Gun violence in the United States: Firearms and Suicide

This is the third post in a series about Reducing Gun Violence in the United States. The previous post described Gun Markets, Ownership, and Violence Risk.

In this post, I’ll introduce the relationship between firearms and suicide.

Background on Suicide

In 2017, there were around 24,000 firearm suicides in the United States; this accounts for half of all suicides during that year (over 47,000).

Suicide was the tenth leading cause of death overall, and the second leading cause of death for people under the age of 35 (source: CDC WISQARS).

The number of firearm deaths due to various causes looked like this (source CDC Wonder):

  • Suicide: 60% (23,854)
  • Homicide: 37% (14,542)
  • Legal Intervention (typically due to law enforcement activities): 1.4% (538)
  • Unintentional: 1.2% (495)
  • Unknown: 0.8% (338)

Suicide rates vary dramatically across the various states, with some states having as many as four times the number of suicides as other states:

Suicide Rates in the United States (source CDC WISQARS)


The following graph sorts the states left to right; states with highest levels of self-reported emotional and psychological well-being on the left, and those with lowest levels on the right. States with the highest suicide rates are not those states which have the lowest levels of emotional and psychological well-being. On its face, this is a puzzling result.

Suicide rates (age-adjusted) related to rates of well-being (source Gallup Well-Being)


Let’s continue looking at the rates of firearm ownership and suicide, firearm suicide, and non-firearm suicide across several states. What we see is that

  • the more firearms are owned in the state, the higher the rate of firearm suicide
  • the more firearms are owned in the state is not related to the number of non-firearm suicides
  • rates of suicide overall are much higher in states with more gun ownership

Rates of firearm ownership and suicide (source: Firearms in the Northeast)

Let’s take a look at acts where people try to harm themselves:

  • Most people attempting to harm themselves do so by poisoning, cutting, or piercing (85%)
    • Poisoning, cutting, and piercing only result in fatal injuries 3% of the time
  • Very few people attempting to harm themselves do so using firearms (5%)
    • Use of a firearm in self-harm results in a fatal injury 91% of the time

In short, when people use a firearm to hurt themselves, they are very, very likely to end up with a fatality.

Deliberate Self-Harm and Case Fatality Rate by Act, Seven Northeastern states, 1994-2000 (source CDC WISQARS and HCUP-NIS)

Looking at the data another way:

  • Those people whose suicide attempt was successful had used a firearm in more than half of cases
  • Those people whose suicide attempt was unsuccessful had used poison or an overdose 83% of the time

A key insight is that if access to firearms is difficult for people in a crisis where they are considering suicide, they are more likely to use a different method, which is much more likely to result in a life being saved.

Methods of Self-Harm (source CDC WISQARS and HCUP-HIS)

When reviewing cases of survivors of suicide attempts, we find some interesting other information:

  • suicidal acts are typically impulsive, and the thoughts that lead to those acts are typically temporary
  • the choice of suicide method is largely dependent on the availability of that method (such as a gun)
  • less than 10% of suicide survivors re-attempt suicide a second time
    • so if we can lessen the risk of a successful first suicide attempt, those people are much, much more likely to survive long-term

Saving a person who has suicidal thoughts today means very likely saving their life in the long run.

Data-driven Studies

How do we know that firearms availability actually is a cause of increased suicide risk, rather than just being correlated with it?

More than a dozen studies between 1991 and 2005 show that having a firearm in a home greatly increases the risk of suicide for all members of the household, especially young adults and children. These studies controlled for age, alcohol usage, community, depression, education, illegal drug use, medication usage, and mental health diagnosis.

Accessibility of Firearms and Risk of Suicide Among Household Members (source: Accessibility of Firearms)

Suicide rates do not vary much per state, but rates do have to do with the availability of firearms in the home. Between 2008 and 2009, there were over 11,000 suicides in states with high gun ownership rates vs about 6,000 suicides in states with low gun ownership. The rate of suicide attempts overall did not vary from high to low gun ownership states.

Is Risk Independent of Underlying Suicidal Behavior? (source: Risk Independence of Suicide)

There is also a strong relationship between safer storage of guns in the home and lower rates of suicide for youth. Note how the rates of suicides in cases with guns stored unlocked (unsafely) is more than twice that of rates of suicides with guns stored safely (locked).

