From: [r--l--r] at [Think.COM] (Ralph Palmer) Newsgroups: talk.politics.guns Subject: Text of the NEJM study Date: 29 Oct 93 18:13:42 GMT I've spent the last few lunch hours scanning and typing in the NEJM article. Read the details folks and draw your own opinions. They picked some real doosey families for the study with the following highlights: 50 % has been arrested before 31% used illegal drugs 11% have been hospitilized for drinking 31% of hosehold members hit or hurt in the home Don't count on fancy alarms or locks to save you either, they state that they don't lower your risk of getting killed. If you plan to do an indepth study, get the original text as this does contain errors, although I verified the raw data in the tables. Anyone who wants to complain about the errors can spend 3 hours of thier own time when the next article comes out. LET THE GAMES BEGIN.... Gun Ownership and Homicide in the Home -Kellermann ET AL. New England Journal of Medicine Vol 329 No 14 Pg 1110-1116 October 7, 1993 Abstract Background. It is unknown whether keeping a firearm in the home confers protection against crime or, instead, increases the risk of violent crime in the home. To study risk factors for homicide in the home, we identified homicides occurring in the homes of victims in three met- ropolitan counties. Methods After each homicide, we obtained data from the police or medical examiner and interviewed a prox for the victim. The proxies' answers were compared with those of control subjects who were matched to the vicUms according to neighborhood, sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. Results. During the study period, 1860 homicides oc- curred in the three counties, 444 of them (23.9 percent) in the home of the victim. After exduding 24 cases for various reasons, we interviewed proxy respondents for 93 percent of the victims. Controls were identified for 99 HOMICIDE claims the lives of approximately 24,000 Americans each year, making it the I Ith leading cause of death among all age groups, the 2nd leading cause of death among all people 15 to 24 years old, and the leading cause of death among male Afri- can Americans 15 to 34 years old.' Homicide rates declined in the United States during the early 1980s but rebounded thereafter.2 One category of homicide that is particularly threatening to our sense of safety is homicide in the home. Unfortunately, the influence of individual and household characteristics on the risk of homicide in the home is poorly understood. Illicit-drug use, alco- holism, and domestic violence are widely believed to increase the risk of homicide, but the relative impor- tance of these factors is unknown. Frequently cited options to improve home security include the installa- tion of electronic security systems, burglar bars, and reinforced security doors. The effectiveness of these protective measures is unclear, however. Many people also keep firearms (particularly hand- guns) in the home for personal protection. One recent survey determined that handgun owners are twice as percent of these, yielding 388 matched pairs. As com- pared with the controls, the victims more oRen lived alone or rented their residence. Also, case households more commonly contained an illicitrug user, a person with pnor arrests, or someone who had been hit or huri in a fight in the home. After controlling for these charac- teristics, we found that keeping a gun in the home was strongly and independently associated with an in- creased risk of homicide (adjusted odds raUo, 2.7; 95 per- cent confidence interval, 1.6 to 4.4). Virtually all of this nsk involved homicide by a family member or intimate ac- quaintance. Conclusions. The use of illicit drugs and a history of physical fights in the home are important risk factors for homicide in the home. Rather than confer protection, guns kept in the home are associated with an increase in the nsk of homicide by a family member or intimate acquaint- ance. (N Engl J Med 1993;329:1084-91.) ------------------------- From the Departments of Internal Medicine (A.L.K., J.G.B., B.B.H., Pre- venlive Medicine (A.L.K.), Biostatisdcs and Epioemiology (A.L.K., G.S.), and Pathology a.T.F), Universiq of Tennessee, Mempis; the Departments of Pedi- atrics (F.P.R.), Epioemmology (F.P.R.), ano Patholoa (D.T.R), University of Washington, Seattle, Harhorview Injury Prevention and Research Center, Seattle (F.P.R., J.P.); ano the Departments of Biology (N.B.R., A.B.L.) and Epidemi- ology and Biostadsdcs (N.B.R.) and the Centet for Adolescent Health (N.8.R.), Case Western Reserve University, Cleveland. Address reprint requests to Dr. Kellermann at the Emory Center for Injury Prevendon, School of Public Health, Emory University, 1599 Clihon Rd., Atlanta, GA 30329. Supporlcd by granls (CCR 402424 and CCR 403519) from the Centers for Dbease Cl n evenl: ------------------------- likely as owners of long guns to report "protection from crime" as their single most important reason for keeping a gun in the home.3 It is possible, however, that the risks of keeping a firearm in the home may outweigh the potential benefits. To clarify these issues, we conducted a population- based case-control study to determine the strength of the association between a variety of potential risk fac- tors and the incidence of homicide in the home. METHODS Identlflcatlon ot Case Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio, are the most populous counties in their respective states. The population of King County is predominantly white and enjoys a relatively high standard of living. In contrast, 44 percent of the population of Shelby County and 25 percent of the population of Cuyahoga County are African American. Fifteen per- cent of the households in Shelby Counly and 11 percent in Cuya- hoga County live below the poverty level, as compared with S per- cent in King County.7 All homicides involving residents of King County or Shelby County that occurred between August 23, 1987, and August 23, 1992, and all homicides involving residents of Cuyahoga County that occurred betweenJanuary 1,1990, and August 23,1992, were reviewed to identify those that took place in the home of the victim. Any death ruled a homicide was included, regardless of the method used. Assault-related injuries that were not immediately fatal were included if death followed within three months. Cases of homicide involving children 12 years of age or younger were excluded at the request of the medical examiners. Selectlon ot Case Subjects and Recrultment ot Cae Proxle A home was defined as any house, apartment, or dwelling occu- pied by a victim (i.e., a case subject) as that person's principal residence. Homicides occurring in adjacent structures (e.g., a ga- rage) or the surrounding yard were also included. Murder- and multiple homicides were considered a single event. In the case Or a murder-suicide, the homicide victim was included ir he or she was older than the suicide victim; in multiple homicides, thc oldcst victim was included. Reports made at the scene were collected to ensure that study criteria were met. In King County, the medical examiner's stafr conducted all investigations Or the homicide scene. In Shelby Coun- ty and Cuyahoga County, police detectives conducted these investi- gations. In addition to recording the details of the incident rOr law- enrorcement purposes, investigators obtained the names Or persons closc to the victim who might provide us with an interview at a later date, thereby serving as proxies lor the victim. These lists were supplemented with names obtained rrom newspaper accounts, obit- uaries, and calls to runeral homes. Approximately three weeks arter a victim's death, each proxy was sent a signed letter outlining the nature Or the project. A $10 incen- tive was olrered, and a rollow-up telephone call was made a lew days later to arrange a time and place ror an interview. At the lime of this meeting, inrormed consent was obtained. Sehctlon and Rcrultment ot Controls Arter each interview with a case proxy, we sought a control sub- ject matched to the case suyect according to sex, race, age range ( 15 to 24 years, 25 to 40 years, 4 1 to 60 years, and 61 years or older), and neighborhood Or residence. To minimize selection hias, the controls were identified by a previously validated procedure ror the random selection Or a matching household in the neighborhood.'