Gun violence is a defining public health challenge of our time. As the United States grapples with the shooting deaths of 17 people in Parkland, Florida, on 14 February 2018, the medical and public health communities must step up and do our share to prevent such devastation from recurring. Effective public health strategies have reduced such threats as motor vehicle injury, tobacco use, accidental poisonings, and drownings. Effective strategies are built on research to identify patterns of risk, illuminate productive targets for intervention, and assess the effectiveness of interventions. Unfortunately, the United States lacks a comprehensive public health approach to gun violence, due in large part to the absence of federal funding for research on gun violence for more than 2 decades.

In 2013, after the tragedy at Sandy Hook Elementary School, President Obama directed federal agencies to mount research programs to improve understanding of the causes of gun violence and interventions to reduce it. As a result, the Centers for Disease Control and Prevention (CDC) asked the Institute of Medicine (IOM) and the National Research Council (NRC) to define a public health research agenda for gun violence. The resulting consensus report, “Priorities for Research to Reduce the Threat of Firearm-Related Violence,” laid out the highest-priority research questions to effect progress in a 3- to 5-year time frame (1). These recommendations remain relevant and may be even more urgent today. Without research, policymakers are flying blind when they propose new laws or policies.

A provision in a 1996 omnibus spending bill known as the Dickey Amendment forbade the CDC from using its funds to promote or advocate for gun control. This was interpreted as a prohibition on supporting any research on firearms, and the CDC program was dismantled. As a result, we lack even the most basic information about the prevalence and safety of firearms in the United States, as well as data on the effectiveness of interventions aimed at reducing the probability of injury and death related to their use.

The shooting in Parkland has prompted renewed calls for research, including from members of Congress. The 2013 IOM/NRC report provides an immediately actionable blueprint to advance such an agenda. The report notes that public health research should be integrated with insights from criminal justice and other fields because no single agency or research strategy can provide all of the answers. The proposed research agenda focuses on characteristics of firearm violence, risk and protective factors, interventions and strategies, the effects of gun safety technology, and the influence of video games and other media.

To develop effective strategies to reduce firearm injury and death, it is important to understand what is and what is not known. We lack good data on the number and types of guns in the United States. We need to understand the scope and nature of gun acquisition, ownership, and use across the U.S. population, especially among groups at risk for perpetrating or experiencing gun violence. To protect civil liberties, these data should be collected anonymously. We also need good data on fatal and nonfatal gun incidents, including the proportions that are accidental versus intentional.

Factors that may influence the risk posed by guns range from how securely they are stored to complex predictors at the societal, community, situational, and individual levels. At the individual level, risk for perpetration of gun violence coincides with low educational attainment, substance use, and a history of aggression and abuse. In the home, secure storage of guns and accessibility by children are areas of major concern. At the community level, poverty and drug trafficking are known to increase the risk for violence, and at the societal level, cultural norms that promote violence as an acceptable means of conflict resolution may be harmful. These are just a few of the many factors that may relate to risk for gun violence. Only dedicated research can reveal which of these factors, alone or in combination, are the most promising targets for intervention.

It is important for research agendas to include evaluations of the effectiveness of interventions to prevent gun violence. Recently, various interventions have been proposed or implemented, such as firearm safety education programs or modifications to the physical environment, including installation of metal detectors. However, we lack conclusive evidence about their effectiveness. Policymakers should be wary of potential unintended consequences of untested “solutions.”

Firearm technologies may provide an important opportunity to reduce the public health burden of gun-related injury. Like an airbag in a car or a childproof cap on a pill bottle, the objectives of firearm technologies range from preventing unintentional shootings by young children to reducing suicide. The IOM/NRC report argued that research should examine product safety measures. Specifically, the report proposes research to identify the effects of different technologies designed to reduce firearm injury and death and to explore state and international policy approaches to firearm safety technology for applicability to the United States.

Finally, the IOM/NRC report advocated for study of the influence of video games and other media on violence. In more than 50 years of research, no study has focused on real-life firearm violence as a specific outcome of violence in media. As a result, a direct relationship between the two is unproven.

If implemented, the public health research agenda proposed in the 2013 IOM/NRC report would provide knowledge to inform our nation's approach to minimizing firearm-related violence and its effects on the health of the U.S. public. Scientific evidence generated by this research would enable the development of sound policies that support the rights and responsibilities central to gun ownership in the United States. It is time to bring the full power of science to bear to deal with this issue of such great concern to our country. We need researchers from different disciplines, including public health, social and behavioral sciences, mental health, and law enforcement, to work together to tackle this problem. That can only happen if we restore the much-needed research funding. It is time to end the counterproductive research freeze.