Firearm storage practices and suicide risk for 5 to 19-year-olds (source: Gun Storage Practices)

Let’s return to the topic of what we know about these guns that are in people’s homes:

  • Around 265 million firearms are in the hands of civilians (source: Stock and Flow)
  • 1/3 of US households own guns (estimate) (source: Stock and Flow)
  • 5 million children live in homes with guns (estimate) (source: Firearm Storage with Children)
  • Firearms are the most lethal method of commonly completed suicides (source: Case Fatality Rates)
    • The majority of the guns used in these suicides come from the victim’s homes (source: Self-Inflicted Injuries)
    • More than 90% of these guns have been in the home for more than two weeks, often years (source: Suicide in the Home)
  • Gun owners and members of gun-owning homes are neither more depressed nor any more suicidal than members of non-gun-owning homes (source: Recent Psychopathology)
  • No likely factor yet unstudied can account for the strong relationship between firearm availability and suicide (source: Are We Missing Something?)

There are success stories for suicide prevention based on empirical data. Here is one from the Israeli military. In the early 2000s, the Israeli military noticed that many service members were committing suicide, mostly during weekends with their service weapons. In 2006, the Israeli changed their firearm policy to prevent service members from taking their guns home on the weekend.

The result? (source: Decrease in Suicide)

  • Suicide rates dropped by 40% over the weekend
  • Suicide rates during the week remained unchanged

Are we using this data that we know?

As seen above, strong evidence exists that firearms do play a direct role in increasing suicide risk. Are we actually using this information?

A survey of emergency department employees, doctors, and nurses who worked with suicidal patients were asked if they thought restricting access to firearms would affect the suicide rate. They were asked the question:

“Had a firearm not been accessible to them, how many do you think would have found another way to die by suicide?”

The results were that a large fraction thought that most or all of the firearm suicide attempters would have found a similarly lethal way to die by suicide if their firearms had not been available (which we know is not true by the data presented above):

  • 67% of nurses
  • 43% of attending physicians
  • 44% of resident physicians

Would suicide victims have died by another means if firearms were not available? (source: Lethal Means Restriction)

Those healthcare providers were then asked if they asked suicidal patients if they had firearms in their home.

  • only two-thirds asked when a patient said they were suicidal and had a plan to use a gun
  • less than 20% asked when a patient said they were suicidal but did not have a plan with a gun

Do you ask if firearms are at home? (source: Lethal Means Restriction)

In fact, when surveyed, most Americans do not think that restricting access to guns will have an effect on suicide rates, and they also show broader disbelief about restricting access to lethal means of suicide:

Does a gun in the home increase the risk of suicide? (source: Suicide Relationship Belief)

Generally speaking, members of the public do not believe the reality of the data about suicide prevention which shows that having a gun at home substantially increases the risk of suicide, both for the owner themselves and other household members.


Background on Suicide

  • 60% of people in the US who are involved in firearm violence die due to suicide (almost 24,000 people)
  • Suicide rates are not correlated with general well-being
  • Suicide rates are significantly higher in states with higher gun ownership
  • Most people attempting to harm themselves use non-fatal methods (> 80% of the time)
    • But people using firearms in a suicide attempt will succeed more than 90% of the time
  • Only 10% of suicide survivors go on to attempt it again later
    • So saving someone’s life today from suicide means very likely saving their life in the long run

Data-driven Studies

  • Many studies confirm that the availability of firearms cause an increase in suicide rates (not only correlation)
    • Especially affects young adults and children when firearms are in the home
  • Rate of suicide attempts does not vary from high to low gun ownership states
  • Gun owners and members of gun-owning homes are neither more depressed nor any more suicidal than members of non-gun-owning homes
  • Firearms in the home are a major contributor to the 47,000 suicide deaths that occur in the US every year

Are we using this data that we know?

  • Members of the public do not believe the reality of the data about suicide prevention which shows that having a gun at home substantially increases the risk of suicide, both for the owner themselves and other household members
    • This includes medical professionals such as emergency department personnel who see suicidal patients on a day to day basis

Next up: Laws, the Second Amendment, Litigation, and Obstacles to Research and Policy


