Firearm Surrender Laws: Prompting Promise for Women's Health
Authors: Joslyn Fisher, Amy Bonomi
Journal: Annals of Internal Medicine (2017)

Editorials17 October 2017Firearm Surrender Laws: Prompting Promise for Women's HealthFREEJoslyn Fisher, MD, MPH and Amy Bonomi, PhD, MPHJoslyn Fisher, MD, MPHFrom Baylor College of Medicine, Houston, Texas, and Michigan State University, East Lansing, Michigan.Search for more papers by this author and Amy Bonomi, PhD, MPHFrom Baylor College of Medicine, Houston, Texas, and Michigan State University, East Lansing, Michigan.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2399 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Homicide is a leading cause of death in women of childbearing age (1). Further, more than half of female homicides with a known perpetrator are committed by a current or former intimate partner (2). Firearm access in the home exacerbates the risk for homicide by an intimate partner (3). Although federal legislation, such as the Violence Against Women Act, restricts domestic abusers' access to firearms, state and local implementation of these regulations is highly variable.In this issue, Díez and colleagues report a timely study that informs a simmering national debate about firearm-related policy (4). The researchers used data from the Federal Bureau of Investigation's Uniform Crime Reports to investigate the effect of “relinquishment” laws on intimate partner homicide rates across all 50 states from 1991 to 2015. Relinquishment laws are those that prohibit firearm possession by domestic abusers who are subject to a restraining order and require abusers to surrender their firearms.The authors' findings are promising: States with relinquishment laws were found to have intimate partner homicide rates that were significantly (14%) lower than in states without these laws. In contrast, non–statistically significant reductions were observed in states with laws that prohibited firearm possession by abusers who were subject to a restraining order but did not require abusers to surrender the firearms. Taken together, these findings underscore the importance of firearm surrender within broader policy debates about domestic abuse.One notable challenge in Díez and colleagues' study involves potential confounding factors. For example, other federal and state laws implemented during the study period, such as laws pertaining to civil protection orders and stalking, may also have been related to homicide rates. It is also possible that states with firearm relinquishment laws also have more robust community outreach and social media campaigns against intimate partner violence.Despite these limitations, the findings underscore the likely benefit of state-level policy that removes firearms completely from the hands of abusers by requiring that they surrender them to approved authorities. In addition, the study is a call to action across 3 important clinical and policy arenas for health care professionals advocating for our patients' health.First, as health care professionals, we are reminded of our critical role in clinic-based screening for intimate partner violence and related risks (including firearms in the home) (3). Intimate partner violence affects 1 in 3 women (5) and is associated with significant clinical morbidity for which women seek health care (6). The U.S. Preventive Services Task Force supports clinical screening for intimate partner violence in women of reproductive age (7), with referral to community-based advocates (8) to provide safety planning and assist in obtaining resources, such as civil protection orders (9).Second, as members of influential health organizations, such as the American College of Physicians (ACP), we can advocate for our larger community of patients. For example, the ACP influenced the overturning of Florida's firearms gag rule. Díez and colleagues' findings further support the “Call to Action From 8 Professional Health Organizations and the American Bar Association,” which included a call for increased research to discover strategies to diminish firearm-related harms (10).Third, as health care professionals, we can educate and influence our local, state, and national policymakers to support evidence-based legislative efforts that help our patients. We can encourage policymakers to adopt firearm surrender policies, which would