! After marking Ofr a one-block avoidance zone around the home of the case subject, the interviewer started a neighborhood census at a randomly assigned point along a predetermined route radiating out rrom the case subject's residence. Households where no one was home were approached twice more, at dilrerent times Or day and on dilrerent days Or the week. If contact could not be established afteF three tries, no rurther elrorts were made. Arter each neighborhood census was completed, an adult (a person 18 years old or older) in the first household with a member who met the matching criteria was offered a S10 incentive and asked to provide an interview. Whenever possible, attempts were made to interview a proxy ror the actual matching control subject. When no interview was granted, the next matching household on the route was approached. Ir a closer match on the route was round on the second or third visit to the neighborhood, an adult respondent in the closer household was interviewed and any earlier, more distant interviews were discard- ed. Overall, census data were obtained rrom 70 percent Or the households approached to identiry each match. Eighty-rour percent Or the interviews were obtaiDed from the closest matching house- hold, 13 percent rrom the second, 3 pcrcent rrom the third, and 60 85 (20.2) Circumstances Quarrel 185 (44) Romantic Triangle 29 (6.9) murder-suicide 19 (4.5) Felony related 92 (21.9) Drug dealing 32 (7.6) Homicide only 56 (13.3) other 7 (1.7) Relationship of offenoer to vicfim Spouse 70 (16.7) Initmate acquaintense 58 (13.8) First degree relative 40 (9.5) other relative 12 (2.9) Roomate 12 (2.9) Friend 130 (31) Police officer 15 (3.6) Stranger 15 (3.6) Unknown (unidentified suspect) 73 (17.4) Other 6 (1.4) Method of Homicide Handgun 180 (42.9) Rifle 10 (2.4) Shotgun 15 (3.6) Unknown firearm 4 (1.4) knife 111 (26.4) Blunt instrument 49 (11.7) Strangle or suffication 27 (6.4) Burns, smoke, scalding 10 (2.4) other 14 (3.3) Victum Resisted assailant YES 184 (43.8) NO 140 (33.3) Not noted 96 (22.9) Evidence of Forced Entry YES 59 (14) NO 354 (84.3) Not noted 7 (1.7) Legally Excusable circumstances YES 15 (3.6) NO 405 (96.4) intruder; six involved strangers. Two involved the po- lice. The rest involved a spouse, family member, or some other person known to the victim. Attempted resistance was reported in 184 cases (43.8 percent). In 21 of these (5.0 percent) the victim unsuccessfully attempted to use a gun in self-defense. In 56.2 percent of the cases no specific signs of resist- ance were noted. Fifteen victims (3.6 percent) were killed under legally excusable circumstances. Four were shot by police acting in the line of duty. The rest were killed by another member of the household or a private citizen acting in self-defense. i Comparabillty of Case Subjects and Controls Potential proxy respondents were identified for 405 of the 420 case subjects (96.4 percent). Interviews were obtained from 93 percent of those approached in Shelby County, 99 percent in Cuyahoga County, and 98 percent in King County. The households of those who agreed to be interviewed did not differ from the households of those who refused with respect to the age, sex, or race of the victim or the method of homi- I cide (firearm vs. other). Interviews with a matching control were obtained for 99.7 percent of the case interviews, yielding 388 matched pairs. Three hundred fifty-seven pairs were matched for all three variables, 27 for two variables, and 4 for a single variable (sex). The demographic characteristics of the victims and controls were simi- lar, except that the case subjects were more likely to have rented their homes (70.4 percent vs. 47.3 per- cent) and to have lived alone (26.8 percent vs. 11.9 percent) (Table 2). Although efforts were made to conduct every interview in person, proxy respondents for the case subjects were much more likely than the controls to request a telephone interview (40.2 percent vs. 12.6 percent). Despite efforts to interview a proxy respondent for each control, only 48.2 percent of the control interviews were obtained in this manner. Unlvarlate Analysls Alcohol was more commonly consumed by one or more members of the households of case subjects than by members of the households of controls (Table 3). Alcohol was also more commonly consumed by the case subjects themselves