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Extreme risk protection orders (ERPOs) provide a civil mechanism to temporarily remove firearm access from individuals at high risk of harming themselves or others. Evidence and theory suggest that ERPOs can prevent firearm-related harm, but the policy's impact on racial/ethnic equity is largely unknown. To examine potential inequities by race/ethnicity in public perceptions and use of California's ERPO law, we drew on two complementary data sources: 1) a 2020 state-representative survey of California adults, and 2) ERPO court documents for the first 3 years of policy implementation (2016-2018). Majorities (54-89%) of all racial/ethnic groups reported that ERPOs are at least sometimes appropriate, and 64-94% were willing to ask a judge for an ERPO for a family member. However, Black and Hispanic/Latinx survey participants less often perceived ERPOs as appropriate and were less willing to serve as petitioners, with Black participants citing lack of knowledge about ERPOs and not trusting the system to be fair as their top reasons for unwillingness. Similarly, review of ERPO court documents revealed that no family or household members served as petitioners for Black and Hispanic/Latinx ERPO respondents. Additionally, Black respondents were the least likely to have documented access to a firearm and legal representation in court. Racial/ethnic equity in ERPO use may be improved by reducing barriers to petitioning, incorporating non-law enforcement intervention professionals like behavioral health specialists into the ERPO process, providing legal assistance to respondents and petitioners, and investing in the social safety net.

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OBJECTIVE: To determine risk factors among licensed firearm retailers for disproportionate sales of handguns that are later subjected to ownership tracing, generally after use in crime. DESIGN: Case-control; the study period was 1998-2003. Cases were all eligible firearm retailers whose handguns were later traced at a rate that significantly (p<0.05) exceeded the expected value. Controls were a 4:1 random sample of the remainder. Data were obtained from sales and tracing records for 1998-2003 and site visits conducted August-December, 2004. SUBJECTS AND SETTING: 60 cases and 240 controls, from the 573 retailers in California selling >or= 50 handguns annually during the study period. MAIN OUTCOME MEASURE: Status as a case. Odds ratios were used to measure relative risk. RESULTS: In multivariate analyses, cases had larger sales volumes, sold inexpensive handguns more often, had a higher percentage of sales denied because the prospective purchasers were prohibited from owning firearms, and were more likely to be in an urban area, in or near a city with a policy of tracing all recovered crime guns. The effects of several risk factors, including status as a pawnbroker and sales to law enforcement personnel, appeared to be mediated by purchaser characteristics for which denied sales are a proxy measure. CONCLUSIONS: A number of factors-most of them characteristics of the retailers or of their handgun purchasers, and most of them available in existing data-were linked to disproportionate sales of handguns that are later used in crime.

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OBJECTIVE: To determine the retailer and community level factors associated with frequent and disproportionate sales of handguns that are later used in violent and firearm related crimes (VFC handguns). DESIGN: Cross sectional. The authors used California records to identify all handguns sold by study subjects during 1996-2000 and federal gun tracing records to determine which of these guns had been recovered by a police agency in the US or elsewhere and traced by 30 September 2003. SUBJECTS AND SETTING: The 421 licensed gun retailers in California selling at least 100 handguns annually during 1996-2000. MAIN OUTCOME MEASURE: The number of VFC handguns per 1000 gun years of exposure. Differences are expressed as incidence rate ratios (RR) with 95% confidence intervals (CI). RESULTS: Subjects accounted for 11.7% of California retailers with handgun sales, 81.5% of handgun sales, and 85.5% of VFC handguns. Among subjects, the 3426 VFC handguns accounted for 48.0% of all traced handguns and 65.0% of those linked to a specified crime. The median VFC handgun trace rate was 0.5/1000 gun years (range 0-8.8). In multivariate analysis, this rate increased substantially for each single-point increase in the percentage of proposed sales that were denied because the purchasers were prohibited from owning guns (RR 1.43; 95% CI 1.32 to 1.56), and was increased for pawnbrokers (RR 1.26; 95% CI 1.02 to 1.55). Community level crime rates and sociodemographics had little predictive value. CONCLUSIONS: Risk factors, largely determined at the retailer level, exist for frequent and disproportionate sales of handguns that are later used in violent and firearm related crimes. Screening to identify high risk retailers could be undertaken with data that are already available.

