Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun violence prevention research

Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun... Abstract The Society for Behavioral Medicine (SBM) urges restoration of Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention. Unfortunately, there have been no concerted CDC-funded research efforts in this area since 1996, due to the passage of the Dickey Amendment. To remedy the information-gathering restrictions caused by the Dickey Amendment bans, it is recommended that Congress remove ‘policy riders’ on federal appropriations bills that limit firearms research at the CDC; expand NVDRS firearms-related data collection efforts to include all fifty states; fund CDC research on the risk and protective factors of gun use and gun violence prevention; fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence; and support the development of evidence-based policy and prevention recommendations for gun use and ownership. Implications Practice: The outcomes of unfettered and objective peer-reviewed research can be used to determine best practices for the development of effective, evidence-based clinical and community-based prevention and intervention efforts which aim to prevent gun-related injuries and deaths and inform recommendations for safer gun use and storage. Policy: The outcomes of peer-reviewed firearms studies can be used to inform the development and implementation of effective policies regarding the nature of gun sales, the screening of potential buyers, the registration and tracking of firearms purchases, and laws regulating gun ownership. Research: Firearms research needs to be vigorously funded to better elucidate the factors associated with gun deaths and injuries and to inform the development of evidence-based recommendations for firearms policies and use. INTRODUCTION The Society for Behavioral Medicine (SBM) urges restoration of the Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention [1, 2, 3], yet there has been no concerted CDC-funded firearms research since the passage of the 1996 Dickey Amendment [4–9]. The funding ban has resulted in a dramatic reduction of studies on the correlates and predictors of gun violence, including research on what leads to accidental gun deaths, homicides, and suicides, and the policies and practices that can prevent them [10, 6, 11]. SBM urges the restoration of CDC funding for firearms investigations to better understand the factors associated with gun deaths and injuries and to inform the development of evidence-based recommendations for firearms policies and use. Background Firearms injuries are a leading cause of non-medical deaths in America, surpassing motor vehicle fatalities in twenty-one states and the District of Columbia [12]. Note the breadth and scope of this problem: • Data from 5 years of CDC statistics estimate that 91 Americans are killed every day by gun violence [13], with over 33,000 deaths per year [14]. The CDC’s 5-year average of gun-related injury data (2010–2014) found that, annually, 78,815 individuals are injured by guns in the U.S. [14]. Guns also account for nearly 70% of U.S. homicides [15]. More Americans lose their lives to gun violence compared to citizens from similarly developed countries [10, 16, 17]. The U.S. makes up about 5% of the world’s population yet, in the last decade, has suffered nearly a third of the world’s mass shootings [18]. The pervasiveness of this problem is startlingly illustrated in a 2016 study, which found that the likelihood of an American knowing a gun violence victim within their personal network over the course of their lifetime is between 98 and 99.9% [19]. • Gun violence statistics reflect marked health disparities in the United States. The likelihood of witnessing a gun-related threat or injury was found to be significantly higher for Black or Latino children [20]. In 2013, African Americans suffered over 57% of all firearms deaths, even though they comprised only 13% of the U.S. population [1]. • Gun ownership increases the risk of completed suicides and domestic violence deaths and injuries. Gun injuries account for more completed suicides compared to all other means combined [21]. The presence of guns in the home also increases the severity and deadliness of domestic violence [2, 22–25]. • Gun violence is a leading cause of injury and death in American children and youth. The Gun Violence Archive, a clearinghouse of gun violence statistics, reports that, in 2016 alone, 446 children (aged 0–12) and 2,072 teenagers were injured or killed in gun violence incidents [26]. Gun violence is the leading cause of death among African American males 15–34 years of age [1]. In 2014, firearms caused 88% of teen homicides and 41% of teen suicides [27, 28]. • Finally, gun violence exacts a financial toll on individual and community resources [1, 3, 29]. Nationally-reported direct and indirect costs of gun violence are estimated to range from approximately $100 billion to $229 billion dollars per year [1, 3]. Firearms deaths and injuries comprise a serious public health problem. Yet, the CDC has not comprehensively funded firearms research since the passage of the 1996 Dickey Amendment [4–9, 13]. Though many efforts have been undertaken to restore CDC funding for gun use/gun violence research [4, 8], concerns persist in some circles regarding alleged threats to Second Amendment protections and perceived gun control research bias [10, 4–5, 30–33]. Hence, attempts to reinstate CDC funding have failed, despite repeated efforts by various legislators, the spate of American mass shootings (e.g., Columbine, Aurora, Blacksburg [home of Virginia Tech], Sandy Hook, and Orlando), and even a reversal of position by former Representative Jay Dickey (R-Ark), who originally sponsored the Dickey Amendment [5, 6, 8, 17, 31, 32, 34]. The U.S. Courts, including the U.S. Supreme Court, have asserted that the Second Amendment is consistent with and does not bar a broad array of sensible laws to reduce gun violence [35, 36]. Nevertheless, we currently have insufficient evidence or research to inform lawful efforts in this direction. ASSESSMENT OF CURRENT POLICIES Lack of funding has resulted in a 20-year gap in sustained information-gathering regarding the correlates and predictors of gun violence, including what leads to accidental gun deaths, homicides, and suicides. Funding gaps not only impact the financing of straightforward examinations of gun use but also impede studies that utilize gun-related information or examine gun-related factors as part of their investigations. • The CDC’s National Violent Death Reporting System (NVDRS), a clearinghouse on violence-related data, is seriously underfunded, and collects data from only 32 of 50 states [8, 10]. • The CDC’s Injury Center Core State Violence and Injury Prevention Program (Core SVIPP), funds state-level initiatives to reduce injury and violence, yet will not fund investigations on gun-related suicides or gun-related intimate partner homicides [37]. Consequently, research efforts on gun violence have fallen dramatically [6, 10, 11]. In the absence of sustained funding, not enough researchers conduct firearms studies. A report from the Mayors Against Illegal Guns [10] observed that academic publications on firearms “fell by 60 percent” between 1996, when the Dickey Amendment was enacted, and 2010 (p.6).The funding ban has discouraged new researchers and programs from launching investigations in this area [10, 11, 38]. Garen Wintemute, MD, a nationally-recognized expert on gun violence research, asserted that “counting all academic disciplines together, no more than a dozen active, experienced investigators have focused their careers primarily on firearms research” [33, 38, 39]. Moreover, the private sector does not make up for the firearms research funding gap. Wintemute noted that fewer than five private foundations currently fund firearms research [40]. Hence, not enough is known about what contributes to gun violence injuries and deaths and what policies and practices can prevent them. RESEARCH GAPS AND RECOMMENDATIONS Without the reinstatement of funding for firearms research, these gaps in knowledge are expected to continue and grow increasingly more critical. As such, there is a strong need to better understand the risk factors that contribute to incidents of accidental death, homicide, and suicide. An urgent need also exists for more and better data to guide best practices and policies for safe gun ownership and use. Studies examining the impact of existing laws that aim to curb gun trafficking, ban military-style assault weapons, and restrict firearms in public places are needed. Research examining current strategies and policies, as they relate to gun-related morbidity and mortality [33], especially with respect to child and community health and safety and health disparities among children and communities [30, 41], is particularly needed. SUMMARY AND POLICY RECOMMENDATIONS Public health research has a proud and storied history of contributing to reductions in deaths and injuries from, among other causes, motor vehicle accidents, drownings, fires, and tobacco use [6, 10, 13, 31, 33, 42]. As Kellerman and Rivara [6] noted, “This progress was achieved without banning automobiles, swimming pools, or matches. Instead, it came from translating research findings