than by their matched con- trols. Case subjects were reported to have manifested behavioral correlates of alcoholism (such as trouble at work due to drinking) much more often than matched controls. Illicit-drug use (by the case subject or an- other household member) was also reported more 'F commonly by case households than control house- holds. Previous episodes of violence were reported more frequently by members of case households. When asked if anyone in the household had ever been hit or hurt in a fight in the home, 31.8 percent of the proxies for the case subjects answered affirmatively, as com- pared with only 5.7 percent of controls. Physical fights in the home while household members were drinking and fighting severe enough to cause injuries were re- Table 2. Dem Pairs of Case Subjects arld Controls.* Case Charistics SUBJECTS CONTROLS Sex (%) Male 63. 1 63. 1 Female 36. 9 36. 9 Race or ethnic group (%) White 32. 9 34.5 Blach 62. 1 61.6 Native American, Eshimo, 1. 0 0. 5 Aleut Asian or Pacific Islander 2 8 2 8 Other 1.0 0. 5 Age groupQyr (%) 15-24 13. 1 13. 1 25-40 40 2 40. 5 41-60 26. 0 26. 0 61 20.6 20.4 Median gears of educalion of 12 12 household head Median socioeconomic status 4 4 of household headt Type of dwelling (%) House 54. 6 60. 3 Other 45. 4 39. 7 Rented 70. 4 47. 3 Owned 29. 6 52. 7 Median no of residentslroom 0. 5 0. 6 Lived alone (%) 26. 8 11. 9 Telephone interview (%) 40. 2 12. 6 Proy respondents in- 100 48. 2 terviewed %Becuse of rnunding, nol %11 percnbge tObl IOD. tSocioeconomic sbtus wu nsureo ccording lo the Hol- lingd score on % sc-le of l lo 5, wilh I s Ihe highesl core,12 ported much more commonly by case proxies than controls. One or more members of the case households were also more likely to have been arrested or to have been involved in a physical fight outside the home than members of control households. Similar percentages of case and control households reported using deadbolt locks, window bars, or metal security doors. The case subjects were slightly less Iikely than the controls to have lived in a home with a burglar alarm, but they were slightly more likely to have controlled security access. Almost identical per- centages of case and control households reported own- ing a dog. One or more guns were reportedly kept in 45.4 per- cent of the homes of the case subjects, as compared with 35.8 percent of the homes of the control subjects (crude odds ratio, 1.6; 95 percent confidence interval, 1.2 to 2.2). Shotguns and rifles were kept by similar percentages of households, but the case households were significantly more likely to have a handgun (35.7 percent vs. 23.3 percent; crude odds ratio, 1.9; 95 percent confidence interval, 1.4 to 2.7). Case house- holds were also more likely than control households to contain a gun that was kept loaded or unlocked (Table 3). Multivariate Analysls Six variables were retained in our final conditional logistic-regression model: home rented, case subject or control lived alone, any household member ever hit or hurt in a fight in the home, any household member - ever arrested, any household member used illicit drugs, and one or more guns kept in the home (Table 4). Each of these variables was strongly and independ- ently associated with an increased risk of homicide in the home. No home-security measures retained signifi- cance in the final model. After matching for four char- acteristics and controlling for the effects of five more, we found that the presence of one or more firearms in the home was strongly associated with an increased risk of homicide in the home (adjusted odds ratio, 2.7; 95 percent confidence interval, 1.6 to 4.4). Stratified analyses with our final regression model revealed that the link between guns and homicide in the home was present among women as well as men, blacks as well as whites, and younger as well as older people (Table 5). Restricting the analysis to pairs with data from case proxies who lived in the home of the victim demonstrated an even stronger association than that noted for the group overall. Gun ownership was most strongly associated with homicide at the hands of a family member or intimate acquaintance (adjusted odds ratio, 7.8; 95 percent confidence in- terval, 2.6 to 23.2). Guns