Reducing Firearm Injury and Death for Young Texans Through Safety Courses and Waiting Periods

Introduction

Firearm violence is an American public health crisis.[1] Mass shootings, while a small percentage of overall firearm incidents, often incite calls for change due to their high-profile nature. In the U.S., there were nearly 700 mass shootings in 2021 alone, 42 of which were school-related.[2] Over the last 10 years, the state of Texas has experienced the most school mass shootings in the country.[3] Of great concern is that mass shooters are increasingly minors themselves. Of the 1,050 shooters involved in school shootings between 1970 and June 2020, 80.2% were between ages 5 and 20, with nearly 65% of school shooters between ages 14 and 18.[4] Since 2018, this trend has continued; two-thirds of the deadliest mass shootings in the United States were committed by individuals 21 years or younger.[5]

It is vital to address this upward trend in gun violence, and there is major unease about young peoples’ access to firearms. While it is generally recognized that action is needed, agreement on how to tackle the crisis is lacking.[6] In this policy brief, we examine the rising rates of firearm violence among people under the age of 21 and assess current gun safety policies. Finally we provide two policy solutions — firearm safety education courses and waiting periods — both with the goal of reducing firearm-related injuries and deaths in Texas.

Current Laws and Policy Addressing Firearm Safety

In response to mounting firearm-related issues over the past few years, nine of the 50 states have established policies requiring individuals to complete safety training courses prior to obtaining a license to carry.[7] In contrast, current Texas firearm laws concerning child access still contain no clauses focused on educating adults or minors about safe gun handling and storage.[8]

Texas and American Medical Association Policies

The Texas Medical Association (TMA) and the American Medical Association (AMA) — both highly respected medical organizations that together represent hundreds of thousands of physicians — have published policy stances on a variety of gun safety topics.

There are two major policies from the TMA: 260.112 and 260.015.

TMA Policy 260.112 addresses parental education on the prevention of firearm accidents among children. It states that physicians have a role in reducing firearm morbidity and mortality through various actions such as firearm inquiry, encouraging safe storage, and disseminating informational materials.

TMA Policy 260.015 addresses firearms by recognizing gun violence as a public health issue and calling upon medical professionals to promote evidence-based strategies to combat it. This includes calling on physicians to promote the Texas Hunter Education program, provide guidance on the dangers of firearm ownership in an informational and non-judgmental manner, and offer guidance on safe firearm storage with trigger locks and gun cabinets. The TMA also calls for more research on firearm public health and safety, particularly on topics like waiting periods for firearm purchases.

The AMA, which has support from physicians across the country, has published more stringent stances on firearm safety:

AMA H-145.992 specifically advocates for a mandatory 7-day waiting period before being able to acquire a firearm in the country.

AMA H-145.990 addresses how physicians should increase their efforts to reduce firearm accidents in children, similar to the TMA 260.112 policy.

AMA H-145.997 acknowledges that firearm violence is a public health issue in the United States and seeks to develop better legislation on gun safety education. 

AMA D-145.996 aims to reduce firearm-related injury and morbidity in youth by identifying and supporting the distribution of firearm safety materials in a clinical setting.

Our discussion in the following sections aligns with these policy stances and specifically examines how firearm safety courses and waiting periods could make a difference.

The Efficacy of Firearm Safety Courses

All firearms have the potential to be dangerous. Although there is sometimes a “one-size-fits-all” mentality when it comes to firearm safety courses, it is important to acknowledge that there is a broad spectrum of firearms on the market. Handguns were the most used type of firearm in mass shootings across 13 different states between 2005 and 2015.[9] However, more recent mass shooting events in Texas have primarily involved the use of semi-automatic centerfire rifles, commonly referred to as assault weapons.

Effect of Training

In a national survey, 81% of respondents agreed that individuals should receive at least some sort of formal education and/or training prior to owning a firearm.[10] In addition, a 2016 national survey of gun owners found that 35% of respondents believed that their storage and safety practices were influenced by a gun safety training course.[11] While this seems low, only about 61% of gun owners self-report receiving some sort of safety training.[12] This means more than half of those who received training found that it influenced their storage and safety practices.

