Gun Violence Through a Public Health Lens

Full video, powerpoint presentation and edited transcript; "Gun Violence Through a Public Health Lens​"; February 10, 2017.




Bruce Shapiro: There’s kind of no right place to start a conversation like this but, establishing a common language around public health and gun violence is probably as good a place as any. This is an area in which there has been a tremendous amount of new research and new thinking in the last five and 10 years that is only slowly finding it's way into public policy. Thinking about violence impact, thinking about gun violence prevention, thinking about everything from the short-term trajectory to the generational trajectory of these issues.

And the person who is going to be our guide through an initial discussion of this is Professor Daniel Webster. Professor Webster is a professor in health policy and management at Johns Hopkins University's Bloomberg School of Public Health. He also serves as professor of public safety leadership in the School of Education's division at Johns Hopkins. He is both Director of the school’s Center for Gun Policy and Research, and Director of the Johns Hopkins Baltimore Collaborative for Violence Prevention. We’ve asked Professor Webster to give an initial talk, frame some issues and then we’ll have a conversation with him.

Daniel Webster: I was looking at the slate of speakers and realizing there’s a lot of good stuff coming after me, so I'm kind of weaving around what I know other people are going to really hit in a more in-depth way. My task is at least, in part, to give a sense of what this whole public health thing means when you look at a problem like gun violence. It’s actually kind of a fun thing to do.

When I was a graduate student at Johns Hopkins in the late 80’s, this whole idea was very new and we were kind of figuring it out just then. What does it actually mean to apply a public health lens to this? And I’ve spent the bulk of my career in public health. I started teaching a course in I believe 1992, at our school of public health on violence prevention and kind of making it up as I was going. I think Susan Sorenson, who’s going to speak with you soon, was also teaching a similar type of course.

One of the things that has frustrated me a little bit in tackling this issue is whenever I hear people say, “Well, you need to take the public health approach.” Well there’re about 39 different public health approaches! Public health is such a vast field: so many disciplines and so many ways to look at this angle. Never say “the public health approach,” okay? There are a bunch. I am just going to hit a few in this conversation this morning. Of course, in the Q&A, we can go into other areas as well. I teach a whole course that is all kind of geared to all these different public health angles.

This is just a data slide and I’m just going to hit a couple of points and recognize that the 2015 data, these come from death certificates, vital records, that CDC compiles, to give you a sense just sort of where the fatal and non-fatals lie to underscore that for every gun homicide, there’re about two gun suicides. Unintentional shootings is something we have a very difficult time tracking and even though I have a number in this chart, I don’t really trust it because there’s just some complexity in how the call to death gets recorded for what most of us think of as unintentional or accidental type of shootings. Most of the shootings that come to be treated at hospitals are from criminal or interpersonal violence.

But I don’t even trust these numbers, either. These come from what is supposed to be a nationally representative sample of hospitals and trauma centers around the United States. It’s a reasonable start but there’s a lot of people who do research in this area that have a healthy dose of skepticism about whether these accurately reflect what non-fatal gun violence looks like in the United States just because gun violence changes so it’s so different across place and time.

I want to just give you a picture of a couple of trends of note. When I started in this field I was really motivated by young black males in Baltimore and the incredibly high rate at which they were dying from gun violence. And there is a wonderful, wonderful story here that is just all in this graph of what tremendous progress there's been in reducing the rate of gun homicide. Now it is starting, a little, to go up. I am deeply concerned about that, but just for a point of perspective, boy, we’ve come a long way. This is another graph that's not going in the right direction. This is a firearm suicide rate for non-Hispanic White males, 45 to 59. So that is another trend going in the opposite direction.

I said I was just going to give you a flavor of just a variety of ways that public health applies and is relevant to the more broader area of violence. In my school, many of the students who come to my class are focused on children and on child development. There’s so much we’ve learned about that that is relevant to preventing violence, ranging from the importance of environmental lead and how that affects behavior and risk for aggressive, violent and impulsive behavior. We’ve learned that public health programs, nurse visitation programs for generally young parents who lack economic and social resources are good, not only for child development but that they are also protective in the sense of reducing risks for violence. And then we have a whole body of research showing some promise in reducing aggressive behavior through social skills training.

