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A public health crisis: Recommendations to reduce gun violence in America

      The Academy Board of Directors has identified five areas of priority including:
      • Reproductive rights
      • Environmental health
      • Toxic stress in children
      • Opioid crisis
      • Violence prevention
      Within 48 hours of the horrific massacre at Marjory Stoneman Douglas High School High School in Lakeland, Florida, the Academy issued a press release calling for Congressional Leadership to create a bipartisan National Commission on Mass Shootings. This public mandate supports one of the Academy's priority areas—violence prevention. The directive listed seven evidence-based recommendations for immediate consideration. Those recommendations included:
      • 1.
        Creating a universal system for background checks designed to highlight an applicant's history of dangerousness and require that all purchasers of firearms complete a background check.
      • 2.
        Strengthening laws to assure that high-risk individuals, including those with emergency, temporary, or permanent protective or restraining orders or those with convictions for family violence, domestic violence and/or stalking, are prohibited from purchasing firearms.
      • 3.
        Banning the future sale, importation, manufacture, or transfer of assault weapons, and calling for a more carefully crafted definition of the term “semiautomatic assault weapon” to reduce the risk that the law can be evaded.
      • 4.
        Ensuring that health care professionals are unencumbered and fully permitted to fulfill their role in preventing firearm injuries through health screening, patient counseling, and referral to mental health services of individuals with high-risk danger behaviors.
      • 5.
        Focusing federal restrictions of gun purchase for persons on the dangerousness of the individual and fully funding federal incentives for states to provide information about dangerous histories to the National Instant Check System for gun buyers.
      • 6.
        Supporting enriched training of health care professionals to assume a greater role in preventing firearm injuries through health screening.
      • 7.
        Researching the causes of and solutions to firearm violence.
      The following week, the Academy invited a broad list of organizations to sign a letter to Congressional Leadership calling on them to commission the recommended bipartisan committee. We were encouraged to see widespread support for our gun safety initiative when 97 organizations signed on in support in less than 72 hours. While President Trump has announced the formation of a commission, we cannot know what, if any, impact it will have. That is why it is imperative that we continue a constant drumbeat to call attention to this public health crisis.
      On behalf of the Academy's leadership, I would like to thank the Violence Prevention Expert Panel for its prompt preparation of a policy brief that further describes the issue of gun violence and presents the evidence behind the seven recommendations published in this issue. This timely response by the Academy is critical as we work to craft policies with the potential to have a national impact. To follow-up on this successful initial effort, the Academy “s leadership will be urging the Congressional Nursing Caucus to hold a hearing on mass shootings and to develop a strategy to leverage these evidence-based recommendations to advocate for gun safety.
      I know many of us have renewed hope for national action to curtail access to firearms based on the protest movement of young people basically calling out adults for failing to provide for their safety. These pioneering advocates for life have been articulate, indignant, and unfazed by attacks from adults. If the March for Our Lives is any indication of their long-term approach, we can expect to see this topic remain at the forefront of public discussion.
      It is time to call gun violence what it is—a public health crisis. The most recent focus has been on mass shootings; however, gun violence on the streets of our urban cities claims comparable numbers of lives as do mass shootings. However, this ongoing series of incidents are treated as one-off occurrences, generating such little publicity or outrage as to be deemed “invisible” to most citizens.
      Another important aspect of gun violence centers on the widespread epidemic of suicide and suicidal ideation. Suicide ranks as the 10th leading cause of death in America and, on average, there are 123 successful suicides every day (
      • Suicide Statistics
      American Foundation for Suicide Prevention.
      ). The majority (51%) of suicides committed in 2016 involved a firearm (
      • Suicide Statistics
      American Foundation for Suicide Prevention.
      ). In 2015, the most recent year for which statistics are available, 565 children and adolescents died by firearm suicide—the highest number recorded in a single year. In all, 90% of gun suicides attempted by children and adolescents end in death, and over 80% of children who die by firearm suicide used a weapon from their own home (
      • Child Gun Suicide
      Unlocked and Loaded: How America's children are dying by gun suicide.
      ). Mental health issues and guns can literally be a lethal combination.
      It is important that we approach increasing gun safety as a marathon, not a sprint. I see corollaries between maximizing gun safety and decreasing the use of tobacco products. When I was a young nurse, we could smoke in the nurses” lounge. Cigarette smoking was allowed on airplanes – in the back. It took scientific evidence and the will of the general public to support the dangers of second-hand smoke and two decades of changes both large and small, much of it done at the local and state levels, to restrict smoking. The initiative to curtail smoking was not designed to eliminate an individual's right to smoke. It was to ensure that the public knew just how dangerous smoking was to the smoker and the non-smokers in the vicinity. In addition, lawmakers had to be educated that cigarette taxes decreased teenagers' likelihood of starting the practice. While smoking curtailment was not as politically-charged as the issues related to gun rights, make no mistake that a large corporate lobby worked tirelessly to thwart anti-smoking efforts.
      Gun violence will most likely not be adequately addressed overnight. It will require each of us to take a long-term approach to advocating for gun safety—whenever and wherever we have the opportunity. We need to use the best evidence available to advance gun safety—at home, in the workplace, at school and in other public spaces.
      Finally, this public health crisis calls out for swift and immediate action. The Academy's policy brief included in this issue points out, “As we address mass shootings, it is important to support the implementation of family, school, and community-based programs with demonstrated success in preventing and addressing the toxic stress, bullying, mental health, and violence cascades which are often underlying mass shootings and other forms of violence.” (
      • Gonzalez-Guarda R.
      • Dowdell E.B.
      • Marino M.A.
      • Anderson J.C.
      • Laughon K.
      American Academy of Nursing on Policy: Recommendations in Response to Mass Shootings.
      ) Implementing practical evidenced-based violence prevention strategies can be the foundation for those us committed to ending senseless gun violence.

      References

        • Child Gun Suicide
        Unlocked and Loaded: How America's children are dying by gun suicide.
        (Everytown Research; Retrieved from)
        • Gonzalez-Guarda R.
        • Dowdell E.B.
        • Marino M.A.
        • Anderson J.C.
        • Laughon K.
        American Academy of Nursing on Policy: Recommendations in Response to Mass Shootings.
        (American Academy of Nursing, Policy Brief)2018
        • Suicide Statistics
        American Foundation for Suicide Prevention.
        (Retrieved from)