  • CDC Wonder – a public resource of health-related datasets for CDC staff, public health departments, researchers, and the general public. The year 2017 is the most recent year for which comprehensive, compiled data exists for firearm violence
  • CDC WISQARS – a public database that provides fatal and nonfatal injury, violent death, and cost of injury data.
  • Gallup Well-Being – results from the 2019 Gallup poll on well-being in all 50 US states
  • Firearms in the Northeast – a research study from 2004 on whether firearm availability increases the overall number of suicides rather than the proportion of suicides from guns
  • HCUP NIS – Healthcare Cost and Utilization Project National Inpatient Sample is the largest publicly available all-payer inpatient health care database in the United States, yielding national estimates of hospital inpatient stays. Data from 2005 was used.
  • Accessibility of Firearms – a 2014 study to understand estimates of the association between firearm availability and suicide or homicide
  • Risk Independence of Suicide – a 2013 study looking at the risk independence of suicidal behavior
  • Gun Storage Practices – a 2005 study measuring the association of specific household firearm storage practices and the risk of unintentional and self-inflicted firearm injuries
  • Stock and Flow – results from the 2015 National Firearms Survey
  • Firearm Storage with Children – results from a nationally representative probability-based online survey sample of US adults conducted in 2015
  • Case Fatality Rates – a 2004 study examining how method-specific case fatality rates for suicide differ by age and sex
  • Self-Inflicted Injuries – a 1999 study to determine ownership and usual storage location of firearms used in unintentional and self-inflicted intentional firearm deaths and injuries
  • Suicide in the Home – a 1992 study to assess the strength of the association between the availability of firearms and suicide
  • Recent Psychopathology – a 2009 study to assess the relationship between firearm ownership and possible psychiatric confounders of the firearm–suicide relationship
  • Are We Missing Something? – a 2016 study to determine the plausibility of some unaccounted variable in determining the causal relationship between firearm availability and suicide
  • Decrease in Suicide – a study of the effects of a policy change in the Israeli Defense Forces reducing adolescents’ access to firearms on rates of suicide
  • Lethal Means Restriction – a 2013 study examining the beliefs and behaviors of emergency department providers related to preventing suicide by reducing suicidal patients’ access to lethal methods
  • Suicide Relationship Belief – a 2017 study using nationally representative sample to describe public opinion about whether household firearms increase the risk for suicide

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Gun violence in the United States: Gun Markets, Ownership, and Violence Risk

This is the second post in a series about Reducing Gun Violence in the United States. The previous post described Impact, Trends, and Defensive Use.

In this post, I’ll explore the various legal and illegal methods in which people acquire guns, as well as the risk of violence due to that gun ownership.

Now, let’s dive into gun markets and ownership.

Legal and Illegal Gun Markets

Almost every gun used in crimes in the United States was first acquired through a vendor with a federal license to sell firearms. The US Bureau of Alcohol, Tobacco, and Firearms (ATF) automatically receives information about each and every gun that is sold and anytime local, state, or federal law enforcement officers recover a gun from a crime scene or criminal suspect.

Each gun has a unique serial number, which identifies the make, model, and caliber, and can be used to trace where the gun was originally purchased.

Here are some examples of serial numbers on guns:


The ATF has a great flow chart showing how guns enter the illegal market:

How Guns Flow from Legal to Illegal Commerce

Legal Trade in Guns

  • Starts with gun manufacturers
  • Guns are sold to dealers
  • Those guns are sold to law-abiding gun owners
  • Guns may then be re-sold in legal private sales

Guns enter illegal commerce in several ways (some examples):

  • By private transactions in which guns are bought and later sold to prohibited people at gun shows, flea markets, or through private sales
  • By straw purchasers, who are individuals who buy guns from dealers and transfer them to prohibited people
  • By theft, where firearms are stolen from gun dealers and private citizens

Now, let’s take a look at how many guns enter the market illegally via different avenues. Note how the number of firearms (N firearms) being sold or otherwise transferred by federally licensed dealers without reporting to the ATF (largely to gangs and other criminals) is greater than those for straw purchasers or private sales. It also dwarfs the number of firearms stolen or those obtained via filling out paperwork illegally.

Data from Federal Firearms Trafficking Investigations, 1999-2002 (source: Illegal Gun Market)


When looking at sources of firearms reported by state and federal prison inmates, the largest share of those guns were acquired illegally through the underground market, not through legal purchases, gifts, theft, or buying for someone else. It’s important to note that the “underground market” could mean many things: traffickers selling guns state to state, selling a gun on the street which was stolen from a car, or many other things.

Source of firearms used in crimes by State and Federal prison inmates, 2016 (source: Source of Firearms)

While prison inmates report that only 6% of guns are acquired via theft, an estimated 350,000 – 400,000 firearms are stolen every year. The majority of guns stolen come from Southern states. These Southern states account for (source: Whose guns are stolen):

  • 37% of homes with guns
  • 43% of gun owners
  • Two-thirds of all guns stolen

Additionally, higher gun theft risk is associated with (source: Whose guns are stolen):

  • owning six or more guns
  • carrying a gun in public
  • storing a gun in a vehicle

Gun Ownership and Violence Risk

When a person is involved in an assault, the availability of a firearm can increase the severity of any violent actions. One big reason that having a firearm available to someone who might consider committing a violent act might increase the chance of that act occurring is that possessing a deadly weapon as an assailant lowers their risk of injury. After all, if one is going to break into a person’s house and they have a gun, they’re probably going to face less resistance than if they just have their own fists.