Who Trains and How

Firearm safety education does not have to follow the classic model of simply providing enrollees with access to knowledge-based learning materials. This approach has already proven insufficient for teaching desirable gun safety skills compared to active learning approaches, so when determining the future course of firearm safety education, new methodologies should be employed.[13] Although physicians can be a good resource for preventative firearm safety education and counseling, more focus should be placed on increasing the counseling competency of people other than doctors.[14] For example, police officers or people who are military-trained can be effective teachers of gun safety awareness, as can programs like the Texas Hunter Education Course.[15]

Safety Training Protects Public Safety

Currently, Texas requires anyone who was born after September 2, 1971, and is seeking a Texas hunting license to take a hunter education course. The course must be a combination of classroom instruction and skills exercises taught by a certified instructor. Required topics include safe handling and use of firearms and archery equipment; wildlife conservation and management; hunting laws and regulations; and hunting safety and ethics. Since it was implemented in 1988, there has been a substantial reduction in hunting accidents.[16] Only 17 incidents were reported in 2021, the lowest number of incidents on record. The Texas Farm Bureau confirms that the Hunter Education course has led to a significant drop in hunting incidents,[17] pointing to empirical evidence that demonstrates a clear relationship between taking the education course and the reduction in hunting accidents. The course’s impact on hunter and firearm safety has even led the bureau to declare it a success for Texas.

Other states have mandated training courses for individuals to obtain a license to carry, but there has been a recent shift away from strict license-to-carry laws, including mandatory education requirements. A study conducted by the Bloomberg School of Public Health found that enacting less restrictive carry laws led to a 24% increase in the firearm assault rate.[18] Although it is difficult to isolate the impact of no longer mandating training courses in license-to-carry laws, the same study found that enacting less restrictive laws did not lead to a statistically significant increase in firearm assault rate when in-person firearm safety training was retained. In other words, mandatory safety training can enhance public safety.

License to Carry in Texas

Since 2016, Texas’ open carry law required a license to carry, but beginning September 1, 2021, HB 1927 made it legal for most individuals 21 or over to carry a handgun without a license both openly and/or concealed. Even so, the Department of Public Safety can still issue a license to carry to individuals interested in the benefits that these permits confer (e.g., they are valid in many states and simplify firearm purchases). In 2021, 149,000 Texans applied for a license to carry, which requires a 1-2 hour in-person training component with a Texas Qualified LTC Instructor.[19] As of 2021, there are 4,272 certified instructors in the state of Texas.[20] Thus, the infrastructure remains in place for Texas to mandate licenses to carry. With such demand already present, it is both appropriate and feasible to implement safety courses to fulfill the license-to-carry requirement.

Waiting Periods in Texas and Beyond

A waiting period requires a set number of days to pass between the purchase of a gun and when the buyer can take possession of it. The data indicates that waiting periods are particularly useful alongside education to prevent firearm injury. Waiting period laws decrease gun homicides by approximately 17% by postponing firearm acquisition for a set amount of time after the intent to purchase.[21]

Spotlight on Suicides

Suicides account for 61% of firearm deaths in the state of Texas,[22] and handgun owners have the greatest risk of suicide by firearm during the period immediately after first handgun acquisition.[23] Of the 2,237 firearm suicide deaths in Texas in 2019, 152 of those resulted in the deaths of individuals under the age of 19.[24]

Beyond Texas, states that have mandatory waiting periods had significantly lower firearm suicide rates compared to those without.[25] In the United States, waiting periods — even those as short as 24 hours — helped decrease the incidence of firearm intimate partner violence by 42%, and waiting periods of 2 to 7 days decreased total intimate partner violence by 53%.[26]

Broad Support for Waiting Periods

A clear majority of Texans (69%) are in favor of establishing a waiting period between the time of purchasing and receiving a firearm.[27] The political breakdown is Democrats at 85% and Republicans at 54%. This statewide, bipartisan support suggests it may be possible to reach a compromise focused on reducing firearm violence among youth.

There is also a bipartisan consensus that mental health interventions should play a significant role in tackling the increase in gun violence. However, evidence shows that a combination of laws addressing mental illness exclusions, minimum age requirements to buy a firearm, and mandatory waiting periods are consistent predictors of lower rates of gun-related deaths when compared to access to mental health services alone.[28]

Policy Recommendations

There are many different ways to approach the topic of gun violence in Texas. Multiple laws address gun safety from varying viewpoints, but there are still policy gaps. The upward trend in gun violence in Texas makes effective laws more important than ever.