In public health, we think a lot about environments. One of the most consistent findings, if you look at something like gun homicide, for example, is it’s incredibly concentrated in most cities and it’s concentrated where the social and economic disadvantage is. And of course, that’s no accident. There are explicit policies that determined this concentrated disadvantage, some of which are housing-related. So, looking at housing is another interesting way to think about gun violence in the cities that you report in. There’s no easy fix to that particular problem but there is actually some interesting work being led by professor Charles Branas at the University of Pennsylvania, who is looking at low-cost ways to address blight in urban areas. I’m just going to give you a little taste of what Dr. Branas has done in learning.

One thing is greening of lots in urban areas that have a lot of trash. Simply cleaning them up, making them nice and green. A very nice randomized trial show that that was correlated with an eight percent reduction in gun violence in those areas. Similarly, one thing that you see very commonly in Baltimore, maybe the strongest correlation of spatial data that we have is that there is more shootings in places where there are more vacant dwellings. One low-cost way to address and secure these [vacant dwellings] is being experimented with in some studies and this just sort of gives you a picture of this, that this before and after on the top, this is actually still a vacant dwelling. It just doesn’t look like it. It’s more secure and it doesn’t look like nobody lives there and in one study they showed associated with a 39 percent reduction in gun violence. So, these are incredibly interesting ideas.

Working most of my career in Baltimore, the first thing that anyone says when they talk about gun violence in Baltimore, they make connections to the illegal drug trade. One point I just want to make in our conversation today is that when we’re looking for solutions to reduce gun violence maybe some of them are to stop doing things that don’t work and that actually may be harmful, such as our war on drugs. There is surprisingly little good research on what the impacts of more traditional drug law enforcement practices are. That available evidence can very consistently shows that the traditional, “we’re gonna crack down,” “we’re gonna disrupt this illegal drug market,” very consistently leads to not fewer, but more shootings and deaths.

I’ve just completed some research in Baltimore looking at these practices. What we find is in an area is that surges in drug distribution arrests consistently correlate with subsequent increases in shootings for up to about a five-month period. Even somewhat more innovative approaches with looking at drugs have not shown any favorable effects from those efforts. So, maybe one thing we could do is simply change how we’re policing drugs.

I came to the public health and gun violence spheres as an injury control person. There are certain ways that injury control people think, that we try to apply here, and very naturally we go to regulating dangerous products and certainly guns are a dangerous product. Much of our remaining minutes will be on that. But in public health, we also apply criminal and civil law and I’ll mention some that to discourage diversions of guns for criminal use and then the infection control model, as well.

Some people are familiar with the public health approach of making guns safer. Early on in this discussion the focus was on let’s make guns childproof. We’ve all read or seen or heard about incredibly sad, tragic deaths that occur when a very young child gets their hands on a gun. And a very natural thing that people in public health and elsewhere think about is, “Well goodness, why should a gun be even operable by a young child or even a depressed teen?” So the thinking about safety technology advanced from a simple childproof gun, to a more advanced thinking of so-called “personalized guns.” These were guns that are designed to only fire for so-called authorized users.

So the question seems in some ways to be an obvious thing. If we can make a product safer, we can prevent certain deaths, let’s do it? I think that it’s actually a far more complex set of questions that we need to consider: How many new gun owners will there be when guns are now viewed as safer? How many more households where people make decisions that, “Oh, I don’t have to worry about this harming my child or my teenager, I’ll bring the gun into my home now, it’s safe.” Another question, how many current gun owners will actually buy personalized guns?

When we do this sort of thought experiment, it’s like, “Okay, there’s a tragedy that happened, let’s now substitute that dumb gun with a smart gun and say wow, that would have been prevented?” There’s a lot more complexity. Most of these deaths occur in current gun owners. They have dumb guns, what are they doing with their dumb guns? So there’s important questions here.