If you, as an assailant with a gun, have less resistance in committing a crime, wouldn’t there be less chance of physical violence occurring? Or, if you protect yourself with a gun, aren’t you less likely to come to any harm because you have a deadly weapon which can protect you? Unintuitively, it turns out there is evidence that having a firearm could actually cause a more dangerous attack from someone who is armed.

It’s not difficult to imagine how this situation turns into a chain reaction, where potential criminals begin to carry more and more dangerous weapons, and if you’re a person concerned with lethal violence in your community, you begin to carry more deadly weapons such as guns yourself.

Reflecting on this, an important question to ask is:

Does keeping a firearm in one’s home increase, decrease, or have no effect on the risk of gun homicide in the home?

A few different studies in the US have led to some important observations (sources: Gun Ownership as a Risk Factor, Handguns and Firearm Violence, Risk Factors for Femicide)

  • In 77% of firearm homicide crimes, the offender and victim knew each other
    • Often, they lived in the same house
  • In only 3.7% of firearm homicide crimes was the victim a stranger to the offender
  • Having a gun in the home increased the firearm homicide risk by anywhere from 40 – 170%
  • Women in physically abusive relationships living in a home with a gun increased their risk of being a homicide victim by 400%

So, most often, gun homicide is a result of some kind of conflict in a home. Similarly, having a gun the home dramatically increases the risk of firearm homicide, especially for women as victims.

Another interesting question we can ask is:

Are people who purchase handguns legally more likely to be violent offenders?

A 2010 study in California found that after purchasing handguns (source: Violence Criminal Activity):

  • 1% of purchasers who had no previous criminal record committed a violent crime
  • 5.5% of purchasers who had a previous felony or violent misdemeanor conviction committed another violent crime

So, if one has a previous violent crime conviction, they’re over five times more likely to commit another violent crime after purchasing a handgun

For all people purchasing handguns,

  • Conviction rates for serious violent crimes for those without a previous criminal record were lower than the general population
  • Conviction rates for serious violent crimes for those with a previous criminal record were much higher than the general population

An important takeaway: law-abiding gun owners are even more law-abiding than the average person. But, those people that have serious criminal histories are at much higher risk for future offenses.

Looking at states with the lowest to highest rates of gun ownership (first through fifth quintiles in the left-most set of colored bars below), states with the highest rates of gun ownership show the highest rates of gun assaults. The rates of homicides with guns also increase, but not as dramatically.

Gun Assault Rate Ratio for Gun Ownership (source: Firearm Ownership in the US)

Reflecting on this, if there is more violence with places that have more guns, why is this? Is it something about the place itself, or does it have to do with the individuals who own guns?

Two different studies showed that:

  • States with the highest rates of gun ownership sold more guns that were eventually used in crimes than states that had more restrictive gun laws and lower gun ownership rates
  • All other factors being equal, homes with more guns had higher rates of burglary.
    • Theory: could this be because thieves know that guns have a high street value or personal value for other crimes?


Legal and Illegal Gun Markets

  • The US Bureau of Alcohol, Tobacco, and Firearms (ATF) tracks firearm transactions through unique gun serial numbers
  • Illegal firearm acquisition occurs through various means
    • ~38% through illegal diversion from federally licensed dealers
    • More than straw purchasers (21%), illegal private sales (21%), theft (8%), or lying on background check / licensing forms (4%)
  • Most guns used in crimes reported by prison inmates came through the underground market
    • Only 10% obtained via direct purchase from a gun dealer
  • Majority of guns are stolen from Southern states (two-thirds)
    • Higher incidents for people owning six or more guns, carrying them in public, or storing them in a vehicle

Gun Ownership and Violence Risk

  • Gun availability affects violence, including lethal violence, in many ways:
    • Risk of domestic violence goes up dramatically when a gun is in a home
    • Criminal offenders owning a gun are at higher risk for future offenses
    • More guns available in the home opens up opportunities for theft and future violence
  • Most people who own guns are responsible owners who are law-abiding citizens
    • Yet the risk of violence and threats to safety are still greater overall for gun owners, even if they are safe gun owners