were not significantly linked to an increased risk of homicide by acquaintances, unidentified intruders, or strangers. We found no evidence of a protective benefit from gun ownership in any subgroup, including one restricted to cases of homicide that followed forced entry into the home and another restricted to cases in which resistance was attempted. Not surprisingly, the link between gun ownership and homicide was due entirely to a strong association between gun ownership and homicide by firearms. Homicide by other means was not signi- ficantly linked to the presence or absence of a gun in the home. Living in a household where someone had previous- ly been hit or hurt in a fight in the home was also strongly and independently associated with homicide, even after we controlled for the effects of gun owner- ship and the other four variables in our final model p(adjusted odds ratio, 4.4; 95 percent confidence inter- val, 2.2 to 8.8) (Table 4). Previous family violence was linked to an increased risk of homicide among men as well as women, blacks as well as whites, and younger as well as older people (Table 6). Virtually all of this increased risk was due to a marked association be- tween prior domestic violence and homicide at the hands of a family member or intimate acquaintance (adjusted odds ratio, 20.4; 95 percent confidence inter- val, 3.9 to 104.6). DISCUSSION Although firearms are often kept in homes for per- sonal protection, this study shows that the practice is counterproductive. Our data indicate that keeping a gun in the home is independently associated with an increase in the risk of homicide in the home. The use of illicit drugs and a history of physical fights in the home are also important risk factors. Ef- forts to increase home security have largely focused on preventing unwanted entry, but the greatest threat Table 3. Univariate Analysis of Hyothesizeci Risk on Protection Factors Derived from Data on 388 Matched Pairs of Case Subjects and Controls. Data on 388 Matched Pairs of Case Subjects and Controls. Case CRUDE ODDS Variable Subjects Controls RATIO (95% Cl) Behavorial Factors Any household mcmber drank 277 (73.3) 217 (55.9) 2.4 (1.7-3.3) Alcoholic bevega Case subjct or control drank 238 (62.8) 162 (41.9) 2.6 (1.9-3.5) Alcoholic beverga Drinking caused problems in 92 (24.8) 22 (5.7) 7.0 (4.2-11.8) the household Any household member had troubk 32 (9.0) 3 (0.8) 10.7 (4.1-27.5) at work because of drinking Case subject or control had trouble 20 (5.5) 1 (0.3) 20.0 (4.9-82.4) at worlc because of drinking Any household member hospitalized 41 (11.4) 9 (2.3) 9.8 (4.2-22.5) because of drinking Case subject or control hospitalized 28 (7.6) 2 (O.S) 14.0 (4.7-41.6) because of drinking Any household member used 111 (31.3) 23 (6.0) 9.0 (5.4-l5.0) illicit drugs Case subject or control used 74 (20.3) 16 (4.2) 6.8 (3.8-12.0) illicit drugs Any physical fights in the home 92 (25.3) 13 (3.4) 8.9 (5.2-15.3) during drinking Any houehold member hit or hurt 117 (31.8) 22 (5.7) 7.9 (5.0-12.7) in fight in the home Any family member required medical 62 (17.3) 8 (2.1) 10.2 (5.2-20.0) attention because of fight in the home Any adult houschold member 103 (29.9) 70 (18.8) 2.1(1.4-3.0) involved in physical fight outside tbe bome Any household member arrested 193 (52.7) 90 (23.4) 4.2 (3.0-6.0) Case subject or control arressted 132 (36.0) 60 (15.7) 3.S (2.4-5.2) Environmental Factors Home rented 271(70.4) 183 (47.6) 5.9 (3.8-9.2) Public housing 41(11.1) 38 (9.8) 1.5 (0.7-3.3) Case subject or control lived alone 103 (26.8) 46 (11.9) 3.4 (2.2-5.1) Deadbolt locks 243 (68.8) 292 (75.3) 0.8 (O.5-I.0) Window bars 71(19.2) 81(20.9) 0.8 (O.5-1.3) Metal security door 95 (25.4) 104 (26.8) 0.9 (0.6-1.3) Burglar alarms 26(7.1) 43(11.1) 0.6(0.4-1.0) Controled security access to residence 52 (13.9) 38 (9.8) 2.3 (1.2-4.4) Dog or dogs in homc 94 (24.2) 87 (22.4) 1.1 (0.8-1.6) Gun or guns in home 174 (4S.4) 139 (3S.8) 1.6 (1.2-2.2) Handgun 135 (3S.7) 90 (23.3) 1.9 (1.4-2.7) Shotgun 5O (13.6) 65 (16.8) 0.7 (O.5-1.1) Rifle 45 (12.2) 54 (13.9) 0.8 (O.5-1.3) Any gun kept unlocked 105 (29.6) 69 (17.8) 2.1 (1.4-3.0) Any gun lept loaded 93 (26.7) 48 (12.5) 2.7 (1.8-4.0) Guns kept primarily for self-defense 125 (32.6) 86 (22.2) 1.7 (1.2-2.4) employed correlational analysisS or retrospective- cohort'6 or time-series'7 designs to link rates of homi- cide to specific risk factors. However, hazards suggest- ed by ecologic analysis may not hold at the level of individual households or people.'a In contrast to these approaches, the case-control method studies individ- j ual risk factors in relation to a specific outcome of interest. Case-control research is particularly useful when the list of candidate risk factors is large and the rate of adverse outcomes is relatively low. Under these circumstances, it is usually the analytic method of choice.'9 Although case-control studies offer many advan- tages over ecologic studies, they are prone to several sources of bias. To minimize selection bias, we in- cluded all cases of homicide in the home and rigorously followed an explicit procedure for randomly selecting neighborhood control sub- jects. High response rates among case proxies (92.6 percent) and matching controls (80.6 percent) minimized nonresponse bias. Case respondents did not differ signifi- cantly from nonrespondents with regard to the age, sex, and race of the victim and the type of weapon involved. Although double homicides and murder-suicides were considered single events to avoid overrepresenting their effects, the number of cases excluded for this reason was small. Other threats to the validity of the study were less easy to con- trol. A respondent's recollection of events can be powerfully affected by a tragedy as extreme as a homi- cide in the home. To diminish the effect of recall bias, we delayed our contact with the case proxies to al- low for an initial period of grief. We also used a simple, forced-choice questionnaire to ascertain informa- tion in a comparable manner from case proxies and controls. We tried to obtain data on victims and con- trols as similarly as possible by in- terviewing proxy respondents for the controls whenever possible. Al- though we were able to do so only 48 percent of the time, the re- sponses we obtained from this sub- group were consistent with those obtained from the study population overall. Potential misreporting of sensi- tive information was a serious con- cern, since we had no way to verify each respondent's statements inde- pendently. If case proxies or con- trols selectively withheld sensitive - Table 4. Variables lncludtsd in the Final Con- dWonal LogisUc-Rtsgression Model Derived trom Data on 316 Matchtsd Pairs ot Case Subjtscts and Controls.* . AJUSTED ODDS RATIO (95* Cl) Home rented 4.4 (2.3-8.2) Case subjecl or control 3.7 (2.1-6.6) lived alone Any household memoer hil 4.4 (2.2-8.8) or hurt in a fight in the home Any household memoer 2.5 ( 1.6-4.1) arrcsted Any household memoer 5.7 (2.6-12.6) used illiclt drugs Gun or guns kept in the 2.7 (1.6-4.4) home information about illicit-drug use, alcoholism, or vio- lence in the home, inaccurate estimates of risk could result. We attempted to minimize this problem by re- assuring our respondents of the confidentiality of their responses. We also placed "permissive" statements before each potentially intrusive question to encour- age honest replies. Very few respondents refused to answer our questions, although all were assured that they were free to do so. The rate of domestic violence reported by our con- trol respondents was somewhat less than that noted in a large telephone survey.20 This may be due to region- al or temporal differences in rates of battering, vari- ations in the way we phrased our questions (e.g., screening as compared with an exploratory line of in- quiry), or the increased anonymity afforded by tele- phone interviews as compared with our face-to-face encounters. Underreporting of gun ownership by control re- spondents could bias our estimate of risk upward. We do not believe, however, that misreporting of gun ownership was a problem. In two of our three study communities, a pilot study of homes listed as the ad- dresses of owners of registered handguns confirmed that respondents' answers to questions about gun ownership were generally valid.2' Furthermore, the rate of gun ownership reported by control respondents in each study community was comparable to estimates derived from previous social