This is just a quote from Forbes Magazine about a startup company noting this potentially really rich untapped market of individuals who don’t currently own guns but would own so-called safer guns. What do we actually know to answer some of these questions? Very little is the short thing but I’ll mention this very briefly. There's an article published in American Journal of Public Health of a survey, a national survey, where people were asked basically their interests and whether they would consider buying a so-called personalized gun. And, 60 percent of those who were currently not owners of guns said that they would consider it. Do I think 60 percent will actually do it? Of course not. Maybe not even a tenth of that but, it’s still a very large number of people when you add it up.

We have our own survey we have not published just yet, but we did a national survey of gun owners, their interest in a certain gun, what they think, how likely they would be to buy such a gun if the markup price was an additional 300. This was actually a much smaller markup markup than what the current technology is. Now it’s about an 1800 boost to the price. So, five percent said very likely, 13 percent, somewhat likely.

Generally most gun owners just didn’t trust the technology, and for others there was a price concern. I don’t know how well this shows up in the back, but these are the main points in the question that some of my colleagues and I are having now. So, at the far left side, is the current number of so-called unintentional shooting deaths for youth under the age of 18. The next is the number of suicides that might be prevented, teen suicides in the 13 to 19 range.

This bigger bar is the number of suicides for adults who are of ages when they are more commonly parenting young children or teens, as well as domestic homicides. This is simply to give you a flavor for if this technology just completely eliminates the far bars on the left, you still have to worry about this main bar, which again, is most of the time when a fatality occurs, when someone brings a gun into the home, it’s almost always an adult suicide.

So, we’re doing simulations under various assumptions about uptake of the technology and how effective it is, who might buy it and so on. And, of course, it will vary depending on the assumptions that you make, but just to give you a flavor of some of this, if it reduces the shootings that it’s designed to reduce by 20 percent but increases by 10 percent risk in these other categories, you have a big imbalance. You probably have more gun fatalities than you would have And it changes, again, as you make different assumptions.

I think a far more promising technology – but I think politically we’re further away from – is so-called “microstamping.” We’ve all watched cop shows that show that police often get ballistic evidence that helps them solve the crime, right? It’s fantastic. Really great technology. The problem is that very, very rarely do they actually have the gun that was used in the shooting. So, it’s not always that helpful to actually solve the shooting.

Microstamping uses lasers to put unique markings on the shell casings so that when the technology is applied, you could in essence create a new gun tracing with just the ballistic evidence. So a detective could recover that information, look at the ballistic, the microstamp, and say, “Wow, the gun that was used in this shooting was sold on April 14th, 2010 at this gun shop to this individual”. It’s a completely different scenario because the vast majority of the time, guns are not recovered in shootings. So, I think it would be a real game-changer.

And as much as we talk about prevention and the unique aspects of public health to this problem, it’s in part because the so-called contagion phenomenon, okay? That is a real thing, particularly in urban gun violence. Gun violence spreads like a contagion. And there are public health models, all talked about now, to try to interrupt that contagious process. But one reason that it is contagious is that so many of our shootings aren’t solved. So, it’s resolved with so-called “street justice” which is another body on the ground and that leads to more and more shootings. So, these are important.

Regulating guns. Two big issues is basically who’s legal and who’s not to possess or purchase guns, and what are the accountability measures that are in place, or not, to make sure that those who are prohibited from having guns can get them. So, there’s been a lot of work on the first question of standards for legal gun ownership and there’s actually a new consortium that was formed in 2013 for risk space firearm policy that’s really doing great and important work. But, we had funding from the Joyce Foundation, probably everything I will say from here on out was funded by the Joyce Foundation, thank you Nina. No seriously, you should understand that almost any piece of research that you're going to look at that is directly trying to inform how we solve a problem of gun violence, there’s a pretty darn good darn chance that the Joyce Foundation funded it. So we appreciate their leadership on this.