Next up: Firearms and Suicide


  • Illegal Gun Market – a 2012 study interpreting the empirical evidence on illegal gun market dynamics
  • Source of Firearms – a 2016-2019 study of the source and use of firearms involved in crimes via a survey of prison inmates
  • Gun Ownership as a Risk Factor –  a 1993 case-control study of homicides in homes in three metropolitan areas in the United States
    • There was some criticism of this study and its design; one prominent criticism being that the chance of the estimated associations between homicide risk and firearms may be biased since the cases and controls were different from each other with respect to risk for violence overall
  • Whose guns are stolen – a 2017 examination of demographics and behavioral characteristics of gun owners who report having guns stolen
  • Handguns and Firearm Violence – a 1997 study of the association between the purchase of a handgun and homicide or suicide
  • Homicide and Suicide Risks – a 2003 study of homicide and suicide risks associated with firearms in homes
  • Risk Factors for Femicide – a 2003 study of risk factors for femicide in abusive relationships
  • Violence Criminal Activity – a 2010 study of incidence and risk factors for violent criminal activity among prior gun purchasers
  • Firearm Ownership in the US – a 2015 study of the association between state-level firearm ownership and violence crime

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Gun violence in the United States: Impact, Trends, and Defensive Use

This is the first post in a series about Reducing Gun Violence in the United States.

In 2017, there were almost 40,000 firearm-related deaths.

To put this into perspective, this is just slightly more than the number of deaths due to motor vehicle crashes (around 37,000).

In order to really understand the scope of the problem of gun violence in the United States, let’s start by looking at the data itself. It is important to know that the data will not tell us why there is so much gun violence, but it will provide context.

Now, let’s dive into how gun violence shows up in the United States.

Firearm violence data

Those roughly 40,000 deaths due to firearms can be broken down into several categories (source CDC Wonder):

  • Suicide: 60% (23,854)
  • Homicide: 37% (14,542)
  • Legal Intervention (typically due to law enforcement activities): 1.4% (538)
  • Unintentional: 1.2% (495)
  • Unknown: 0.8% (338)

Slicing this data another way, we can look at the number of people admitted to hospitals with non-fatal gunshot wounds, and how they got there. Note how more than three-quarters of these people were admitted due to assaults (source: CDC Wonder):

  • Assault: 76% (88,702)
  • Unintentional: 18% (21,219)
  • Intentional self-inflicted (failed suicide attempt): 4% (4,357)
  • Legal intervention: 2% (2,136)


Let’s take a look at the rate of firearm homicides and suicides overall. The number of suicides due to firearms has been significantly bigger than the number of homicides for almost twenty years, with a big increase in suicides since 2006.

Firearm homicide and suicide rates per 100,000 people in the US, 1999-2017 (source: CDC Wonder)


Men have a much greater rate of being involved in firearm violence than women; more than 90% of people killing others with guns are men, and almost 90% of suicide victims are men.

Fractions of firearm homicide and suicide per gender in the US, 2017 (sources: CDC Wonder & FBI Crime in the US)

Three of the biggest racial groups that experience firearm violence in the US are whites, blacks, and Native Americans. There is a much larger rate of homicide (both as offenders and victims) among blacks, though the suicide rates are more evenly divided though slightly higher for whites:

Firearm homicide offenders, homicide victims, and suicide victims per race per 100,000 people in the US, 2017 (sources: CDC Wonder & FBI Crime in the US)

There is a rise in suicide rates as people age:

Ages of suicide victims per 100,000 people in the US, 1999-2017 (sources: CDC Wonder & FBI Crime in the US)


However, the number of Americans involved in homicides by age looks very different. Victims of gun homicide peak around age 21, and those pulling the trigger on those guns also peak around ages 18-20.

Ages of firearm homicide victims per 100,000 people in the US, 1999-2017 (sources: CDC Wonder & FBI Crime in the US)

Ages of firearm homicide offenders per 100,000 people in the US, 1999-2017 (sources: CDC Wonder & FBI Crime in the US)


Looking at regional effects, it’s pretty clear that the rate of homicide is greatest in the Southeast and Midwestern states. The states in red have the highest firearm homicide rates, with the states in light green having the lowest firearm homicide rates:

Firearm homicide rates per state (sources: CDC NHSS and US Census)


And, if we look at firearm suicides, some of the Northern Plains states have the highest rates, likewise with some other states in the interior:

Firearm suicide rates per state (sources: CDC NHSS and US Census)


The highest rates of firearm suicide tend to be in rural and non-metro areas. Firearm homicides are generally highest in large metro areas, but then don’t shrink as dramatically in rural areas as some people would expect:

Firearm homicide and suicide rates per area, 2017 (sources: CDC NHSS and US Census)

Gun Ownership

Let’s now look at data related to gun ownership.