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OBJECTIVE: Denial of handgun purchases by prohibited people and knowledge of the structure of gun commerce have helped to deter and prevent firearm violence. The authors hypothesize that handguns involved in a denied purchase would more closely resemble those used in crime compared with handguns sold. DESIGN: Cross sectional. SETTING: Denied and completed handgun sales in California, 1998-2000. MAIN OUTCOME MEASURES: Handgun and purchaser characteristics of denied and completed sales were compared. In particular, handgun characteristics most closely associated with crime guns (type, caliber, barrel length, price) were examined. RESULTS: Compared with handguns sold, handguns in denied sales were somewhat more likely to be semiautomatic pistols (74.6% v 69.4%), to have short barrels (25.9% v 22.2%), and be of medium caliber (48.9% v 37.3%). Ten percent of the handguns in denied sales and 3.4% of handguns sold were identified as inexpensive. CONCLUSIONS: The characteristics of denied handguns are similar to those seen among crime guns. Both groups of guns may reflect the desirability for criminal purposes of pistols, which have larger ammunition capacities than other handguns, and short barrels, which increase their ability to be concealed.

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OBJECTIVE: To determine the association between mortality from violent or firearm related injury and previous handgun purchase. METHODS: Case-control study of 213 466 Californians ages 21 and older who died in 1998; cases were the 4728 violent or firearm related injury deaths, with subsets by specific cause and means of death, and controls were the 208 738 non-injury deaths. The exposure of interest was the purchase of a handgun during 1996-98. The main outcome measure was the odds ratio for handgun purchase, adjusted for age, sex, race, education, and marital status. RESULTS: Handgun purchase was more common among persons dying from suicide (odds ratio (OR) 6.8; 95% confidence interval (CI) 5.7 to 8.1) or homicide (OR 2.4, 95% CI 1.6 to 3.7), and particularly among those dying from gun suicide (OR 12.5; 95% CI 10.4 to 15.0) or gun homicide (OR 3.3; 95% CI 2.1 to 5.3), than among controls. No such differences were seen for non-gun suicide or homicide. Among women, those dying from gun suicide were much more likely than controls to have purchased a handgun (OR 109.8; 95% CI 61.6 to 195.7). Handgun purchasers accounted for less than 1% of the study population but 2.4% of gun homicides, 14.2% of gun suicides, and 16.7% of unintentional gun deaths. Gun suicide made up 18.9% of deaths among purchasers but only 0.6% of deaths among non-purchasers. CONCLUSION: Among adults who died in California in 1998, those dying from violence were more likely than those dying from non-injury causes to have purchased a handgun.

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OBJECTIVES: To determine whether the firearms recovered in buyback programs in a large urban community are the types most closely associated with firearm fatalities in the same geographic area. METHODS: The type, caliber, and manufacturer of 941 handguns recovered in Milwaukee County 1994-96 buyback programs were compared with 369 homicide related and 125 suicide related handguns used in Milwaukee during 1994-97. RESULTS: Buyback handguns differed substantially from those used in homicide and suicide. One third of buyback handguns were semiautomatic pistols versus two thirds of homicide related handguns (p<0.001) and 40% of suicide related handguns (p=NS). Over 75% of buyback handguns were small caliber compared with 24% of homicide and 32% of suicide handguns (p<0.001). The top two manufacturers of buyback handguns represented 30% of these guns but only 5% of fatality related handguns (p<0.001). Companies currently out of business manufactured 15% of buyback handguns versus 7% of fatality related handguns (p<0.001). CONCLUSIONS: Handguns recovered in buyback programs are not the types most commonly linked to firearm homicides and suicides. Although buyback programs may increase awareness of firearm violence, limited resources for firearm injury prevention may be better spent in other ways.

