must involve the health and public safety communities, educators, and other community groups. As part of a public health approach, interventions may target

• the “agent,” meaning the gun or its possessor;

• the “host,” or the victim(s) of firearm-related violence; and

• the “environment,” including social, physical, or virtual environments that may shape gun policies, norms, and behavior.

Unauthorized gun possession or use is associated with higher rates of firearm violence than legal possession of guns. Controlling access to guns through background checks or restrictions on particular types of firearms remains controversial, and the effectiveness of various types of control is inadequately researched. Research on the impact of imposing additional penalties for firearm use in illegal activities has also produced mixed results. Studies on the impact of right-to-carry laws on firearm violence also have inconsistent results and have been debated for a decade.

Interventions Focused on Potential Perpetrators and Victims of Firearm Violence

In 2010, incidents involving firearms injured or killed more than 105,000 individuals in the United States, including approximately 19,000 suicides. Understanding differences among subpopulations with access to guns and targeting interventions to their particular risk factors may confer a public health benefit. For example, alcohol use is attributed with increased levels of firearm-related violence. However, state laws designed to ameliorate the risk of firearm use by those that abuse alcohol differ, and there is a lack of data on the basis for these laws or on their effectiveness. Risk stratification with respect to mental health and the use of firearms is imprecise and not well understood. Although the risk associated with some specific psychiatric diagnoses is better understood now than in the past, mental health issues that foster a propensity toward violence and risk taking are not well defined and not readily recognized by authorities.

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