About four in ten US adults say that they live in a house with a gun (source Pew research):


Who are these gun owners?

Breaking down owners among gender and race, it’s more common for whites and men to own guns (source Pew research):

  • 39% of men
  • 22% of women
  • 36% of whites
  • 24% of blacks
  • 15% of hispanics

White men report that almost half of them (48%) own a gun, and the average age for an American to become a gun owner is at age 22.

Let’s look at the educational level of gun owners. The educational level differs significantly only among whites (source Pew research):

  • 40% have a high-school diploma or less
  • 42% have completed some college
  • 26% have a bachelors degree or higher

We can also look at political affiliation: twice as many people who identify as republicans own guns as those who identify as democrats (source Pew research).

Where do gun owners live?

Looking at where gun owners live (source Pew research):

  • 46% of rural residents own a gun
  • 28% of suburban residents own a gun
  • 18% of urban residents own a gun

How about geographical concentration? (source Pew research):

  • 18% of residents in the Northeast of the country own a gun
  • 36% of residents in the South own a gun
  • 32% of residents in the Midwest own a gun
  • 31% of residents in the West own a gun

Why do people own a gun, and what kinds do they own?

People give different reasons for owning a gun, and most people give multiple reasons (source Pew research):

  • 67% gun owners cite self-defense
  • 38% gun owners cite hunting
  • 30% gun owners cite sport shooting

Similar numbers appear for the types of guns that people own (source Pew research):

  • 62% of gun owners own a handgun or pistol
  • 22% of gun owners own a rifle
  • 16% of gun owners own a shotgun

How many guns do gun owners own? Two-thirds of gun owners own multiple guns, and 29% of gun owners own five or more guns (source Pew research).

Gun ownership over time

Gun ownership over time has been gradually decreasing. The following chart shows the percentage of people in the US who own at least one gun (source NORC GSS):

Though the number of people who own handguns or pistols fluctuates without a clear pattern (source NORC GSS):


Defensive gun use, Gun Access, and Public Safety

Incidents of gun violence are spread across the United States (source: Gun Violence Archive):

… while reports of guns used in self-defense are relatively small, and they’re generally located in southern states where gun ownership is more common (source: Gun Violence Archive):

This data is confirmed by Pew Research, which finds that guns are used for self-defense in less than 1% of crimes. This is contrasting with data saying that 67% of gun owners own guns for self-defense.

Another two particularly interesting data points to note are:

  • 4% of people using guns in self-defense actually injured themselves
  • 4% of people not using guns in self-defense also injured themselves

… meaning that there isn’t a benefit to using a gun in self-defense, statistically – you’re just as likely to get hurt as if you didn’t use a gun.

What’s the legality of using a gun in self-defense?

Only 43% of the self-reported use of guns in self-defense are actually deemed to be legal by criminal court judges. In other words, most people who report using guns for self-defense aren’t legally allowed to do what they did. (source: Gun Use in the US)

Certainly, some use of self-defense is legally justifiable, just not all of it.

What about anger and impulsivity?

9% of US adults (4 million people) have a history of angry and impulsive behavior and have access to firearms in their home.

Those adults who own six or more guns are four times more likely to carry a gun and show angry and impulsive behavior than those who own just one gun (source: Anger / Impulsive)



Firearm Violence Impact

  • 40,000 people a year die from firearm violence
    • 60% – almost 24,000 – are suicides
    • almost 40% – about 14,000 – are homicides
  • Suicide rates have been steadily increasing since 2006
  • Men are nine times as likely to be involved in homicide or suicide as women
  • Suicide risk rises with age
  • Homicide risk (both being an offender and victim) peaks around age 20
  • Northern plains and some Southern states have the highest rates of suicide
    • Higher rates in rural and non-urban areas
  • Southern and Midwestern states have the highest rates of homicide
    • No strong relationship between homicide rates and population density (urban vs rural)

Gun Ownership

  • Four out of ten US adults live in a home with a gun
  • The most common group of people who identify themselves as gun owners are white men who have not completed college, live in rural areas, and are republicans
  • The majority of gun owners own handguns for self-defense
  • Gun ownership has been decreasing over time to 32% of the population

Defensive gun use

  • Guns are used in self-defense for less than 1% of crimes
    • And 4% of those times, the person using the gun for self-defense hurts themselves
    • That’s the same fraction of people that hurt themselves in self-defense without a gun
  • Most people who use guns for self-defense do so in a way that courts view as illegal
  • 9% of US adults own a gun and have a history of angry and impulsive behavior
  • Adults who own six or more guns are four times more likely to carry a gun in public and show angry and impulsive behavior than those who just own one gun

