Policy and Position Statements


Preventing Firearm Misuse, Injury, and Death Position Statement

I. ASTHO Supports State Efforts to Prevent Firearm Misuse, Injury and Death  

The Association of State and Territorial Health Officials (ASTHO) supports state and territorial health agencies’ efforts to prevent firearm injury and death across the lifespan. ASTHO recommends using a multidisciplinary approach to prevent firearm injury and death that draws on best practices and a breadth of expertise from public health practitioners, healthcare providers, and community partners. Effective interventions should encompass all age groups to encourage the systematic and long-term prevention of firearm injury and death. By considering prevention strategies in multiple sectors—family, school, neighborhood, worksite, and healthcare—health agencies can safeguard against firearm misuse, injury, and death.

ASTHO acknowledges that health departments have an important role in this process: to help ensure that health consequences related to the misuse of firearms are clearly understood and considered as part of public policy debates within states and territories. To do this, state health departments should strive to offer fair and unbiased data about the incidence of injury and death and risk factors and health consequences related to firearms in their states. Additionally, state health departments should also serve as a resource for what current research literature indicates to be effective prevention programs and policies. The charged nature of policy debates related to firearm injury and death only underscores how critical state health agencies are to this process and illustrates that these agencies can help articulate areas of common ground that can ultimately help reduce injury and death from firearms.  

II. Background: Improving States’ and Territories’ Firearm Safety Efforts

Firearm injury and death is a major public health concern in the United States, claiming more than 33,000 lives (including homicides, suicides, and unintentional fatalities) and injuring an estimated 84,258 individuals each year.1,2 The majority of these injuries and deaths are caused by acts of violence.3 These numbers are equivalent to a rate of more than 90 deaths per day and more than three deaths each hour. Suicide is the leading cause of firearm-related fatalities in the United States, a fact that has remained constant in published data since 1981.4 In 2013, firearms were responsible for 21,175 suicides and 11,208 homicides.5 Additionally, 2,465 children (ages 0 - 19) died by firearms in 2013, while another 15,091 were injured.1,6  Firearms were the second leading cause of trauma death in pediatric trauma centers between 2009 and 2011.7 Overall, the rate of firearm injury and death is more than five times greater in the United States than in 23 other high-income countries analyzed collectively.6

Firearm injury and death affects people of all backgrounds, but young adults, males, and racial and ethnic minorities are disproportionately affected.8 Significant disparities exist not only in overall mortality rates, but within the different categories of both intentional and unintentional firearm injury and death, including suicide, homicide, and unintentional injuries and deaths.9 In 2009, firearm-related injuries were the leading cause of death among black males 15-34 years of age.10 In 2013, 4,701 black males in that age category were victims of firearm homicide compared to 2,223 similarly aged white males.5 Research published in February 2014 on hospitalizations due to firearm injuries among U.S. children and adolescents revealed that males made up 89 percent of the 7,391 hospitalizations reported in 2009.11 In 2010, more than 50 percent of suicides involved a firearm, resulting in over 19,000 deaths, and white males accounted for over 80 percent of those suicides.3,12

Thirty-two states participate in a national surveillance system that collects data on violent deaths and provides more context on the issue of firearm misuse and injury.  In 2010, 16 states collected data through this surveillance system concerning 16,186 deaths, of which 49.6 percent were firearm-related.13 According to these data, firearms were involved in 66.2 percent of homicides and were the most common method used in homicides of both men (71.3%) and women (47.9%).13

Morbidity and mortality associated with firearm misuse carries significant economic implications. In 2010, firearm injuries cost the United States a total of $174 billion.14 More specifically, the societal cost per firearm assault injury, which includes medical and mental healthcare and police and criminal justice activities, was $5.1 million for each fatality and $433,000 for each individual admitted to the hospital.14  Given the enormous economic, social, and health costs, along with the injuries and loss of life related to firearm misuse, ASTHO affirms that it is essential that state and territorial health agencies examine a broad range of firearm injury and death prevention strategies as integral components of public health practice.

State and territorial health agencies may provide essential leadership to prevent firearm injury and death. They serve as integrating bodies that leverage the range of assets and expertise possessed by key partners, such as public health and healthcare, education, criminal justice, public safety, housing, and labor entities, businesses, faith-based organizations, community leaders, decision- and policymakers, and nonprofit organizations, to prevent firearm injuries and deaths. Alignment across and within these sectors is essential for planning and developing cohesive approaches to promote the health, safety, and well-being of children, youth, and families.

III. Within This Context, ASTHO Recommends That State and Territorial Health Agencies:

  • Promote programs that increase understanding of firearm-related injuries and deaths as a public health issue.15,16
  • Enhance surveillance systems to improve reporting of firearm injury and death; and extend surveillance to all states and territories.15
  • Enact policies that focus on improving the safety of workplaces and community environments.15
  • Support federal funding for research related to preventing firearm injury and death, including accurately evaluating healthcare-based screening and intervention, enhancing knowledge about risk and protective factors, universal background checks, and identifying the effects of different technologies (e.g. new safety features) on reducing firearm injury and death.9,10,15,18,19
  • Support the implementation of evidence-based violence prevention programs within schools and communities, including early intervention strategies and other initiatives to prevent firearm injury and death and prepare communities and schools in the event of an emergency.16
  • Develop and implement public health messaging campaigns on safe firearm use and storage techniques.15
  • Support healthcare providers’ communication with patients about firearm safety.15, 16, 17
  • Improve the availability and quality of mental health services for at-risk children and adults to reduce their risk of suicide or harm to others.15

This statement was not developed or intended to affect the passage of specific Federal, State, or local legislation intended to restrict or control the purchase or use of firearms.

Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate policy committees and approved by the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Prevention Policy Committee Review and Approval: January 2015
Board of Directors review and approval: September 2015
Policy Expires: June 2018

For further information about this position statement, please contact ASTHO Prevention Policy staff at prevention@astho.org. For ASTHO policies and additional publications related to this position statement, please visit www.astho.org/Policy-and-Position-Statements.

Related ASTHO Documents


  1. CDC. “Web-Based Injury Statistics Query and Reporting Systems: Fatal Injury Reports.” Available at http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html. Accessed 6-19-14.
  2. CDC. “Injury Prevention & Control: Data & Statistics (WISQARS).” Available at http://www.cdc.gov/injury/wisqars/. Accessed 6-14-14.
  3. CDC. “Web-Based Injury Statistics Query and Reporting Systems: Fatal Injury Reports.” Available at http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html. Accessed 6-19-14.
  4. Pew Research Center. “Suicides account for most gun deaths.” Available at http://www.pewresearch.org/fact-tank/2013/05/24/suicides-account-for-most-gun-deaths/. Accessed 12-18-14.
  5. CDC. “Web-Based Injury Statistics Query and Reporting Systems: Fatal Injury Reports.” Available at http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html. Accessed 12-18-14.
  6. Richardson EG, Hemenway D. “Homicide, Suicide, and Unintentional Firearm Mortality: Comparing the United States with Other High-Income Countries.” 2003. J Trauma. 2011. 70:238-43. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20571454. Accessed 5-5-15.
  7. American Pediatric Surgical Association. “Firearm Injuries and Children.” Available at http://www.journalacs.org/article/S1072-7515(13)00881-8/pdf.  Accessed 5-15-15.
  8. APHA. “Gun Violence Prevention.” Available at http://www.apha.org/~/media/files/pdf/fact%20sheets/gun_violence_prevention.ashx Accessed 6-19-14.
  9. Institute of Medicine. “Priorities for Research to Reduce the Threat of Firearm-Related Violence. Available at http://www.iom.edu/~/media/Files/Report%20Files/2013/Firearm-Violence/FirearmViolence_RB.pdf. Accessed 6-19-14.
  10. American Academy of Pediatrics. “Policy Statement: Firearm-Related Injuries Affecting the Pediatric Populations.” Pediatrics. 2012. 130: e1416-e1423. Available at http://pediatrics.aappublications.org/content/130/5/e1416.full.pdf+html. Accessed 6-19-14.
  11. Leventhal, J, Gaither J, Sege, R. “Hospitalizations Due to Firearm Injuries in Children and Adolescents.” Pediatrics. 2014. 133:219-225. Available at http://pediatrics.aappublications.org/content/133/2/219.full.pdf+html. Accessed 6-19-14.
  12. CDC. “Injury Prevention & Control: Data & Statistics (WISQARS)”. Available at http://www.cdc.gov/injury/wisqars/.  Accessed 6-14-14.
  13. CDC. “Surveillance for Violent Deaths–National Violent Death Reporting System, 16 States, 2010.” Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6301a1.htm. Accessed 12-22-14. 
  14. Children’s Safety Network. “The Cost of Firearm Violence.” Available at http://www.childrenssafetynetwork.org/publications/cost-firearm-violence. Accessed 6-14-14.
  15. Safe States Alliance. “Policy Statement: Preventing Firearm-Related Violence & Injuries.” Available at https://c.ymcdn.com/sites/safestates.site-ym.com/resource/resmgr/Files/Safe_States_Firearm_Policy_S.pdf. Accessed 6-20-14.
  16. American Academy of Pediatrics. “Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents: Promoting Safety and Injury Prevention.” Available at https://brightfutures.aap.org/Bright%20Futures%20Documents/10-Promoting_Safety_and_Injury_Prevention.pdf. Accessed 6-20-14.
  17. American Academy of Pediatrics. “Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents.” Available at https://brightfutures.aap.org/Bright%20Futures%20Documents/BF3%20pocket%20guide_final.pdf. Accessed 7-18-14.
  18. Safavi, A et al. “Children Are Safer in States with Strict Firearm Laws: A National Inpatient Sample Study.” Journal of Trauma and Acute Care Surgery.  2014. 76: 146-151. Available at: http://journals.lww.com/jtrauma/Abstract/2014/01000/Children_are_safer_in_states_with_strict_firearm.21.aspx. Accessed 7-22-14.
  19. Webster, D, Cercher, C, Vernick, J. “Effects of the Repeal of Missouri’s Handgun Purchaser Licensing Law on Homicides.” Journal of Urban Health. 2014. 91: 293-302. Available at: http://link.springer.com/article/10.1007/s11524-014-9865-8. Accessed 7-22-14.