We published some data looking at the 13 states that had the lowest standards for legal gun ownership. We used a federal survey of people incarcerated in state prisons and looked at that subset who were incarcerated because they shot someone. And we looked at their prior criminal pasts, their age and other things that are relevant to restrictions. What we found is that only 40 percent of those incarcerated for those crimes were illegal gun possessors. What’s important in this very simple pie chart, is that red slice of the pie: 29 percent of those individuals who were legal to possess the guns they used to shoot people, would have been prohibited in other states that had stricter standards. So, a lot of time this gets glossed over. When we think about law-abiding gun owners and criminals, we got these two nice, little groups and we think we know who’s in them and who is not. They're different from state-to-state, sometimes in very dramatic ways.

I mentioned the consortium – Jeff Swanson is an important contributor to it. I don’t know if he’ll talk a little bit more about it, but some of the recommendations driven by good epidemiologic evidence are to basically expand the exclusion criteria in most cases, and restrict it in others. There are some current regulations that really aren’t based upon good risk information.

Here are some examples on this slide. I’m not going go into these in detail except maybe to mention the very last one. Maybe the newest idea: states like California and Washington have instituted gun violence restraining orders, or “ extreme risk protection orders” that provide families and individuals who see very disturbing things going on with a loved one and want to act before, not after, that person uses a gun to harm themselves or others. I think it’s a really promising strategy.

When you look at some of the policies that are driven by expansion, from just thinking of this principally as a felon disqualifier, to other categories, we consistently have found some positive effects in reducing violence that includes domestic violence restraining orders and prohibitions that include expanding disqualifiers to people convicted of violent misdemeanors and includes – well actually not a recategorization – so much of those too dangerous to have a gun, due at least in part to mental illness, is that when Connecticut actually had a process to use the records to disqualify them, Jeff Swanson and his team found some evidence that that indeed lowered risk for that group in committing violent crime.

Another application of law is actually civil courts, but of course Congress is doing its best to block lawsuits against anybody in the gun industry. But we have done some research showing that when you do undercover stings of licensed gun dealers who are problematic – A very small percentage of gun dealers are connected to the vast majority of guns used in crime – probably around five percent of licensed gun dealers account for 80 percent or so of guns recovered in crime. So you can zero in on a relatively small number of individuals with more oversight and even potential lawsuits.

And Chicago was one of the first cities to do that, Detroit as well. We saw pretty substantial decreases in indicators of diversions of guns – certainly after resale, sale –  used in crime. New York City applied a similar approach with undercover stings and lawsuits. There’s word to out-of-state dealers – because that’s where their crime guns come from – and we documented a remarkable 82 percent reduction in probability of guns sold by those dealers that were used in crime in New York City.

I’m going to mention a few state policy studies very quickly. The conversation around guns and gun control often starts with background checks. There’s some information that we have in research, but the two studies where we have the best evidence of positive impacts is when Missouri did away with some of these measures and Connecticut adopted them. One is so-called comprehensive universal background checks, but also through a licensing or permitting process for handgun purchasers. So, Missouri had this law in place for many decades, and then repealed it in 2007. This is a measure of diversions of guns for criminal use shortly after a retail sale, and we’ve documented basically a two-fold increase. That jump coincided with this policy change. Using the gun trace data we also saw remarkable change in the pattern of where guns were coming from. Slightly more than half of guns were Missouri guns being used in crime before this law was repealed, and now it’s more than three-quarters.

Most important, of course, is what’s happening with gun homicides. So, this first little bump here up from 2007 to 2008 – that’s when our policy changes – here is a very abrupt, noteworthy increase. Then, it really shot up in 2015 and I don’t think 2016's looking all that great either for Missouri. We've done some analysis, trying to estimate the impacts when you control for variety of things going on. Our best estimate right now is an 18 percent increase if you look at data through 2014 connected to this policy change. No other state during that time period had as big of per capita increase in gun homicides. We also saw that the policy correlated with increases in law enforcement officers shot in the line of duty and in firearms suicides, which increased 16 percent as well. And an interesting point you might want to note is that, based upon our analysis anyway, this policy change is correlated with a bigger gun suicide increase than gun homicide, just on an absolute basis.

