defensive uses of guns (i.e., incidents in which a gun was “used” by the crime victim in the sense of attacking or threatening an offender) have found consistently lower injury rates among gun-using crime victims compared with victims who used other self-protective strategies (Kleck, 1988; Kleck and DeLone, 1993; Southwick, 2000; Tark and Kleck, 2004). Effectiveness of defensive tactics, however, is likely to vary across types of victims, types of offenders, and circumstances of the crime, so further research is needed both to explore these contingencies and to confirm or discount earlier findings.

Even when defensive use of guns is effective in averting death or injury for the gun user in cases of crime, it is still possible that keeping a gun in the home or carrying a gun in public—concealed or open carry—may have a different net effect on the rate of injury. For example, if gun ownership raises the risk of suicide, homicide, or the use of weapons by those who invade the homes of gun owners, this could cancel or outweigh the beneficial effects of defensive gun use (Kellermann et al., 1992, 1993, 1995). Although some early studies were published that relate to this issue, they were not conclusive, and this is a sufficiently important question that it merits additional, careful exploration.

Firearm-Related Violence as a Public Health Issue

The public health field focuses on problems that are associated with significant levels of morbidity and mortality. The complexity and frequency of firearm-related violence combined with its impact on the health and safety of the nation’s residents make it a topic of considerable public health importance and suggest that a public health approach should be incorporated into the strategies used to prevent future harm and injuries. Violence, including firearm-related violence, has been shown to be contagious. Recognizing this, the academic community has suggested that research examine violence much like is done for contagious diseases (IOM, 2013).

In the past, responses to firearm violence typically have been based in the criminal justice system, which is crucial to public safety, but a more comprehensive and multidisciplinary approach is necessary to reduce the burden of firearm-related violence on individuals, families, communities, and general society (Kellermann et al., 1991). Public health approaches focus efforts on the prevention of violence by characterizing the scope or magnitude of the problem, evaluating potential risk



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