Next up: Gun Markets, Ownership, and Violence Risk


  • CDC Wonder – a public resource of health-related datasets for CDC staff, public health departments, researchers, and the general public. The year 2017 is the most recent year for which comprehensive, compiled data exists for firearm violence
  • FBI Crime in the US 2017 – a statistical compilation of offense, arrest, and police employee data reported by law enforcement agencies voluntarily participating in the FBI’s Uniform Crime Reporting (UCR) Program
  • CDC National Vital Statistics System (NVSS) – a public resource for official vital statistics
  • US Census Bureau – providing aggregate data for public use
  • Pew Research – published “America’s Complex Relationship With Guns”
  • National Opinion Research Center’s General Social Survey (NORC GSS) – a public report for policymakers and scholars to give an unbiased and clear perspective on what Americans think about general social topics
  • Gun Violence Archive – a free 2019 dataset providing public access to accurate information about gun-related violence in the United States
  • Gun use in the United States – a survey of guns used in self-defense and evaluation by criminal judges
  • Anger / Impulsive – a national report on the co‐occurrence of impulsive angry behavior and possessing or carrying a gun among adults

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What is a scientific evidence-based treatment for the common cold?

We all get common colds from time to time; they’re no fun, but rarely life threatening. The common cold in humans is primarily caused by a family of viruses called rhinoviruses, of which there over ninety nine types, which makes finding a “common cure” for all of them unlikely. While no silver bullet cure is likely in sight, at least something to lessen the annoying symptoms would be nice: the cough, the runny nose, the headache, the body soreness, the fatigue.

Clearly, there are steps that one can take when already infected to lessen the intensity and duration of symptoms, including getting enough rest and drinking plenty of rehydrating liquids. As a former biologist, I’ve long been interested in how viruses operate in the body and how we can best treat them pharmacologically (with drugs). While there are many over-the-counter remedies marketed to us, today I became very interested in what drugs I should be reaching for to keep me the happiest when a common rhinovirus has made its home in my sinuses. Which drugs should I purchase that have been proven by scientific study to actually help with cold symptoms, rather than being clever medicinal cocktails that simply sound great in marketing material?


A scientific, evidence-based checklist for treating the common cold with drugs

I’ve put together some very straightforward guidelines for what to do and take when needing relief:

  • Begin treatment as soon as you notice cold symptoms
  • Take a sustained-release first generation anti-histamine
  • Take a nonsteroidal anti-inflammatory (NSAID)
  • Continue taking these every 12 hours until cold symptoms go away
  • Add an oral decongestant if the anti-histamine and NSAID treatment does not relieve symptoms

All of these pointers came directly from, a website with comprehensive yet digestible scientific evidence-based information about the common cold, prevention tips, and treatments. The site has been put together by two medical doctors who specialize in virology and infectious diseases. See their credentials here and here. These tips come from published, peer-reviewed clinical trials, not just anecdotes, “common knowledge”, or hearsay.

Let’s go through the most interesting recommendations one by one and pick them apart.

Begin treatment as soon as you notice cold symptoms

This may be obvious to some people, but for others: the facts here are that “cold symptoms appear as early as 10 hours after a cold infection has started and increase in frequency and severity for 48 hours. After 48 hours, the symptoms usually begin to decline as the result of the natural course of the illness. For this reason, a cold treatment will do the most good when taken at the first recognition of symptoms. The treatment is thus applied over the period when most illness is expected (the first 3 days of infection).”

Another reason to treat early is that nose blowing is very likely to cause sinus disease in colds, and early treatment reduces the frequency of nose blowing by reducing nasal mucous.

A third reason (if you didn’t have enough already) is that the majority of common cold sufferers have clogging of the eustachian tubes between the ar and the throat, which may reduce the frequency of complications involving ear infections.

Take a sustained-release first generation anti-histamine

This one was the big news to me. I had previously thought that no anti-histamines would help reduce symptoms of the common cold, but it turns out that the first generation of anti-histamines can actually reduce symptoms. The first generation of anti-histamines are known as sedating; they often cause drowsiness as a side effect. (References 1, 2, 3)

I have a hard time finding them in stores, but they include:

  • chlorpheniramine (Chlortabs, etc)
  • brompheniramine (Bromfed, Dimetapp, Bromfenex, Dimetane, BPN, Lodrane, etc)
  • clemastine (Tavist)

They have all been shown to be effective in randomized, double-blind studies and sustained-release versions of them are the most effective.

Important: second generation anti-histamines, those which are non-drowsy, are not as effective as the first generation.