枪支暴力是当今时代对公共卫生的挑战。随着美国努力应对2018年2月14日在佛罗里达州帕克兰市枪击致死的17人死亡，医疗和公共卫生界必须加倍努力并尽我们的一份力量，以防止这种破坏再次发生。有效的公共卫生策略已减少了诸如机动车辆伤害，吸烟，意外中毒和溺水等威胁。有效的策略以研究为基础，以识别风险模式，阐明干预措施的生产目标并评估干预措施的有效性。不幸的是，美国缺乏针对枪支暴力的全面公共卫生方法，这在很大程度上是由于超过20年没有联邦政府资助枪支暴力的研究。

2013年，在桑迪胡克小学惨案发生后，奥巴马总统指示联邦机构开展研究计划，以加深对枪支暴力原因的理解并采取干预措施以减少枪支暴力。结果，疾病控制和预防中心（CDC）要求医学研究所（IOM）和国家研究委员会（NRC）定义枪支暴力的公共卫生研究议程。最终达成的共识报告“减少枪支相关暴力威胁的研究重点”提出了在3至5年内实现进展的最高优先级研究问题（1）。这些建议仍然适用，并且在今天可能更加紧迫。没有研究，政策制定者在提出新法律或新政策时就会视而不见。

1996年综合支出法案中的一项规定被称为“迪基修正案”，该规定禁止CDC使用其资金来促进或倡导枪支管制。这被解释为禁止支持任何有关枪支研究的禁令，并取消了CDC计划。结果，我们甚至缺乏关于美国枪支流行和安全的最基本信息，以及旨在减少与枪支使用有关的伤害和死亡可能性的干预措施有效性的数据。

帕克兰（Parkland）的枪击事件引发了新的研究呼吁，其中包括来自国会议员的呼吁。IOM / NRC 2013年报告提供了可立即采取行动的蓝图，以推进这一议程。该报告指出，公共卫生研究应与刑事司法和其他领域的见解相结合，因为没有任何一个机构或研究策略可以提供所有答案。拟议的研究议程重点关注枪支暴力的特征，风险和保护因素，干预措施和策略，枪支安全技术的影响以及电子游戏和其他媒体的影响。

为了制定减少枪支伤害和死亡的有效策略，重要的是了解什么是未知的。我们缺乏有关美国枪支数量和类型的良好数据。我们需要了解整个美国人口中枪支获取，拥有和使用的范围和性质，尤其是在有可能遭受枪支暴力或遭受枪支暴力侵害的群体中。为了保护公民自由，应匿名收集这些数据。我们还需要有关致命和非致命枪支事件的良好数据，包括意外事件与故意事件的比例。

可能影响枪支风险的因素包括从安全性如何存储到在社会，社区，情境和个人层面上复杂的预测因素。在个人层面上，实施枪支暴力的风险与低学历，使用毒品以及侵略和虐待的历史相吻合。在家庭中，安全存放枪支和儿童可及性是主要关注的领域。在社区一级，众所周知，贫困和毒品贩运会增加暴力的风险，而在社会一级，促进暴力作为可接受的解决冲突手段的文化规范可能是有害的。这些只是可能与枪支暴力风险有关的众多因素中的几个。只有专门的研究可以揭示这些因素中的哪些因素，无论是单独还是组合使用，

对于研究议程，重要的是要包括对预防枪支暴力的干预措施有效性的评估。最近，已经提出或实施了各种干预措施，例如枪支安全教育计划或对物理环境的修改，包括安装金属探测器。但是，我们缺乏有关其有效性的确凿证据。政策制定者应警惕未经测试的“解决方案”可能带来的意想不到的后果。

枪支技术可能为减少枪支相关伤害的公共卫生负担提供重要机会。就像汽车上的安全气囊或药瓶上的儿童保护帽一样，枪支技术的目标范围从防止幼儿意外射击到减少自杀。IOM / NRC报告认为，研究应检查产品安全措施。具体而言，该报告提出了一项研究，以查明旨在减少枪支伤害和死亡的不同技术的影响，并探索适用于美国的枪支安全技术的国家和国际政策方法。

最后，IOM / NRC报告提倡研究视频游戏和其他媒体对暴力的影响。在50多年的研究中，没有研究将现实枪支暴力作为媒体暴力的特定结果。结果，两者之间没有直接关系。

如果得到实施，2013年IOM / NRC报告中提出的公共卫生研究议程将提供知识，为我们国家减少与枪支有关的暴力及其对美国公众健康的影响的方法提供信息。这项研究产生的科学证据将有助于制定健全的政策，以支持在美国拥有枪支所有权至关重要的权利和责任。现在是时候发挥科学的全部力量来处理这个引起我们国家极大关注的问题了。我们需要来自不同领域的研究人员，包括公共卫生，社会和行为科学，精神卫生和执法部门，共同努力解决这个问题。只有我们恢复了急需的研究资金，这才可能发生。现在该结束适得其反的研究冻结了。