into effective interventions” (2013, p.549). Similar public health impacts are possible for gun-related deaths and injuries if researchers are properly funded to conduct meaningful studies on the correlates and predictors of safer gun practices and policies. To remedy the information-gathering restrictions caused by the bans imposed by the Dickey Amendment, it is recommended that Congress: • Remove “policy riders” on federal appropriations bills that limit firearms research at the CDC [10]. • Expand NVDRS firearms-related data collection efforts to include all 50 states. • Fund CDC research on the risk and protective factors of gun use and gun violence prevention. • Fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence. • Support the development of evidence-based policy and prevention recommendations for gun ownership and use. Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards P.B., C.A.R., S.R., T.L.N., N.B., and D.P. declare that they have no conflicts of interest. This project was not funded. This manuscript is not being simultaneously submitted elsewhere. All procedures were conducted in accordance with ethical standards. Compliance with Ethical Standards This article does not contain studies with human participants performed by any of the authors. This article does not contain any studies with animals performed by any of the authors. On March 29, 2017, a shorter version of this manuscript was posted, in policy brief format, on the Society for Behavioral Medicine’s Twitter and Facebook pages. The authors have full control of the entire content of this manuscript and allow the journal to review the information and sources. Acknowledgments The authors wish to gratefully acknowledge Dr. David Hemenway, of the Harvard School of Public Health, for his helpful comments and suggestions as well as the expert review provided by the Society of Behavioral Medicine’s Health Policy Committee, Health Policy Council, Child and Family Health Special Interest Group, and Violence and Trauma Special Interest Group. References 1. National Register of Health Service Psychologists. 2015. Gun Violence and the Psychological Response to Mass Violence: A Brief Reference Sourcebook for Psychologists.http://www.nationalregister.org/wp-content/upploads/2015/06/Gun-Violence-and-the-Psychological-Response-to-Mass-Violence-A-Brief-Sourcebook-for-Psychologists1.pdf. 2. Campbell JC, Webster D, Koziol-McLain Jet al.   Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health . 2003; 93( 7): 1089– 1097. Google Scholar CrossRef Search ADS PubMed  3. Follman M, Lurie J, Lee J, West J. What does gun violence really cost? A special investigation by Mark Follman, Julia Lurie, Jaeah Lee, and James West; Based on research by Ted Miller. Mother Jones . 2015.http://www.motherjones.com/ politics/2015/04/true-cost-of-gun-violence-in-america. 4. Frankel TC. Why the CDC still isn’t researching gun violence, despite the ban being lifted two years ago: fear and funding shortfalls remain at the CDC, even though the agency was ordered to resume firearm studies after Newtown studies. The Washington Post . 2015. Retrieved October 23, 2016. https://www.washingtonpost.com/ news/storyline/wp/2015/01/14/why-the-cdc-still-isnt-researching-gun-violence-despite-the-ban-being-lifted-two-years-ago/. 5. Jamieson C. Gun violence research: History of the federal funding freeze: Newtown tragedy may lead to lifting of freeze since 1996. Psychological Science Agenda . 2013. Retrieved July 28, 2016. http://www.apa.org/science/ about/psa/ 2013/02/gun-violence.aspx. 6. Kellerman AL, Rivara FP. Viewpoint first: silencing the science on gun research. JAMA . 2013; 309( 6): 549– 550. Google Scholar CrossRef Search ADS PubMed  7. Masters K. The knowledge gap: another $30 million in CDC injury prevention grants, and not a penny for gun violence research: It’s the latest example of the agency’s reluctance to engage with shootings as a public health crisis. The Trace . 2016. Retrieved July 28, 2016. https://www.thetrace.org/2016/07/cdc-injury-prevention-grants-not-a-penny-for-gun-violence/. 8. Rubin R. Tale of 2 agencies: CDC avoids gun violence research but NIH funds it. JAMA . 2016; 315( 16): 1689– 1691. Google Scholar CrossRef Search ADS PubMed  9. Palfrey JS, Palfrey S. Preventing gun deaths in children. N Engl J Med . 2013; 368( 5): 401– 403. Google Scholar CrossRef Search ADS PubMed  10. Mayors Against Illegal Guns. 2013, January. Access Denied: How the Gun Lobby is Depriving Police, Policy Makers, and the Public of the Data we Need to Prevent Gun Violence---A Report by Mayors Against Illegal Guns. Retrieved October 5, 2016. http://everytownresearch.org/ documents/ 2015/04/. 