Our focus in this brief is the younger demographic; those under 21 years of age. We have two recommendations to address the current shortcomings in gun safety policy for these young people:

1. Implement mandatory firearm safety courses for those under 21 years of age who are seeking to buy any firearm. Given the immense success of the Texas Hunter License program in promoting gun safety, it makes sense to extend this type of education to a broader population to promote safety and overall harm reduction.
2. Create a waiting period of 24-72 hours between the purchase of a firearm and when the buyer can take possession of it. Given the success of waiting periods in other states in reducing suicide, especially for a first-time firearm purchaser, this measure has potential for significant harm reduction while still preserving the right of firearm ownership.

Targeting those under 21 with this dual approach will increase their safety while they are young and most vulnerable, and will help them grow into adults with a strong firearms safety focus.

Endnotes

---

[1] Elinore J. Kaufman and Therese S. Richmond, “Beyond Band-Aids for Bullet Holes: Firearm Violence as a Public Health Priority,” Critical Care Medicine, 48(3), 391–397, March 2020, https://doi.org/10.1097/CCM.0000000000004147.

[2] Gun Violence Archive, Gun Violence Archive 2021, https://www.gunviolencearchive.org/past-tolls.

[3] Sharon Lurye, “States with the Most School Shootings,” U.S. News & World Report, May 27, 2022, https://www.usnews.com/news/best-states/articles/2022-05-27/states-with-the-most-school-shootings.

[4] “Number of K-12 School Shootings in the United States From 1970 to June 16, 2020, by Age of Shooter,” Statista, January 7, 2021, https://www.statista.com/statistics/971544/number-k-12-school-shootings-us-age-shooter/.

[5] Glenn Thrush and Matt Richtel, “A Disturbing New Pattern in Mass Shootings: Young Assailants,” New York Times, June 2 2022, https://www.nytimes.com/2022/06/02/us/politics/mass-shootings-young-men-guns.html.

[6] Adam Lankford and Kaitlyn B. Hoover, “Do the Ages of Mass Shooters Matter? Analyzing the Differences Between Young and Older Offenders,” Violence and Gender, 6(1), 11–15, March 2019, https://doi.org/10.1089/vio.2018.0021.

[7] Everytown Research & Policy, “Which States Require Gun Buyers To Have Firearm Training?” Everytown, last updated January 12, 2023, https://everytownresearch.org/rankings/law/training-required-to-purchase-guns/.

[8] “Child Access Prevention,” Texas Gun Sense, April, 2021, https://www.txgunsense.org/articles/child+access+prevention21.

[9] Thomas J. Hanlon, Catherine Barber, Deborah Azrael, and Matthew Miller, “Type of Firearm Used in Suicides: Findings From 13 States in the National Violent Death Reporting System, 2005–2015,” Journal of Adolescent Health, 65(3), 366–370, June 2019, https://doi.org/10.1016/j.jadohealth.2019.03.015.

[10] Ali Rowhani-Rahbar, Vivian H. Lyons, Joseph A. Simonetti, Deborah Azrael, and Matthew Miller, “Formal Firearm Training Among Adults in the USA: Results of a National Survey” Injury Prevention 24(2),161–165, April 2018, https://doi.org/10.1136/injuryprev-2017-042352.

[11] Cassandra K. Crifasi, Mitchell L. Doucette, Emma E. McGinty, Daniel W. Webster, and Colleen Barry, “Storage Practices of US Gun Owners in 2016,” American Journal of Public Health, 108(4), 532–537, April 2018, https://doi.org/10.2105/ajph.2017.304262.

[12] RAND Corporation, “The Effects of Firearm Safety Training Requirements,” last updated January 10, 2023, https://www.rand.org/research/gun-policy/analysis/firearm-safety-training-requirements.html.

[13] Cheryl Holly, Sallie Porter, Mary Kamienski, and Aubrianne Lim, “School-Based and Community-Based Gun Safety Educational Strategies for Injury Prevention,” Health Promotion Practice, 20(1), 38–47, May 2018, https://doi.org/10.1177/1524839918774571.