For Connecticut, we looked at the reverse when it adopted this policy. We had to go back to 1995 to look at the data over time. What we estimated for the first 10 years that they’ve had that policy in place is a 40 percent lower rate of gun homicides than would have been projected. We’ve been extending that analysis for as many years as we have data, and it correlates with the 29 percent reduction in gun homicide rates. Similarly with Missouri, we saw that this seemed to be correlated with how frequently law enforcement officers get shot with handguns in the line of duty: 80 percent lower fatality rate for that, and gun suicides going down by 15 percent.

Now, this model of thinking about gun violence as an infectious process, there is a model that many of you probably know about that came here to Chicago back in the late 1990’s. Now it is called Cure Violence. Very briefly, the components of that are outreach teams who are so-called “credible messengers”: people known in those neighborhoods who have had similar experiences to the high-risk individuals who might be at risk for being on either side of gun violence in those areas. They try to resolve conflicts without violence and they're doing that right there on the spot, in some cases, but they’re also modeling that and reinforcing that behavior in all of their interactions at different events that they put on.

We've had this program in some shape or form for about a decade in Baltimore, but only in a few neighborhoods, and I've been studying that. Over that roughly nine-year period, we’ve seen an average reduction in non-fatal shootings of 27 percent. We’ve seen significant reductions in homicides in some areas as well. And we also have done street-level anonymous surveys of male youth, and found that the program is correlated with noteworthy reductions in beliefs about the acceptability of using guns to resolve conflicts.

There’s a little bit of research in other areas, as well, including Chicago. And Chicago’s findings are actually pretty similar to Baltimore’s. It’s not as though every single time and place the program went into effect, there's clear evidence of efficacy. But it has a pretty good track record. When this goes into a community, there are fewer shootings. There's research in New York consistent with that as well.

That’s everything you need to know… (laughter). You’re going to learn so much over the next couple of days from some really great people, but that’s my introduction to thinking about public health and gun violence.

BS: Thank you. So we have about 20 minutes for questions and for conversation.

Audience: I want to go back to the comment you made in the beginning about the non-fatal shootings – I guess technically aggravated assault. You said to not trust the numbers on that, are any kind of caveats you can give us that when we’re looking at the data, how to maybe use it in ways?

DW: Sure. So the question had to do with my lack of trust in the data I was presenting for non-fatal shootings. I’ll say a couple of things: One is, as I was indicating before, the hospital-based data that we use for national estimates is based on a relatively small number of hospitals. And if you track over time that indicator along with some other indicators of lethal gun violence, you don’t see the same temporal pattern and some people say, “Oh, well maybe there’s some tremendous change or improvement in trauma care.” I’m sorry, there’s no evidence. There’s no evidence that over the last decade or so, a lot more people are being saved because of advances in trauma care for gun violence. There’s just not good solid evidence. It may be a very small effect, but it’s not really driving over all trends.

You mentioned aggravated assaults. You can look at the FBI’s data that come from local police departments and one of the categories that they will record are so-called “aggravated assaults,” and even a subcategory of aggravated assaults with firearms. In most of those events that are recorded, no one is wounded. An aggravated assault is me taking a gun and threatening you. That’s an aggravated assault. I’m gonna shoot you. An aggravated assault is me firing and missing. An aggravated assault with a gun is someone who comes within a whisker of death, being saved by good trauma care.

So, when you’re looking at these numbers you have to know that it’s an incredibly heterogeneous category of what we're measuring, and I personally don’t trust that from year to year and from place to place, that each of those data points mean the same thing. That’s our biggest data gap. There are a lot of data gaps that we have, in my view, and that’s the biggest.

Audience: Have you also looked into issues of assault where someone doesn’t fire a gun, but uses it to intimidate someone else? I know of a woman whose husband has so many guns, and they have some domestic arguments. So, he just opened the cabinet without saying anything, and the wife fled to another state.

Have you also taken a look into what is known as gun scare? You have the guns, you take them from another state, leave them at friends’ homes, and after a few days, you pick them up. So, that also has been going on.

DW: So, I’ll just make a couple comments briefly. Susan Sorensen is going to cover exactly the kind of scenario you started with. So the question had to do with domestic violence and guns and sometimes, it’s using the guns more as an intimidation and control mechanism – most serious forms of partner violence is really about control, domination, and guns of course work darn well for that. But that's Susan’s area and she’s going to cover that, so I’m going to go to the next thing you were mentioning, having to do basically with guns crossing state lines. If you want any evidence that gun laws matter, look at the patterns in interstate gun trafficking.