11. Sacks CA. In memory of Daniel---Reviving research to prevent gun violence. N Engl J Med . 2015; 372( 9): 800– 801. Retrieved September 2, 2016. http://www.nejm.org/doi/full/10.1056/ NEJMp1415128#t=article. 12. Centers for Disease Control [CDC]. October 7, 2016. Fast Stats: All Firearms Deaths. National Center for Health Statistics . http://www.cdc.gov/nchs/fastats/injury.htm. 13. Doctors for America Press Release. April 6, 2016. Over 100 Medical and Public Health Organizations Call for Federal Gun Research. Retrieved August 17, 2016. http://www.drsforamerica.org/press-releases/over-100-medical-and-public-health-organizations-call-for-federal-gun-research. 14. Everytown Research for Gun Safety. November 30, 2015. Gun Violence by the Numbers. Retrieved October 28, 2016. https://everytownresearch.org/gun-violence-by-the-numbers/. 15. Hodges HJ, Scalora MJ. Challenging the political assumption that “Guns don’t kill people, crazy people kill people!” Am J Orthopsychiatry . 2015; 85: 211– 216. http://dx.doi.org/10_1037/ort0000069. 16. Grinshteyn E, Hemenway D. Violent death rates: the US compared with other High-income OECD countries, 2010. Am J Med . 2016; 129( 3): 266– 273. Google Scholar CrossRef Search ADS PubMed  17. Malina D, Morrissey S, Campion EW, Hamel MB, Drazen JM. Rooting out gun violence. N Engl J Med . 2016; 374( 2): 175– 176. Google Scholar CrossRef Search ADS PubMed  18. Lankford A. Public mass shooters and firearms: a cross-national study of 171 countries. Violence Vict . 2016; 31( 2): 187– 199. Google Scholar CrossRef Search ADS PubMed  19. Kalesan B, Weinberg J, Galea S. Gun violence in Americans’ social network during their lifetime. Prev Med . 2016; 93: 53– 56. Google Scholar CrossRef Search ADS PubMed  20. Schuster MA, Elliott MN, Kanouse DEet al.   Racial and ethnic health disparities among fifth-graders in three cities. N Engl J Med . 2012; 367( 8): 735– 745. Google Scholar CrossRef Search ADS PubMed  21. Drexler M. Guns and Suicide: The Hidden Toll. Harvard Public Health, Magazine of the Harvard T.H. Chan School of Public Health; 2016. https://www.hsph.harvard.edu/magazine/magazine_article/guns-suicide/. 22. Jeltsen M. We’re missing the big picture on mass shootings: Most take place inside the home and are anything but random. Huffington Post---Politics . 2015. Retrieved October 23, 2016. http://m.huffpost.com/us/entry/us. 23. Shaw K. 12 facts that show how guns make domestic violence even deadlier: a statistical guide to firearms, intimate partner abuse, and the children, parents, and police who become victims, too. The Trace . 2016. Retrieved October 23, 2016. https://www.thetrace.org/2016/08/15-facts-that-show-how-gu...escalates-to-mass-shootings-putting-children-in-the-crosshairs. 24. Violence Policy Center. 2015, September. When Men Murder Women: An Analysis of 2013 Homicide Data. Washington, D.C.: Violence Policy Center Publication. http://www.vpc.org. 25. Zeoli AM, Malinski R, Turchan B. Risks and targeted interventions: firearms in intimate partner violence. Epidemiol Rev . 2016; 38( 1): 125– 139. Google Scholar PubMed  26. Gun Violence Archive. 2016, September. Gun Violence 2016, January 1-September 1, 2016. Retrieved 09/02/2016. http://www.gunviolencearchive.org/. 27. Centers for Disease Control and Prevention. 2015. Web-based statistics query and reporting system (WISQARS) [Online]. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2015. http://www.cdc.gov/injury/ wisqars/fatal.html. 28. Child Trends. 2015, December. Databank Indicator: Teen Homicide and Suicide and Firearms Deaths. Retrieved October 28, 2016. http://www.childtrends.org/indicators/teen-homicide-suicide-and-firearm-deaths/#_edn2. 29. Fleegler EW, Lee LK, Monuteaux MC, Hemenway D, Mannix R. Firearm legislation and firearm-related fatalities in the United States. JAMA Intern Med . 2013; 173( 9): 732– 740. Google Scholar CrossRef Search ADS PubMed  30. American Psychological Association. Gun Violence: Prediction, Prevention, and Policy: APA Panel of Experts Report. 2013. http://www.apa.org/pubs/info/reports/gun-violence prevention.aspx. 31. Dickey J, Rosenberg M. How to protect guns while reducing the toll of gun violence. Washington Post---Opinions . 2015. Retrieved October 5, 2016. https://www.washingtonpost. com/opinions/time-for-collaboration-on-gun-research/2015/12/25/. 32. Sacks CA, Malina D, Morrissey S, Campion EW, Hamel MB, Drazen JM. In the Wake of Orlando - Taking steps against gun violence. N Engl J Med . 2016; 375( 9): e19. Google Scholar CrossRef Search ADS PubMed  33. Wintemute GJ. Invited commentary: responding to the crisis of firearm violence in the United States: comment on “Firearm legislation and firearm-related fatalities in the United States.” JAMA Internal Medicine . 