remove firearms from the hands of domestic abusers. In these efforts, we can provide informed feedback on how policies—such as those described by Díez and colleagues (4)—affect our patients' morbidity and mortality, and we can press for increased funding for research to investigate effective interventions.Through these actions across clinical and policy settings, we are directly and indirectly aiding women's health and well-being and advancing an overall movement to improve conditions for women. For women in abusive relationships, the essential advocacy we provide across these clinical and policy settings serves to buffer against abuse, connect women to important resources (8, 9), and potentially prevent women's premature death.References1. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed at www.cdc.gov/injury/wisqars/index.html on 7 September 2017. Google Scholar2. Petrosky E, Blair JM, Betz CJ, Fowler KA, Jack SPD, Lyons BH. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence — United States, 2003–2014. MMWR Morb Mortal Wkly Rep. 2017;66:741-6. [PMID: 28727682] doi:10.15585/mmwr.mm6628a1 CrossrefMedlineGoogle Scholar3. Campbell JC, Webster D, Koziol-McLain J, Block C, Campbell D, Curry MA, et al. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health. 2003;93:1089-97. [PMID: 12835191] CrossrefMedlineGoogle Scholar4. Díez C, Kurland RP, Rothman EF, Bair-Merritt M, Fleegler E, Xuan Z, et al. State intimate partner violence–related firearm laws and intimate partner homicide rates in the United States, 1991 to 2015. Ann Intern Med. 2017;167:536-43. doi:10.7326/M16-2849 LinkGoogle Scholar5. Black MC, Basile KC, Breiding MJ, Smith SG, Walters ML, Merrick MT, et al. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2011. Google Scholar6. Rivara FP, Anderson ML, Fishman P, Bonomi AE, Reid RJ, Carrell D, et al. Healthcare utilization and costs for women with a history of intimate partner violence. Am J Prev Med. 2007;32:89-96. [PMID: 17234483] CrossrefMedlineGoogle Scholar7. Moyer VA, U.S. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;158:478-86. [PMID: 23338828]. doi:10.7326/0003-4819-158-6-201303190-00588 LinkGoogle Scholar8. Sullivan CM, Bybee DI. Reducing violence using community-based advocacy for women with abusive partners. J Consult Clin Psychol. 1999;67:43-53. [PMID: 10028208] CrossrefMedlineGoogle Scholar9. Holt VL, Kernic MA, Wolf ME, Rivara FP. Do protection orders affect the likelihood of future partner violence and injury? Am J Prev Med. 2003;24:16-21. [PMID: 12554019] CrossrefMedlineGoogle Scholar10. Weinberger SE, Hoyt DB, Lawrence HC, Levin S, Henley DE, Alden ER, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015;162:513-6. [PMID: 25706470]. doi:10.7326/M15-0337 LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Baylor College of Medicine, Houston, Texas, and Michigan State University, East Lansing, Michigan.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2399.Corresponding Author: Joslyn Fisher, MD, MPH, Department of Medicine, Ben Taub General Hospital, Baylor College of Medicine, 1504 Ben Taub Loop, Houston, TX 77030; e-mail, [email protected]edu.Current Author Addresses: Dr. Fisher: Department of Medicine, Ben Taub General Hospital, Baylor College of Medicine, 1504 Ben Taub Loop, Houston, TX 77030.Dr. Bonomi: Human Development & Family Studies, Michigan State University, 552 West Circle Drive, East Lansing, MI 48824.This article was published at Annals.org on 19 September 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoState Intimate Partner Violence–Related Firearm Laws and Intimate Partner Homicide Rates in the United States, 1991 to 2015 Carolina Díez , Rachel P. Kurland , Emily F. Rothman , Megan Bair-Merritt , Eric Fleegler , Ziming Xuan , Sandro Galea , Craig S. Ross , Bindu Kalesan , Kristin A. Goss , and Michael Siegel Metrics Cited byPreventing Violence-Related Maternal Death: A Call to ActionThe Health Care Professional's Pledge: Protecting Our Patients From Firearm InjuryChristine Laine, MD, MPH and Darren B. Taichman, MD, PhD 17 October 2017Volume 167, Issue 8Page: 591-592KeywordsFirearm injuriesHealth careHealth care policyHomicideHospital medicineIntimate partner violenceMorbidityObstetrics and gynecologyPatient advocacySafety ePublished: 19 September 2017 Issue Published: 17 October 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...