If gun laws don’t matter, why do nearly 90 percent of guns used in New York City in crime come from out of state? All that we know about illegal gun markets – and Harold Pollack is going to give you great information on that later – is that people prefer local connections. They prefer local people who they can trust. So, if you’re seeing guns coming from Texas to Minneapolis, for example, oddly enough, that’s a good sign. T

The reason I say that is that it indicates some local scarcity there. Not necessarily that there aren’t enough guns in Minnesota – I bet there’s plenty of guns in Minnesota to be used in violence – but what Phil Cook, an economist studying this work, so aptly described is that the scarcity in the market is a trusted supplier. So, what gun laws are doing is basically getting people into uncomfortable places to make gun transactions, that raises prices and risk and ultimately, at least based upon our research, can mean less gun violence. The market is such that there are constraints on it that fewer guns are being used. But these patterns clearly tell us that weak gun laws are harming, not only the states where there are laws, but it’s affecting others as well.

Audience: Usually when we talk about suicide, especially suicide with firearms, it’s kind of in an abstract manner. It was really shocking to actually see the numbers up there: two suicides for every homicide. But there’s always kind of a hesitancy to cover suicides because of the sense that doing so can actually cause more suicides. So, I was wondering, is there a way to write about that without giving people ideas?

DW: Well, I’ll confess, I'm not the expert on this very particular question of reporting on suicides and the degree to which it leads to more. My understanding though is that this may be confined to a sort of subset. So when there are clusters, for example, of teen suicides in an area, then there’s a big report on it and then more- Look, plenty of teens are thinking about suicide, sadly. They are. They don’t need a news article. But it may be that it becomes more acceptable or maybe even tantalizing because you get in the paper and people say what a great kid you were or whatever. So, I doubt very much that the bulk of the suicides that we're talking about, affecting adults who are middle-aged and beyond, that there would be a contagious phenomenon for reporting on that very common phenomenon.

Audience: In one of the earlier slides you listed effective and non-effective violence prevention methods. One that was listed as non-effective was: beat policing, hotspots, community policing. Are you able to go into any more detail there?

DW: I went through that really quickly so let me be more clear. That particular little bullet on the slide pertained to approaches that were explicitly focused on drugs. We are going to come up with a strategy that’s going to address illegal drugs in a given area through a variety of community policing. And, there’s about one study that I can think of that shows good impact from that, and a whole lot that don’t. So I think most of what happens in law enforcement, addressing drugs, does not translate into less gun violence, and more commonly, it’s more [violence].

Audience: You spoke about violence as a contagion. In Minneapolis, it always surprises me how common it is for people to look to Chicago after a shooting, whether it started down here or not. What can you tell us about how that contagion might look to you right after a shooting?

DW: Honestly, I don’t think there’s any research that really examines that. Most of the contagion phenomenon is studied within cities and within neighborhoods and within particular social networks. It’s certainly quite plausible, however. I mean think about your friends in relationships, a lot of them are through your phone or computer, right? And, so it’s certainly possible, in this day and age, that certain trends or phenomenon that lead up to a shooting could extend well beyond the spatial components that we're looking at now.

Audience: Are there any other built-in environment factors that you’re going to see researchers focusing on, or perhaps making progress on others?

DW: Well, just on housing policy and gun violence, there’s not a tremendous amount of research on this. But when we sort of came into a better age of enlightenment about how we did public housing and we razed a lot of the high rise places that were in Chicago, Baltimore and many other cities, and we tried to very intentionally de-concentrate where public housing was and what it looked like… there are at least a few studies out there that show correlations from when you change how concentrated those public housing units are, that typically lead to fewer shootings in that area and actually even in a broader geographic area than you might expect. A lot of time and we think about spatial relationships and gun violence, if you’re doing something in a particular place, there’s a skepticism, “Oh, the violence is just going to move somewhere else, right?” Sometimes that happens.