2013; 173( 9): 740. Retrieved August 30, 2016. http://archinte.jamanetwork.com/article.aspx?articleid=1661391. 34. Dickey J, Rosenberg M. We won’t know the cause of gun violence until we look for it. Washington Post---Opinions . 2012. Retrieved September 2, 2016. https://www.washingtonpost.com/ opinions/we-wont-know-the-cause-of-gun-violence-until-we-look-for-it/ 2012/07/27/ gJQAPfenEX_story.html? utm_term=.6729ec9a818f. 35. American Bar Association. February 6, 2015. Gun Violence Laws and the Second Amendment: A Report of the American Bar Association. Washington, D.C.: American Bar Association White Paper. https://www.americanbar.org/content/dam/ aba/images/ abanews/GunViolenceWhitePaper_020615.pdf. 36. Weinberger SE, Hoyt DB, Lawrence HC3rdet al.   Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med . 2015; 162( 7): 513– 516. Google Scholar CrossRef Search ADS PubMed  37. Masters K. The knowledge gap: 141 medical groups urge Congress to restore funding for gun violence research: Doctors call on lawmakers to “end the dramatic chilling effect” of a law seen as curbing almost all CDC studies. The Trace . 2016. Retrieved July 28, 2016. https://www.thetrace.org/2016/04/cdc-gun-violence-research-ban-doctors-for-america/. 38. Ellis EG. Congress refuses, so California funds its own gun violence research center. Wired---Science . 2016. Retrieved September 2, 2016. http://www.wired.com/ 2016/06/ congress-refuses-california-funds-gun-violence-research-center/. 39. Mascia J. Politics: In first Post-Charleston gun vote, Congress preserves CDC research ban: 19-year prohibition on CDC studies on gun violence stays in place. The Trace . 2015. Retrieved August 30, 2016. https://www.thetrace.org/2015/06/cdc-funding-gun-violence-rider/. 40. Thacker PD. How Congress blocked research on gun violence: the ugly campaign by the NRA shut down studies at the CDC. Slate . 2012. http://www.slate.com/articles/ health_and_science/ science/2012/12/gun_violence_ research_nra _ and_congress_ blocked_gun_control_studies_at_cdc.html. 41. Lee LK, Fleegler EW, Farrell Cet al.   Firearm laws and firearm homicide: a systematic review. JAMA Intern Med . 2017; 177( 1): 106– 119. Google Scholar CrossRef Search ADS PubMed  42. U.S. Department of Health and Human Services, Public Health Service( 1994). For a Healthy Nation: Returns on Investment in Public Health. https://archive.org/stream/ forhealthynation00 unse#page/42/mode/2up. © Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Translational Behavioral Medicine Oxford University Press

Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun violence prevention research

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Abstract

Abstract The Society for Behavioral Medicine (SBM) urges restoration of Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention. Unfortunately, there have been no concerted CDC-funded research efforts in this area since 1996, due to the passage of the Dickey Amendment. To remedy the information-gathering restrictions caused by the Dickey Amendment bans, it is recommended that Congress remove ‘policy riders’ on federal appropriations bills that limit firearms research at the CDC; expand NVDRS firearms-related data collection efforts to include all fifty states; fund CDC research on the risk and protective factors of gun use and gun violence prevention; fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence; and support the development of evidence-based policy and prevention recommendations for gun use and ownership. Implications Practice: The outcomes of unfettered and objective peer-reviewed research can be used to determine best practices for the development of effective, evidence-based clinical and community-based prevention and intervention efforts which aim to prevent gun-related injuries and deaths and inform recommendations for safer gun use and storage. Policy: The outcomes of peer-reviewed firearms studies can be used to inform the development and implementation of effective policies regarding the nature of gun sales, the screening of potential buyers, the registration and tracking of firearms purchases, and laws regulating gun ownership. Research: Firearms research needs to be vigorously funded to better elucidate the factors associated with gun deaths and injuries and to inform the development of evidence-based recommendations for firearms policies and use. INTRODUCTION The Society for Behavioral Medicine (SBM) urges restoration of the Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention [1, 2, 3], yet there has been no concerted CDC-funded firearms research since the passage of the 1996 Dickey Amendment [4–9]. The