Men and Firearms: Proven Public Health Interventions to Curb Violence

January 24, 2023 | Marcus Plescia, Lindsey Myers

This post has been updated. It was originally published on June 29, 2022.

In focus in the foreground, a hand holds up a white paper square, the center of the square has the shape of a handgun cut out. An out-of-focus-crowd is in the backgroundThe recent mass shootings in Buffalo, Uvalde, and elsewhere across the country, have drawn renewed attention to firearm violence as a major public health issue in our nation. It’s a particularly important issue to consider during Men’s Health Month because men are disproportionately victims and perpetrators of firearm violence. Approximately 58% of firearm owners are men. Men represent 86% of firearm-related deaths and 87% of nonfatal firearm injuries.

While mass shootings are horrific, 54% firearm-related deaths are due to suicides, and 87% of firearm-related suicide deaths are among men. Firearms are used in more than half of intimate partner homicides, most of which are committed by men. CDC’s recent MMWR revealed that the 2020 firearm homicide rate in the U.S. was the highest recorded in 26 years, which underscores the need to implement strategies to reduce firearm injuries and deaths.

Interventions to address firearm violence are often perceived as controversial. But there is considerable common ground around this issue. Gun shop owners and members of “gun clubs” are concerned about the high levels of suicide and domestic violence amongst firearm owners and are willing to take action. Regardless of political party, all Americans want to feel safe and eliminate the threat of mass shootings.

ASTHO has reviewed and compiled evidence-based interventions to prevent firearm-related violence to use in our work supporting states and territories. A number of strategies are available for state and territorial health departments to expand their public health approaches to firearm-related violence depending on their stage of readiness to address this issue.

Develop a Comprehensive Public Health Approach

Every state can identify firearm violence as a public health issue and emphasize the need for a comprehensive approach that uses data-informed decision making and addresses risk and protective factors at multiple levels (individual, family, school, community, and societal). To accomplish this, states need to be able to access multiple data sources and improve data infrastructure to monitor violent injuries.

The National Violent Death Reporting System is currently funded in every state, but additional funding is needed to ensure states can fully implement the system across all their jurisdictions. Partnerships at the state and local levels with law enforcement, faith-based communities, workplaces, schools, civic groups, and gun-owner clubs can identify common agendas, middle ground, and ultimately change social norms. Finally, health departments can use data and timely communications to tie firearm-related deaths back to social determinants as we have done with many other public health issues.

Federal Policy Interventions

On June 25, President Biden signed into law the Bipartisan Safer Communities Act (S 2938) setting the stage of the first federal firearm legislation in decades. The law contains firearm safety measures, as well as funding to expand mental health, school safety, and telehealth resources. Key components of the law that align with the emerging evidence base for firearm injury prevention include:

  1. Funding to assist states in creating and administering laws that have sufficient due process protections that help ensure firearms are kept out of the hands of individuals whom a court has determined to be a significant danger to themselves or others.
  2. Closing loopholes in domestic violence regulations so that anyone who has been adjudicated for dating abuse would no longer be eligible to purchase or possess a firearm.
  3. Requiring a more thorough background review process for people between ages 18 and 21 who attempt to buy a firearm.
  4. Funding to enhance mental health services, enhance community-based violence prevention initiatives, improve treatment programs for children and adults who have experienced trauma, and support implementation of the 9-8-8 suicide and crisis lifeline.

Other Approaches

Some state health departments can take policy and regulatory steps to address firearm violence. These include requiring background checks on all commercial firearm and ammunition sales, raising the age requirement to purchase semi-automatic weapons from 18 to 21, or banning the sales of semi-automatic weapons altogether. The potential impact of these policies has not been well-studied, and much can be learned from the experience of states that have implemented them. Additionally, existing firearm violence prevention research suggests that policies such as mandating the safe and secure storage of firearms, lethal means safety counseling, and indirect strategies, such as decreasing the density of alcohol outlets and improving physical environments (e.g., making greener spaces or adding brighter streetlights), may be effective at reducing risk for firearm violence.

While men are disproportionally impacted by firearm injury and death, firearm violence has far-reaching consequences and is a public health issue. Interventions can be implemented to reduce the death and suffering associated with this issue and there is consensus for federal actions, including those recently enacted by Congress. Federal policies are important because they are far-reaching and comprehensive. However, as with most public health issues, our knowledge of what works and what should be expanded nationally draws from state and local actions and experience.

Table 1. ASTHO Technical Package of Interventions to Prevent Firearm Injuries and Death

Strategy Potential Indicators Mechanisms Levels of Influence
Enhance public health surveillance systems related to firearm injury and death.
  • State and federal reports that use the National Violence Death Reporting (NVDRS) System, firearm syndromic surveillance, and other data sources.
  • Improved data completeness in the NVDRS.
  • Funding available to states for NVDRS.
  • Improve reporting of firearm injury and deaths.
  • New funding lines and resources.
  • Model state data sharing policies or regulations to incentivize complete data reporting.
  • Ensure health consequences related to misuse of firearms are understood and considered as part of political debates.
  • Advocate for funding for NVDRS.
  • State Violent Death Reporting Systems
  • State child fatality review teams
  • State SBHC associations
  • State medical and primary care associations
  • State coroners/medical examiner associations.
  • State policy makers
  • Federal agencies (CDC, HRSA)
  • National Associations (APHA, CSTE, Safe States, NAME, NCSL, NALBOH, NASHP, NGA)
Expand promising policies and practices to prevent firearm injuries and deaths
  • State policies
  • Federal policy
  • Number of states implementing evidence-informed and evidence-based programs and policies
  • Funding for research and evaluation
  • State public health websites featuring firearm-related data and promoting a public health approach.
  • Create space for state and territorial health officials to have frank dialogue about potential policy solutions.
  • Frame firearm-related violence and suicide as public health issues.
  • Facilitate cross-state learning.
  • Promote the principles of boundary-spanning leadership.
  • ASTHO Senior Leader Reserve Corps.
  • Promote the comprehensive, multi-level approaches, including upstream health equity approaches outlined in CDC’s violence prevention technical packages.
  • Identify, assess, and track state policy interventions (e.g. background checks, waiting periods, child access laws, extreme risk protection laws, permits, laws that restrict access to certain types of firearms or ammunition, etc.)
  • Advocate for funding additional research and evaluation on effective policies and practices.
  • Provide resources and tools related to EBPs.
  • Federal policy makers
  • State policy makers
  • State medical and primary care associations
  • Universities and research institutions
  • National Public health Associations (APHA, CSTE, Safe States Alliance, AMA, APA, etc.)
Promote secure storage of firearms
  • State policies
  • Federal policy
  • State and local resources available related to safe storage
  • State programs focusing on collaboration with the firearm community
  • ASTHO policy statement on preventing firearm misuse, injury, and death.
  • Model policies for state and local government.
  • Recommendations related to locating temporary secure locations for firearm storage within states.
  • Capacity building related to forming partnership between public health and the firearm community.
  • Encourage partnerships between firearm retailers, ranges, and clubs and public health efforts to educate about the elevated risk of suicide to the gun-owning community (e.g. Gun Shop Projects).
  • Encourage clinicians and health care system to educate patients about firearm safety (e.g. ED-CALM).
  • Educate and train gun owners using evidence-based gun safety courses to prevent unintentional injury.
  • Federal policy makers
  • State policy makers
  • National, state, and local veteran service administrations.
  • State medical and primary care associations
  • State and local gun retailers and firing ranges