary by respondents' firearm ownership status.Figure. Crude incidence rates of violent deaths by means (firearm vs. nonfirearm) and intent (suicide vs. homicide) in 50 states based on data from the Centers for Disease Control and Prevention, 2014–2015.The rate of firearm homicide in Hawaii, New Hampshire, North Dakota, and Vermont and the rate of nonfirearm homicide in New Hampshire, North Dakota, Vermont, and Wyoming should be interpreted with caution, because their numerators comprise ≤20 deaths. Data on intent of violent death were obtained from the Web-based Injury Statistics Query and Reporting System.* A total of 30.6% (95% CI, 27.7%–33.5%) of U.S. adults correctly identified the most frequent intent of nonfirearm violent death in their state. Download figure Download PowerPoint Table. U.S. Adults Who Correctly Identified the Most Frequent Cause of Violent Death in Their State*Discussion: Suicide was more common than homicide in all states, and suicide by firearm was more common than homicide by firearm in all states except Illinois, Maryland, and New Jersey. However, most U.S. adults—including health care professionals—did not identify the most frequent intent and means of violent death in their state. These findings are consistent with the well-established relationship between risk perception and the ease with which a pertinent categorical example can be summoned from memory, which in most persons is probably affected by the salience of homicides in media coverage (1, 2).Our findings suggest that correcting misperceptions about the relative frequency of firearm-related violent deaths may make persons more cognizant of the actuarial risks to themselves and their family, thus creating new opportunities for prevention. If communication strategies could enhance the accuracy of perceived risk, some persons living in households with firearms might be motivated to remove these weapons from their home or at least keep unsafely stored firearms locked and unloaded to reduce access by potentially vulnerable family members. Future research should evaluate whether and under what circumstances promoting awareness about the relative frequency of suicide versus homicide (overall and by firearm), combined with evidence that firearm access increases the risk for suicide several-fold, enhances more accurate risk perception and motivates behavioral change regarding firearm storage.References1. Kahneman D. Thinking, Fast and Slow. New York: Farrar, Straus & Giroux; 2011. Google Scholar2. Genovesi AL, Donaldson AE, Morrison BL, Olson LM. Different perspectives: a comparison of newspaper articles to medical examiner data in the reporting of violent deaths. Accid Anal Prev. 2010;42:445-51. [PMID: 20159065] doi:10.1016/j.aap.2009.09.006 CrossrefMedlineGoogle Scholar3. Sagarin BJ, Cialdini RB, Rice WE, Serna SB. Dispelling the illusion of invulnerability: the motivations and mechanisms of resistance to persuasion. J Pers Soc Psychol. 2002;83:526-41. [PMID: 12219852] CrossrefMedlineGoogle Scholar4. Centers for Disease Control and Prevention. WISQARS (Web-based Injury Statistics Query and Reporting System). 2018. Accessed at www.cdc.gov/injury/wisqars on 6 March 2018. Google Scholar5. Betz ME, Azrael D, Barber C, Miller M. Public opinion regarding whether speaking with patients about firearms is appropriate: results of a national survey. Ann Intern Med. 2016;165:543-50. [PMID: 27455516]. doi:10.7326/M16-0739 LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: School of Public Health and Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington (E.R.M., A.R.)Harvard T.H. Chan School of Public Health and Harvard Injury Control Research Center, Harvard University, Boston, Massachusetts (D.A.)Bouvé College of Health Sciences, Northeastern University, and Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts (M.M.)See also: Related article (page 704) and editorial comment (page 725).Acknowledgment: The authors thank Drs. Carmen Gonzalez and John Crowley for encouraging work on this project.Financial Support: By the Fund for a Safer Future and The Joyce Foundation.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1533.Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Ms. Morgan (e-mail, [email protected]edu).This article was published at Annals.org on 30 October 2018. 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Bornstein, MD, and Christine Laine, MD, MPHWhat Can I Do as a Physician to Prevent Firearm Injury?James S. Kahn, MD 20 November 2018Volume 169, Issue 10Page: 734-737KeywordsDeath ratesDisclosureFirearm injuriesForecastingHealth careHomicideMemoryPerceptionStatistical dataSuicide ePublished: 30 October 2018 Issue Published: 20 November 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...