funding ban has resulted in a dramatic reduction of studies on the correlates and predictors of gun violence, including research on what leads to accidental gun deaths, homicides, and suicides, and the policies and practices that can prevent them [10, 6, 11]. SBM urges the restoration of CDC funding for firearms investigations to better understand the factors associated with gun deaths and injuries and to inform the development of evidence-based recommendations for firearms policies and use. Background Firearms injuries are a leading cause of non-medical deaths in America, surpassing motor vehicle fatalities in twenty-one states and the District of Columbia [12]. Note the breadth and scope of this problem: • Data from 5 years of CDC statistics estimate that 91 Americans are killed every day by gun violence [13], with over 33,000 deaths per year [14]. The CDC’s 5-year average of gun-related injury data (2010–2014) found that, annually, 78,815 individuals are injured by guns in the U.S. [14]. Guns also account for nearly 70% of U.S. homicides [15]. More Americans lose their lives to gun violence compared to citizens from similarly developed countries [10, 16, 17]. The U.S. makes up about 5% of the world’s population yet, in the last decade, has suffered nearly a third of the world’s mass shootings [18]. The pervasiveness of this problem is startlingly illustrated in a 2016 study, which found that the likelihood of an American knowing a gun violence victim within their personal network over the course of their lifetime is between 98 and 99.9% [19]. • Gun violence statistics reflect marked health disparities in the United States. The likelihood of witnessing a gun-related threat or injury was found to be significantly higher for Black or Latino children [20]. In 2013, African Americans suffered over 57% of all firearms deaths, even though they comprised only 13% of the U.S. population [1]. • Gun ownership increases the risk of completed suicides and domestic violence deaths and injuries. Gun injuries account for more completed suicides compared to all other means combined [21]. The presence of guns in the home also increases the severity and deadliness of domestic violence [2, 22–25]. • Gun violence is a leading cause of injury and death in American children and youth. The Gun Violence Archive, a clearinghouse of gun violence statistics, reports that, in 2016 alone, 446 children (aged 0–12) and 2,072 teenagers were injured or killed in gun violence incidents [26]. Gun violence is the leading cause of death among African American males 15–34 years of age [1]. In 2014, firearms caused 88% of teen homicides and 41% of teen suicides [27, 28]. • Finally, gun violence exacts a financial toll on individual and community resources [1, 3, 29]. Nationally-reported direct and indirect costs of gun violence are estimated to range from approximately $100 billion to $229 billion dollars per year [1, 3]. Firearms deaths and injuries comprise a serious public health problem. Yet, the CDC has not comprehensively funded firearms research since the passage of the 1996 Dickey Amendment [4–9, 13]. Though many efforts have been undertaken to restore CDC funding for gun use/gun violence research [4, 8], concerns persist in some circles regarding alleged threats to Second Amendment protections and perceived gun control research bias [10, 4–5, 30–33]. Hence, attempts to reinstate CDC funding have failed, despite repeated efforts by various legislators, the spate of American mass shootings (e.g., Columbine, Aurora, Blacksburg [home of Virginia Tech], Sandy Hook, and Orlando), and even a reversal of position by former Representative Jay Dickey (R-Ark), who originally sponsored the Dickey Amendment [5, 6, 8, 17, 31, 32, 34]. The U.S. Courts, including the U.S. Supreme Court, have asserted that the Second Amendment is consistent with and does not bar a broad array of sensible laws to reduce gun violence [35, 36]. Nevertheless, we currently have insufficient evidence or research to inform lawful efforts in this direction. ASSESSMENT OF CURRENT POLICIES Lack of funding has resulted in a 20-year gap in sustained information-gathering regarding the correlates and predictors of gun violence, including what leads to accidental gun deaths, homicides, and suicides. Funding gaps not only impact the financing of straightforward examinations of gun use but also impede studies that utilize gun-related information or examine gun-related factors as part of their investigations. • The CDC’s National Violent Death Reporting System (NVDRS), a clearinghouse on violence-related data, is seriously underfunded, and collects data from only 32 of 50 states [8, 10]. • The CDC’s