Administration

SANTA CLARA

2220 Moorpark Avenue

San lose, Calilornia 95128

cated to the Heaitb

VALLGY

or the Whole Community

Tel.(408)885-4202
Fax.(408)885^248

HeACTHi HOSPOAL SYSTCM

PUBLIC HGALTW
OePARTMGNT

Public Health Department
FIREARM VIOLENCE PREVENTION
EDUCATIONAL SYMPOSIUM

February 20,1997
Purpose; Educate policy makers regarding firearm violence in Santa Clara County and potential
prevention strategies from a public health perspective.
6:30

Opening/Introductions

Dena Dickinson, Deputy Director
Public Health Department

6:35

Welcome/Intro Elected Officials

Susan Hammer,Mayor,San Jose
James T. Beall, Jr., Chair,Board of
Supervisors

Public Health Approach to Firearm Violence

Dena Dickinson

Police Chiefs Association Report

Chief Lariy Todd

6:45

6:50

'^:00

Los Gatos/Monte Sereno

Police Department
7:10

Experiences in Trauma Medical Care

Dr. Luther Cobb

Chief of Trauma,VMC
7:20

FamilyA^ictim Perspective

7:30

Youth Perspective

7:40

East Bay Corridor Experience

Tony Hernandez

Andres Soto,Policy Director
Pacific Center for Violence
Prevention

7:50

NRA Report on Firearm Safety

Daryl Davis,President-Elect
NRA Members Council of

Silicon Valley
8:00

Legal Perspective

Barrie Becker,Executive Director

Legal Community Against
Violence
8:10
9:00

Questions and[ Public Comment
Adjourn
The Public Health Oepartmeni is a division of the Santa Clara Valley Health & Hospital System. Owned and operated by tlie County of Santa Clara.

NITIATIVES
VIOLENCE PREVENTION: A Vision of HnpfFinal Report of Attorney General Daniel Lungren’s Policy Council
on Violence Prevention, 1995
Promote policies and strategies that increase the
constructive use of media to deglamorize violence and
promote nonviolent social norms.

IHREARMSI

fll!COHOI>i

Promote policies and strategies that reduce deaths and
injuries from firearms.

Promote policies and strategies that reduce violence
associated with alcohol.

Promote policies and strategies that strengthen commu
nities and schools by expanding local ownership and
control.

RAMliy

Promote policies and strategies that support families,
recognizing them as the basic institution for developing
and nurturing children.

REtAtlONSHI

YOUTH I

RESPECT foi
DIVERSITY

PERSONAL &Sq ClAL
RESPONSIBIU

RESjEARCH
EVALUATIOI

Promote policies and strategies that foster and support
violence-free relationships.

Promote policies and strategies that ensure the devel
opment of healthy and responsible youth.

Promote policies and strategies that recognize that all
people matter, fostering a respect for diversity.

Promote policies and strategies that advance personal
and social responsibility.

Promote policies and strategies to support violence
prevention research and evaluation based on the public
health model.

IREARM
ACTS

FIREARMS
IN SANTA
CLARA

I

PUBLIC HEALTH DEPARTMENT

Santa Clara Count

COUNTY

Firearms were responsible for 76% of homicides against children.
In 1993 and 1994, over half

(58%)of all homicides in
Santa Clara County (SCC)
were committed using
firearms'. Of assault injuries,
14% were a result of
firearms'. Also in 1993 and

1994,56% of males

committing suicide used a
firearm, and 18% of female
suicides resulted from a self-

inflicted gunshot wound'.

Handguns are the leading
killers of kids in CaliforniaL

In Santa Clara County
between 1993 and 1994,76%

I

of homicides killing people
aged 21 years and under
were committed using
firearms'. During that same

The Public Health Approach to Violence Prevention

time frame in SCC,firearms
were involved in 20% of all
homicides and assault

hospitalizations, most of

which occurred among males
aged 15-34'.
Control measures such as

stricter industry regulation,
zoning laws banning
residential handgun dealers,
or policies requiring trigger
locks and safety boxes can

when people working in public health
approach a problem not only do they
consider the consequences of an issue,
such as deaths due to guns, but they

Episode tracking, community data
analysis, program planning,
development, implementation, and

also examine the various causes of a

prevention effort.

problem, such as joblessness or access
to firearms.