Take a nonsteroidal anti-inflammatory drug

We know these as NSAIDs, perhaps the most popular being Ibuprofen. NSAIDs are great for pain relief, inflammation, and fever, which often accompany nasal discomfort (Reference 5). Not as much research has gone into this area, but there are some clinical trials for using NSAIDs for the common cold.

Add an oral decongestant if the anti-histamine and NSAID treatment does not relieve symptoms

Decongestants shrink the tiny blood vessels in the nose, which are most at fault for causing nasal congestion. Nasal sprays work wonders very quickly, but wear off fast and can cause burning. Taking oral decongestants are less powerful and don’t work as quickly, but don’t cause as much discomfort. They are safe in recommended doses, even for those with high-blood pressure, but they typically don’t work for more than three days straight. (Reference 6).

What doesn’t work

There are plenty of items to buy at the nearby Walgreens, and plenty of medication that your doctor can give you that will NOT work for treating the common cold.

  • Cough medicine
  • Expectorants
  • Vitamin C mega-doses
  • Antibiotics

Let’s pick these claims apart, too.

Cough medicine

Medicines that work have well-documented clinical trials showing that they work; cough medicines have little such documented medical trials for in colds. It’s no surprise that few studies showing high effectiveness show up in medical journals – they are not effective, at least not at the doses which are safe for us to take.


Expectorants help with thinning mucous, which can help to prevent secondary infection. But they do little to help with the primary viral infection of the common cold. At best, they help with cough, but their effectiveness is mixed.

The Vitamin C myth

“There have been at least twenty well controlled studies on the use of mega doses of vitamin C in the prevention of colds, the treating the duration of colds, and in treatment of the severity of colds, and in none of those instances has there been any, really good evidence that vitamin C in mega doses does anything.” – Dr. Marvin Lipman, NPR

So why do people so adamantly believe that a mega-dose of vitamin C is an effective treatment for the common cold? For one, vitamin C is good for you – very good for you. Most people believe that if something is good for you, more of it must be better. However, this isn’t really based in any kind of real science – about 200mg is all the body can absorb per day. Perhaps equally (if not more convincing) is the placebo effect – the psychological effect (but not truly physical effect) of drugs. In other words, if you want to take a mega-dose of vitamin C, go ahead – but just know that it is not treating your symptoms.


Antibiotics are some of the worlds greatest medicines – many of them exist on the list of the World Health Organizations list of Essential Medicines. However, they are useful to destroy bacteria, not viruses. Common colds are caused by viruses, and no dose or type of antibiotic known to medical doctors or researchers destroys viruses. Let me be clear – your doctor might prescribe antibiotics for something that feels like a virus – but know that your doctor is prescribing it to clean up a bacterial infection (which they may feel in their professional opinion is causing your symptoms). You may not have a common cold, after all. I’ll not get into antibiotic over-prescription here; that is a huge topic on its own.

Extra references

I included some references without direct web urls.

1. Doyle, W.J., T.P. McBride, D.P. Skoner, B.R. Maddern, J.M. Gwaltney, Jr., and M. Uhrin. 1988. A double-blind, placebo-controlled clinical trial of the effect of chlorpheniramine on the response of the nasal airway, middle ear and eustachian tube to provocative rhinovirus challenge. Pediatric Infectious Disease Journal. 7:229-238.

2. Gwaltney, J.M.Jr., J. Paul, D.A. Edelman, R.R. O’Connor, and R.B. Turner. 1996. Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds. Clin. Infect Dis. 22:656-662.

3. Gwaltney, J.M., Jr., and H.M. Druce. 1997. Efficacy of brompheniramine maleate for the treatment of rhinovirus colds. Clinical Infectious Diseases. 25:1188-1194.

4. Gaffey, M.J., D.L. Kaiser, and F.G. Hayden. 1988. Ineffectiveness of oral terfenadine in natural colds: evidence against histamine as a mediator of common cold symptoms. Pediatric Infectious Disease Journal. 7:223-228.

5. Insel, P.A. 1996. Analgesic-antipyretin and antiinflammatory agents and drugs employed in the treatment of gout. In Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 9th ed. J.G. Hardman, L.E. Limbird, P.B. Molinoff, R.W. Ruddon, and A.G. Gilman, editors. McGraw Hill, New York. 617-657.

6. Hoffman, B.B., and R.J. Lefkowitz. 1996. Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 9th ed. J.G. Hardman, L.E. Limbird, P.B. Molinoff, R.W. Ruddon, and A.G. Gilman, editors. McGraw Hill, New York. 199-248.

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