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CONTEXT: Some states prohibit the purchase of handguns by persons convicted of selected misdemeanor crimes, but most do not. California has denied handgun purchases by violent misdemeanants since 1991; the effectiveness of these policies is unknown. OBJECTIVE: To determine the risk factors for new criminal activity among violent misdemeanants who seek to purchase handguns and whether denial of handgun purchase by violent misdemeanants affects their risk of arrest for new crimes, particularly gun and/or violent crimes. DESIGN: Retrospective, population-based cohort study. SETTING AND SUBJECTS: Persons aged 21 to 34 years who sought to purchase a handgun through a licensed dealer in California during 1989-1991 and who had at least 1 violent misdemeanor conviction in the preceding 10 years. The study cohorts consisted of 986 persons whose purchase applications were made in 1991 and were denied (denied persons) and 787 persons whose purchase applications were made in 1989-1990 and were approved (purchasers). MAIN OUTCOME MEASURES: Incidence and relative risk of first arrest in California for new gun and/or violent crimes and for nongun, nonviolent crimes during a 3-year follow-up after actual or attempted handgun purchase. RESULTS: During the 3-year follow-up, 546 (33.0%) of 1654 subjects with follow-up information were arrested for a new crime, including 296 (31.9%) of 927 denied persons and 250 (34.4%) of 727 purchasers. After adjusting for differences in age, sex, and prior criminal history, purchasers were more likely than denied persons to be arrested for new gun and/or violent crimes (relative hazard [RH], 1.29; 95% confidence interval [CI], 1.04-1.60), but not for nongun, nonviolent crimes (RH, 0.96; 95% CI, 0.78-1.19). In both groups, risk of arrest was strongly related to age and number of convictions accrued prior to actual or attempted handgun purchase. CONCLUSION: Our results indicate that denial of handgun purchase to violent misdemeanants is associated with a specific decrease in risk of arrest for new gun and/or violent crimes.

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BACKGROUND: There continues to be considerable controversy over whether ownership of a handgun increases or decreases the risk of violent death. METHODS: We conducted a population-based cohort study to compare mortality among 238,292 persons who purchased a handgun in California in 1991 with that in the general adult population of the state. The observation period began with the date of handgun purchase (15 days after the purchase application) and ended on December 31, 1996. The standardized mortality ratio (the ratio of the number of deaths among handgun purchasers to the number expected on the basis of age- and sex-specific rates among adults in California) was the principal outcome measure. RESULTS: In the first year after the purchase of a handgun, suicide was the leading cause of death among handgun purchasers, accounting for 24.5 percent of all deaths and 51.9 percent of deaths among women 21 to 44 years old. The increased risk of suicide by any method among handgun purchasers (standardized mortality ratio, 4.31) was attributable entirely to an excess risk of suicide with a firearm (standardized mortality ratio, 7.12). In the first week after the purchase of a handgun, the rate of suicide by means of firearms among purchasers (644 per 100,000 person-years) was 57 times as high as the adjusted rate in the general population. Mortality from all causes during the first year after the purchase of a handgun was greater than expected for women (standardized mortality ratio, 1.09), and the entire increase was attributable to the excess number of suicides by means of a firearm. As compared with the general population, handgun purchasers remained at increased risk for suicide by firearm over the study period of up to six years, and the excess risk among women in this cohort (standardized mortality ratio, 15.50) remained greater than that among men (standardized mortality ratio, 3.23). The risk of death by homicide with a firearm was elevated among women (standardized mortality ratio at one year, 2.20; at six years, 2.01) but low among men (standardized mortality ratio at one year, 0.84; at six years, 0.79). CONCLUSIONS: The purchase of a handgun is associated with a substantial increase in the risk of suicide by firearm and by any method; the increase in the risk of suicide by firearm is apparent within a week after the purchase of a handgun. The magnitude of the increase and the relation between handgun purchase and the risk of death by homicide differ between men and women.

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OBJECTIVES: The purpose of this study was to determine whether denial of handgun purchase is an effective violence prevention strategy. METHODS: Individuals denied handgun purchase because of a prior felony conviction and handgun purchasers with a felony arrest at time of purchase were examined. RESULTS: Relative to those denied purchase, handgun purchasers were found to be at greater risk for subsequent offenses involving a gun (relative risk [RR] = 1.21, 95% confidence interval [CI] = 1.08, 1.36) or violence (RR = 1.24, 95% CI = 1.11, 1.39), after adjustment for number of prepurchase weapon/violence charges. CONCLUSIONS: Denial of handgun purchase to persons with a prior felony conviction may lower their rate of subsequent criminal activity.

