This week’s JAMA article on whether and to what degree gun laws impact the carrying of guns by teenagers reflects, to me, both the great strengths and inherent weaknesses of the public health approach to research on gun violence. This is not to say that public health research in toto should be abandoned or in any way proscribed, although the NRA would no doubt endorse a variation of the anti-lawyer joke, ‘What do we call 10,000 public health researchers buried under water? A good start,’ (there should only be 10,000 public health researchers.)

The strength of public health gun research is that it is grounded in the idea that guns are a risk to health, and if anyone doubts that rather mundane statement, frankly, what follows isn’t for you. I have written nearly 400 commentaries on my own website and I’m done trying to convince the “other side” that guns create risk. You don’t believe it, take another puff on your cigarette and go lay brick, okay?

Public health research has informed us about gun risk relative to homicide, suicide, assault and domestic violence. It has been instrumental in linking gun violence to the absence and/or presence of regulations and laws. It has also enabled us to better understand how the existence of a massive civilian arsenal affects criminal behavior in this country as opposed to every other industrialized country where unregulated guns do not abound. And I should add that the pro-gun response to public health is so intellectually vapid that I would be insulting gun owners to say that their interests have been supported by anything remotely smacking of serious research. Noise ain’t research.

The weakness with public health gun research, however, is that it proves nearly impossible to validate its findings through studies that capture before-and-after changes in public policies and laws. This is because most of the regulatory and legal responses to gun violence over the past twenty years have been changes that eased regulations and restrictions on gun ownership and gun access, rather than making it more difficult for guns to get into the ‘wrong hands.’ To the degree that public health researchers have been able to compare the results of changes in the regulatory environment that promoted safer-gun use, the examples have not been definitive or comprehensive enough to bolster a generic ‘more gun laws equals less gun violence’ argument.

The authors of this current study are aware of these limitations and, in fact, are at pains to assure the readers that their conclusions are, at best, inferential and would need further validation before definitive conclusions could be reached. Nevertheless, certain important findings stand out, chief among them the correlation between teen-age gun access and the level of gun regulation and per-capita gun ownership in different states.

Teen access to guns is probably, in all its dimensions, the single, most important problem facing the constituencies who want to reduce gun violence. This is not only because the age cohort 14-19 is where gun violence first becomes a significant behavioral and health issue, but kids who acquire guns in the pre-adult years tend to keep using them as they move into their adult years. If we could do a better job restricting teen access to guns, it would have a significant impact on the overall rate of gun violence.

Buried in the conclusion of this study, however, is a caveat that deserves further comment, namely, the degree to which teen gun access is clearly associated with the number of guns owned by adults. And the level of gun ownership wouldn’t be an issue per se if it weren’t for the attempts by the NRA to reduce the minimum age for handgun purchase and promoting the idea that guns are ‘cool.’ Most Americans live in states that do not regulate whether parents give their children access to guns. If you’re a gun-owning adult, you wouldn’t let your teen-age children drink and drive, but you’ll let them play around with the guns, right?