Injury Center Core State Violence and Injury Prevention Program (Core SVIPP), funds state-level initiatives to reduce injury and violence, yet will not fund investigations on gun-related suicides or gun-related intimate partner homicides [37]. Consequently, research efforts on gun violence have fallen dramatically [6, 10, 11]. In the absence of sustained funding, not enough researchers conduct firearms studies. A report from the Mayors Against Illegal Guns [10] observed that academic publications on firearms “fell by 60 percent” between 1996, when the Dickey Amendment was enacted, and 2010 (p.6).The funding ban has discouraged new researchers and programs from launching investigations in this area [10, 11, 38]. Garen Wintemute, MD, a nationally-recognized expert on gun violence research, asserted that “counting all academic disciplines together, no more than a dozen active, experienced investigators have focused their careers primarily on firearms research” [33, 38, 39]. Moreover, the private sector does not make up for the firearms research funding gap. Wintemute noted that fewer than five private foundations currently fund firearms research [40]. Hence, not enough is known about what contributes to gun violence injuries and deaths and what policies and practices can prevent them. RESEARCH GAPS AND RECOMMENDATIONS Without the reinstatement of funding for firearms research, these gaps in knowledge are expected to continue and grow increasingly more critical. As such, there is a strong need to better understand the risk factors that contribute to incidents of accidental death, homicide, and suicide. An urgent need also exists for more and better data to guide best practices and policies for safe gun ownership and use. Studies examining the impact of existing laws that aim to curb gun trafficking, ban military-style assault weapons, and restrict firearms in public places are needed. Research examining current strategies and policies, as they relate to gun-related morbidity and mortality [33], especially with respect to child and community health and safety and health disparities among children and communities [30, 41], is particularly needed. SUMMARY AND POLICY RECOMMENDATIONS Public health research has a proud and storied history of contributing to reductions in deaths and injuries from, among other causes, motor vehicle accidents, drownings, fires, and tobacco use [6, 10, 13, 31, 33, 42]. As Kellerman and Rivara [6] noted, “This progress was achieved without banning automobiles, swimming pools, or matches. Instead, it came from translating research findings into effective interventions” (2013, p.549). Similar public health impacts are possible for gun-related deaths and injuries if researchers are properly funded to conduct meaningful studies on the correlates and predictors of safer gun practices and policies. To remedy the information-gathering restrictions caused by the bans imposed by the Dickey Amendment, it is recommended that Congress: • Remove “policy riders” on federal appropriations bills that limit firearms research at the CDC [10]. • Expand NVDRS firearms-related data collection efforts to include all 50 states. • Fund CDC research on the risk and protective factors of gun use and gun violence prevention. • Fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence. • Support the development of evidence-based policy and prevention recommendations for gun ownership and use. Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards P.B., C.A.R., S.R., T.L.N., N.B., and D.P. declare that they have no conflicts of interest. This project was not funded. This manuscript is not being simultaneously submitted elsewhere. All procedures were conducted in accordance with ethical standards. Compliance with Ethical Standards This article does not contain studies with human participants performed by any of the authors. This article does not contain any studies with animals performed by any of the authors. On March 29, 2017, a shorter version of this manuscript was posted, in policy brief format, on the Society for Behavioral Medicine’s Twitter and Facebook pages. The authors have full control of the entire content of this manuscript and allow the journal to review the information and sources. Acknowledgments The authors wish to gratefully acknowledge Dr. David Hemenway, of the Harvard School of Public Health, for his helpful comments and suggestions as well as the expert review provided by the Society of Behavioral Medicine’s Health Policy Committee, Health Policy Council, Child and Family Health Special Interest Group, and Violence and Trauma Special Interest Group. References 1. 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