surveys22 and Cook's gun-prevalence index.'5 Four limitations warrant comment. First, our study was restricted to homicides occurring in the home of the victim. The dynamics of homicides occurring in other locations (such as bars, retail establishments, or the street) may be quite different. Second, our re- search was conducted in three urban counties that lack a substantial percentage of Hispanic citizens Our results may therefore not be generalizable to more rural communities or to Hispanic households. Third, it is possible that reverse causation accounted for some of the association we observed between gun ownership and homicideQi.e., in a limited number of cases, people may have acquired a gun in response to a spe- cific threat. If the source of that threat subsequently caused the homicide, the link between guns in the home and homicide may be due at least in part to the failure of these weapons to provide adequate protec- tion from the assailants. Finally, we cannot exclude the possibility that the association we observed is due to a third, unidentified factor. If, for example, people who keep guns in their homes are more psychological- ly prone to violence than people who do not, this could explain the link between gun ownership and homicide in the home. Although we examined several behavior- al markers of violence and aggression and included two in our final logistic-regression model, "psychologi- cal confounding" of this sort is difficult to control for. "Psychological autopsies" have been used to con- trol for psychological differences between adolescent victims of suicide and inpatient controls with psy- chiatric disorders,23 24 but we did not believe this ap- proach was practical for a study of homicide victims and neighborhood controls. At any rate, a link be- tween gun ownership and any psychological tend- ency toward violence or victimization would have to be extremely strong to account for an adjusted odds ratio of 2.7. Given the univariate association we observed be- tween alcohol and violence, it may seem odd that no alcohol-related variables were included in our final multivariate model. Although consumption of alco- holic beverages and the behavioral correlates of alco- holism were strongly associated with homicide, they were also related to other variables included in our final model. Forcing the variable "case subject or con- trol drinks" into our model did not substantially alter Table 5. Homicide in the Home in Relation to Gun Ownership, According to Subgroup. NO, OF AWUSTeD ODO SubGroup PAIF5 RTIO (95* Cl) Sex Female 121 3. 6 (1.6-8.1) Male 195 2. 3 (1. 1-4. 6) R-ce Whtite 103 2. 7 (1. 0-6. 9)t Black 196 2. 9 (1. 5-5. 7) Age (yr) 15-40 169 3 .4 (1. 4-8 .0) >41 147 2. 3 (1.2-4. 6) Suspect related to or victum with victim Yes 138 7. 8 (2. 6-23. 2) No 178 1. 8 (1.0-3. 4) Evidence of forced entty Yes 46 2. 5 (0. 7-8 .4) No 219 2.8(1. 5-5.2) Victim resisted assilant Yes 141 3. 0 (1.3-6. 2) No 105 3. 1(1.2-8 1) method of homicide Firearm 159 4. 8 (2.. 2-10. 3) Odter 157 .12 (0. 5-2. 7) AII the reull were c Iculted by condhbn l logistk regre- ion fter control for the cov rite- D-ted in T bb 4 Cl denola confidence intervl tThe vlue i bti tic-lly ignificunl; the lower DDund of the 95 percent confidence interv l i 10 becu e of rounding Table 6. Homicide in the Home in Relation to Prior Domestic Violence, According to Subgroup. NO. OF adjusted ODDS Subgroup pairs RATIO (95% Cl Sex Female 121 4.4(1.6-11.9) Male 195 4.4 (1.5-12.6) Race White 103 6.9 (1.7-27.6) Black 196 2.9 (1.2-7.3) Age (yr) 15-40 169 5.2 (1.7-16.0) 41 147 4.5 (1.7-12.0) Suspect related to or intimate with victim Yes 138 20.4 (3.9-104.6) No 178 1.9 (0.8-4.7) Victim resisted assailant Yes 141 7.2 (2.1-25.3) No 105 4.0 (1.0-17.0) Evioence of forced entry Yes 46 1.4 (0.4-4.4) No 219 8 1 (2.8-23.1) Method of homicioe Firearm 159 3.1 (1.0-9.0) Other 157 5.4 (1.9-15.6) %AII tb results wtre c Iculed b conohion l bistk rcres- sion cnntl for the t nvtri-tt fisteo in Tbk 4. Cl oenotts confide intt rv l. the adjusted odds ratios for the other variables. Fur- thermore, the adjusted odds ratio for this variable was not significantly greater than 1. Large amounts of money are spent each year on home-security systems, locks, and