I tell you I’m looking at a lot of place based studies, and more commonly than not, it does not. And it just as likely has protective effects that extend in bordering areas as well. I think again that is probably a function of the contagious phenomenon, that a shooting, that a policy – whatever policy or program it was that was placed area – a shooting that was prevented has the potential to prevent other shootings that would have emanated from there. We don’t have walls around our communities, you know, except on the southern border.

BS: Do you have any thoughts about legislative efforts to deter people from getting guns? There’s a bill in the Wisconsin legislature, for example, that would ban people that have repeat misdemeanors and also prevent straw buying. A general question: what about efforts to try to deter potential gun owners from getting guns?

DW: So, first part is, with respect to the violence misdemeanors, I noted a study in California that showed that when they expanded disqualifiers to include violent misdemeanors, and to be important – I think that this is something that could well be a trend –  in thinking about some of these disqualifiers, they do not have to be lifelong. Okay?

I didn’t print it in here, but there’s incredible age curve that once you get beyond 30 or so, your risk of committing violent events goes down a lot. So, we do have some evidence of short, even like 10-year disqualifying period correlating with significantly fewer commissions of violent crime. So I think there’s good work on that. Very specifically on straw purchases. It’s sort of a complex set of policies that are related to that, but something I didn’t report on here: We're looking at background check policies and enforcement efforts that aren’t connected to a licensing mechanism and we do have some preliminary evidence that suggests that the degree to which law enforcement actually follows up and makes arrests for straw purchases matters, in terms of availability of guns and use of guns in criminal violence.

BS: Let me ask two close out questions. First is social media. As journalists, we're all probably on social media. Is there any data on social media and contagion? Social media and prevention efforts? That’s question A. Question B, we hear a lot about the ban on CDC gun violence and research. How significant an impediment is that to your work or to public understanding?

DW: Sure, so to answer the first question on social media and gun violence, there’s not a lot of good stuff out there yet. Maybe it’s just coming out and I haven’t seen it but I’m talking to a whole lot of people – some are researchers and some not – who really think that some of what is behind pretty substantial increases in Chicago and Baltimore and some other places, that- First of all, know that most of these shootings are connected to conflict. Okay? These are conflicts, so, policing has a role but, to lower gun violence, we have to find ways to resolve conflicts without shooting each other.

There’s good information that, the same sort of signs of disrespect that were leading to shootings pre-social media, that now those signs of disrespect occur in Instagram posts and other things that prompt someone to say I’m going after so and so. “He thinks he’s so tough and he's going to whatever.” So, I do think it’s important, I don't have a lot of research to share with that.

As it relates to the CDC and its funding of gun violence research, this is what I’ll say to that: First of all, it’s a very misunderstood policy in and of itself. There’s no outright prohibition, that the CDC may not give grants to study gun violence. I actually have gotten three grants from CDC to study gun violence. The sort of unwritten rule – or what has been applied at the CDC going back to 20 years ago – is that they had that their budget cut because they were funding research that the gun lobby didn’t like very much. So what happened is, they required you to sign something if you got a grant saying you’re not going to use these funds to advocate for gun control. We weren't using those funds to advocate for gun control before, but this really had a chilling effect at CDC.

They’re protecting their budgets, they’re concerned about Zika and they’re concerned about opioids. They’ve got all kinds of priorities. So, they'll fund me to study a Cure Violence program in Baltimore because that doesn’t threaten the gun lobby so much. I’m not looking at where these guns come from, how they are connected to policies, or to people selling guns. I’m looking at this as a behavioral issue. So they are funding that kind of work. You won’t find it on their website, written down, that we only fund stuff that the gun lobby won’t bother us about but that’s basically what has happened. It has had a big chilling effect. We’ve been able to keep going over these years, again, mostly because of the Joyce Foundation and the Joyce Foundation encouraging other foundations to get involved in this.

So we find a way to get it done and it’s still good, it’s still important. So, nobody come out of here thinking that there’s no gun research because of the CDC ban. There's gun research going on, it’s just not nearly enough.

BS: Okay, thank you Daniel.