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OBJECTIVES: To describe a gun exchange program and assess potential benefits for participants and host communities. METHODS: Mail survey of participants in a Sacramento, California gun exchange program, August 1993; the response rate was 79%. Comparative data were obtained from nationwide polls of gun owners. RESULTS: Most (62%) respondents were men; 40% were more than 55 years old; none was less than 25. Concern that children might find and use the gun was the most frequently cited reason for participating (46% of respondents). Of 141 firearms exchanged, 72% were handguns; 23% of respondents indicated that the guns they turned in were not in working order. Of respondents who owned a gun at the time of the program (rather than those who owned no guns and turned in a gun owned by someone else), 41% owned no guns after participating; the prevalence of handgun ownership declined from 79% to 32%. Those who continued to own guns were as likely as gun owners nationwide to keep a gun loaded in the house (odds ratio (OR) 0.9, 95% confidence interval (CI) 0.4 to 1.7) or to carry a gun with them (OR 1.5, 95% CI 0.6 to 3.8). CONCLUSIONS: Gun exchange programs may reduce risk for firearm violence among some participants, but a number of factors limit their overall benefits to host communities.

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BACKGROUND: New policy options are emerging in the debate regarding the regulation of firearms in the United States. These options include the treatment of firearms as consumer products, the design of which can be regulated for safety; denial of gun ownership to those convicted of misdemeanors; and strategies to curtail the illegal sale of guns. The public's opinion of these innovative gun-policy options has not been thoroughly assessed. METHODS: We conducted two telephone surveys of 1200 adults each in the United States in 1996 and 1997-1998. Cognitive interviews and pretests were used in the development of the survey instruments. Potential participants were then contacted by random-digit dialing of telephone numbers. RESULTS: A majority of the respondents favored safety standards for new handguns. These standards included childproofing (favored by 88 percent of respondents), personalization (devices that permit firing only by an authorized person; 71 percent), magazine safeties (devices that prevent firing after the magazine or clip is removed; 82 percent), and loaded-chamber indicators (devices that show whether the handgun is loaded; 73 percent). There was strong support for policies prohibiting persons convicted of specific misdemeanors from purchasing a firearm. Support for such prohibitions was strongest for crimes involving violence or the illegal use of a firearm (83 to 95 percent) or substance abuse (71 to 92 percent). There was also widespread support for policies designed to reduce the illegal sale of guns, such as mandatory tamper-resistant serial numbers (90 percent), a limit of one handgun purchase per customer per month (81 percent), and mandatory registration of handguns (82 percent). Even among the subgroup of respondents who were gun owners, a majority were in favor of stricter gun regulations with regard to 20 of the 22 proposals covered in the poll. CONCLUSIONS: Strong public support, even among gun owners, for innovative strategies to regulate firearms suggests that these proposals warrant serious consideration by policy makers.

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STUDY OBJECTIVE: We studied a population of young adults who legally purchased handguns to determine whether an association exists between the purchase of an assault-type handgun and prior or subsequent criminal activity. METHODS: We conducted a longitudinal study of 5,360 legally authorized purchasers of handguns in California in 1988 who were younger than 25 years at the time of purchase. Our main outcome measures were (1) adjusted relative risk (RR) for the purchase of an assault-type handgun for subjects with a criminal history compared with subjects without such a history and (2) adjusted RR for new criminal activity during the 3 years after handgun purchase for purchasers of assault-type handguns compared with purchasers of other handguns. RRs were adjusted for sex and race/ethnicity. RESULTS: Handgun purchasers with a criminal history were more likely than those with no criminal history to purchase assault-type handguns (4.6% and 2.0%, respectively; RR = 2.0; 95% confidence interval [CI] 1.5 to 2.8). Among handgun purchasers who had a criminal history, purchasers of assault-type handguns were more likely than purchasers of other handguns to be charged with new offenses (RR = 1.5; 95% CI, 1.3 to 1.9), including offenses involving firearms of violence (RR = 1.7; 95% CI, 1.3 to 2.20. Among those who had previously been charged with Violent Crime Index offenses (murder, rape, robbery, aggravated assault), those who purchased assault-type handguns were more than twice as likely as purchasers of other handguns to be charged with a new offense (RR = 2.3; 95% CI, 1.5 to 3.4) and three times as likely to be charged with a new offense involving firearms or violence (RR = 3.0, 95% CI, 1.9 to 4.6). CONCLUSION: In this population, the purchase of an assault-type handgun was associated with both prior and subsequent criminal activity.