other measures in- tended to improve home security. Unfortunately, our results suggest that these efforts have little effect on the risk of homicide in the home. This finding should come as no surprise, since most homicides in the home involve disputes between family members, intimate acquaintances, friends, or others who have ready ac- cess to the home. It is important to realize, however, that these data offer no insight into the effectiveness of home-security measures against other household crimes such as burglary, robbery, or sexual assault. In a 1983 poll, Seattle homeowners feared "having someone break into your home while you are gone" most and "having someone break into your home while you are at home" 4th on a list of 16 crimes.25 Although homicide is the most serious of crimes, it occurs far less frequently than other types of house- hold crime. Measures that make a home more diffi- cult to enter are probably more effective against these crimes. Despite the widely held belief that guns are effective for protection, our results suggest that they actually pose a substantial threat to members of the household. People who keep guns in their homes appear to be at greater risk of homicide in the home than people who do not. Most of this risk is due to a substantially great- er risk of homicide at the hands of a family member or intimate acquaintance. We did not find evidence of a protective effect of keeping a gun in the home, even in the small subgroup of cases that involved forced entry. Saltzman and colleagues recently found that as- saults by family members or other intimate acquaint- ances with a gun are far more likely to end in death than those that involve knives or other weapons.26 A gun kept in the home is far more likely to be in- volved in the death of a member of the household than it is to be used to kill in self-defense. Cohort and interrupted time-series studies have demonstrated a strong link between the availability of guns and community rates of homicide.215-l7 Our study con- firms this association at the level of individual house- holds. Previous case-control research has demonstrated a strong association between the ownership of firearms and suicide in the home. 10,23,24 Also, unintentional shooting deaths can occur when children play with loaded guns they have found at home.27 In the light of these observations and our present findings, people should be strongly discouraged from keeping guns in their homes. The observed association between battering and homicide is also important. In contrast to the money spent on firearms and home security, little has been done to improve society's capacity to respond to the problem of domestic violence.2829 In the absence of effective intervention, battering tends to increase in frequency and severity over time.28-30 Our data strong- ly suggest that the risk of homicide is markedly in- I creased in homes where a person has previously been hit or hurt in a family fight. At the very least, this observation should prompt physicians, social work- ers, law-enforcement officers, and the courts to work harder to identify and protect victims of battering and other forms of family violence. Early identification and effective intervention may prevent a later homicide.31 32 We are indebted to the men and women of the following law- i enforcement agencies and offices for their support of this project: in Shelby County, Tennessee, the Memphis Police Department, Shel- by County Sheriff's Department, Bartlett Police Department, Col- I lierville Police Department, Germantown Police Department, Mill- ington Police Department, and Shelby County Medical Examiner's Office; in Cuyahoga County, Ohio, the Cleveland Police Depart- I ment and Cuyahoga County Coroner's Office- and in Ring County Washington, the Seattle Police Department Bellevue Police De- I partment, King County Sheriff's Department, and King County Medical Examiner's Office. Without their assistance, this work would not have been possible. We are also indebted to Noel Weiss and William Applegate for their comments and suggestions, to Viv- ian C. Driscoll and Steven Walker for their help with data collec- tion, and to LaGenna Betts for her assistance in the preparation of the manuscript.