[14] Laura A. Seewald, Matthew Myers, Marc A. Zimmerman, Maureen A. Walton, Rebecca M. Cunningham, Laney A. Rupp, Maya Haasz, and Patrick M. Carter, “Firearm Safety Counseling Among Caregivers of High-School Age Teens: Results From a National Survey,” Preventive Medicine, 165(A), 107285, December 2022, https://doi.org/10.1016/j.ypmed.2022.107285.

[15] Mary E. Aitken, Samantha D. Minster, Samantha H. Mullins, Heather M. Hirsch, Purnima Unni, Kathy Monroe, and Beverly K. Miller, “Parents’ Perspectives on Safe Storage of Firearms,” Journal of Community Health, 45(3), 469–477, October 2020, https://doi.org/10.1007/s10900-019-00762-2.

[16] R. Tyler Spradley, “Constituting Safety in Hunter’s Education: An Analysis of Safety Messages in Texas Hunter’s Training Discourse,” Proceedings of the International Crisis and Risk Communication Conference, Volume 3, 41-44 (Orlando, FL: Nicholson School of Communication and Media, 2020) https://www.doi.org/10.30658/icrcc.2020.10.

[17] See https://texasfarmbureau.org/hunter-education-improving-firearm-safety-in-texas/.

[18] Mitchell L. Doucette, Alexander D McCourt, Cassandra K. Crifasi, Daniel W. Webster, “Impact of Changes to Concealed Carry Weapons Laws on Fatal and Nonfatal Violent Crime, 1980-2019,” American Journal of Epidemiology, 192(3), 342–355, March 2023, https://doi.org/10.1093/aje/kwac160.

[19] Texas Department of Public Safety, 2021 Annual Firearm Report, https://bit.ly/3lyxQ2V.

[20] Texas Department of Public Safety, Active License Holders and Instructors 2021, https://bit.ly/3LHDAlu.

[21] Michael Luca, Deepak Malhotra, and Christopher Poliquin, “Handgun Waiting Periods Reduce Gun Deaths,” Proceedings of the National Academy of Sciences, 114(46), 12162–12165, October 2017, https://doi.org/10.1073/pnas.1619896114.

[22] “Texas Gun Deaths: 2019,” The Educational Fund to Stop Gun Violence, last updated March 2021, https://efsgv.org/state/texas/.

[23] David M. Studdert, Yifang Zhang, Sonja A. Swanson, Lea Prince, Jonathan A. Rodden, Erin E. Holsinger, Matthew J. Spittal, Garen J. Wintemute, and Matthew Miller, “Handgun Ownership and Suicide in California,” New England Journal of Medicine, 382(23), 2220–2229, June 2020, https://doi.org/10.1056/NEJMsa1916744.

[24] “Texas Gun Deaths: 2019,” The Educational Fund to Stop Gun Violence, last updated March 2021, https://efsgv.org/state/texas/.

[25] Michael D. Anestis, Edward A. Selby, and Sarah E. Butterworth, “Rising Longitudinal Trajectories in Suicide Rates: The Role of Firearm Suicide Rates and Firearm Legislation,” Preventive Medicine, 100, 159–166, July 2017, https://doi.org/10.1016/j.ypmed.2017.04.032.

[26] Smart, Rosanna, Andrew R. Morral, Rajeev Ramchand, Amanda Charbonneau, Jhacova Williams, Sierra Smucker, Samantha Cherney, and Lea Xenakis, The Science of Gun Policy: A Critical Synthesis of Research Evidence on the Effects of Gun Policies in the United States, 3rd ed. (Santa Monica, CA: RAND Corporation, 2023) https://www.rand.org/pubs/research_reports/RRA243-4.html.

[27] Michael O. Adams, Renée Cross, and Mark P. Jones, Texas Trends Survey 2022: Gun Safety, https://uh.edu/hobby/txtrends/gunsafety2022.pdf.

[28] Jacob Smith and Jonathan Spiegler, “Explaining Gun Deaths: Gun Control, Mental Illness, and Policymaking in the American States,” Policy Studies Journal 48(1), 235–256, December 2017, https://doi.org/10.1111/psj.12242.

 

This material may be quoted or reproduced without prior permission, provided appropriate credit is given to the author and Rice University’s Baker Institute for Public Policy. The views expressed herein are those of the individual author(s), and do not necessarily represent the views of Rice University’s Baker Institute for Public Policy.