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OBJECTIVE: To determine whether there is an association between criminal activity and preference for a particular class of handgun among young adults who purchase handguns legally. DESIGN: Historical cohort study. MATERIALS AND METHODS: Subjects were 5,360 authorized purchasers of handguns in California in 1988 who were 21 to 25 years of age, divided into two groups: all eligible purchasers with a previous criminal history (n = 2,765), and a random sample of purchasers with no such history (n = 2,595). Handguns were classified as small and inexpensive or larger and expensive. Associations were assessed by relative risks adjusted for gender and race or ethnicity. MEASUREMENTS AND MAIN RESULTS: Handgun purchasers with a previous criminal history were more likely than those without such a history to purchase a small, inexpensive handgun (relative risk (RR) = 1.28; 95% confidence interval (CI), 1.16-1.42). Among handgun purchasers with no previous criminal history, those who purchased a small, inexpensive handgun were more likely than purchasers of other handguns to be charged with new crimes after handgun purchase (RR = 1.73; 95% CI, 1.34-2.24) and were nearly twice as likely to charged with new crimes involving firearms or violence (RR = 1.93; 95% CI, 1.38-2.69). CONCLUSION: In this population, criminal activity both before and after handgun purchase was associated with a preference for small, inexpensive handguns.

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CONTEXT: Under current federal law, many persons with prior convictions for misdemeanor offenses pass criminal records background checks and legally purchase handguns. OBJECTIVE: To determine whether authorized handgun purchasers with prior misdemeanor convictions are more likely than those with no criminal history to be charged with new crimes, particularly offenses involving firearms and violence. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: A total of 5923 authorized purchasers of handguns in California in 1977 who were younger than 50 years, identified by random sample. MAIN OUTCOME MEASURES: Incidence and relative risk (RR) of first charges for new criminal offenses after handgun purchase. RESULTS: Of the 5923 authorized purchasers, 3128 had at least 1 conviction for a misdemeanor offense prior to handgun purchase, and 2795 had no prior criminal history. Follow-up to the end of the 15-year observation period or to death was available for 77.8% of study subjects and for a median 8.9 years for another 9.6%. Handgun purchasers with at least 1 prior misdemeanor conviction were more than 7 times as likely as those with no prior criminal history to be charged with a new offense after handgun purchase (RR, 7.5; 95% confidence interval [CI], 6.6-8.7). Among men, those with 2 or more prior convictions for misdemeanor violence were at greatest risk for nonviolent firearm-related offenses such as weapon carrying (RR, 11.7; 95% CI, 6.8-20.0), violent offenses generally (RR, 10.4; 95% CI, 6.9-15.8), and Violent Crime Index offenses (murder or non-negligent manslaughter, forcible rape, robbery, or aggravated assault) (RR, 15.1; 95% CI, 9.4-24.3). However, even handgun purchasers with only 1 prior misdemeanor conviction and no convictions for offenses involving firearms or violence were nearly 5 times as likely as those with no prior criminal history to be charged with new offenses involving firearms or violence. CONCLUSIONS: Handgun purchasers with prior misdemeanor convictions are at increased risk for future criminal activity, including violent and firearm-related crimes.

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OBJECTIVES: Many policies seeking to limit handgun violence rest on the largely untested "crime gun hypothesis," which holds that subclasses of handguns differ in their risk for use in violent crime. This study tests that hypothesis for handguns used in homicides of law enforcement officers and describes the population of homicide-involved handguns. METHODS: A cross-sectional study was done of civilian (criminal) handguns used in homicides of law enforcement officers from 1980 to 1989. Life tables were generated for each year's cohort of new handguns to estimate gun-years at risk, analogous to person-years, for rate and relative risk calculations. RESULTS: Four hundred thirty-five deaths involved 428 civilian handguns. Revolvers were at greater risk than pistols. For both, risk was lowest for .22-caliber handguns. Risk was greatest for .32-caliber pistols and .38-caliber revolvers. Forty-six percent of handguns had a barrel length of 3 in or less. CONCLUSIONS: Subclasses of handguns differ substantially in their risk for use in fatal shootings of law enforcement officers. Such epidemiological data may be useful in formulating efforts to prevent these and similar instances of firearm violence.

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Faced with the national epidemic of gun violence, legislators should be especially sensitive to their constituents' support for various policy options. This support is best evidenced by well-conducted public opinion polls. We review public opinion polls on gun policy since 1987. Although the public support for a number of promising interventions targeting the design and manufacture of firearms has not been meaningfully investigated, strong support is evidenced for most other gun-control options. The public also believes, contrary to Supreme Court rulings, that the Second Amendment to the Constitution protects a broad individual right to bear arms.

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