This process typically includes three
key elements, as shown in Figure 1.
Figure 1.

Host

(victim or perpetrator)

help reduce fatalities and
injuries associated with
firearms.
Agent
(gun/alcohol)

Environment

(policies, dealers)

A 1996 telephone survey
showed that awareness

about handgun-related crime

is low in Santa Clara County.
It found, however,that once

I

informed of firearm injury
and death facts, the majority
of Santa Clara County
residents vocalized support
for gun control legislation^

The issues surrounding any of these
elements ~ host, agent, environment
~ are interrelated and each element

evaluation are critical to a violence

Just as issues are viewed from multiple
perspectives, solutions (or
interventions) should be designed to
address different levels as shown in the

graphic below. Some interventions for
gun violence could include:
community outreach and education,
conflict resolution training, parenting
training, youth diversion,
identification and assessment of potendal
victims, as well as policies regulating
firearm availability and safety.
The Spectrum of Prevention
Influencing policy & legislation

contributes to the greater problem.
Changing organizational practices

Viewing violence within this

framework requires that several
processes, disciplines and approaches
be incorporated to create a cohesive,
multidisciplinary prevention plan.
1

Fostering coalitions & networks

Educating providers
Promoting community education

Strengthening individual knowledge & skills

Suicides & Firearms

Over half of all suicides were committed with a gun.

Relative to other means, the rate of success in

suicide attempts is much higher when firearms

Suicide Methods

Santa Clara County, 1993 and 1994 Average

are used\ Overall, firearms are used in over

half of all suicides in the county’. By gender,
guns are used by over half of all males, 56%,
committing suicide, and guns account for 4%

Gases
Z0%

Poisoning

\

/

13.3%
Call

Hang’-.-

-.3%

of self inflicted injury hospitalization in males’.
Among females, 18% of female suicides are
due to gun shots’. Gun shot wounds account
for 0.4% of all self inflicted hospitalizations
among females’.
Suffocation
43%'

Much debate surrounds the question whether
limiting access to handguns would prevent
some suicides. Studies among Juvenile

Other 1
3.9%

populations, however, have shown that
Firearm
51.9%

decreased availability through more restrictive
gun control laws is associated with a reduced
Sount ,SM*Cl»raCouniyPL4sl«He«£r'fPppartmert, Oaaaae.Control and Prevtn(«3n,.

suicide rate among youth’=. "

0»ta Manageownt and StahBo.
l. Death Receire«,1993.19M.

36% of all California homicide crimes

were precipitated by an argument.
Homicide Crimes

Contributing Circumstances
California, 1993

Related

58% of all homicides in Santa Clara
County were carried out with a firearm.

Top Five Causes of Death in Females by Age, as Compared to Males
Santa Clara County,1992-1994

Firearm assaults are the third leading killer of Santa
Clara County females aged 15 to 44 years’.
Firearms kill women in this age group more

Cause of Death

!

FIREARMS: Targeting Women

15-44 YEARS of AGE
Breast Cancer
Ovarian Cancer

frequently than do motor vehicle crashes(see chart)’.

AssautU by Firearm
Cerebrovascular Disease

Connective Tissues Disease

Data show that the greatest threat to a woman
comes from the people and guns within her own

45 - 59 YEARS of AGE

home=. More women (28%) in California are killed

Breast Cancer

by their current or former partner than by strangers

Lung Cancer

(14%)’^

Acute Myocardial Infarction
Ovarian Cancer

Nationally, between 1976-1987, more than twice as

Other Cancer
TO

50

40

X

20

10

20

X

40

Death Rales per 100,000 population
S^.Om

.nd H0.P4*) S«t

On«M« ConM and Pi«v«nIc««rMarw^

0«s*rlrT»nl.
Raccrdt

M

60

70

many American women were shot and killed by
their husbands or boyfriends as were murdered by
strangers using guns, knives or any other means^
More women are killed by their husbands than men
are killed by their wives^

Firearm Manufacture & Saies

Santa Clara County is home to 240 licensed gun dealers.

Guns are subject to fewer safety
regulations than cars, baby cribs, or
teddy bears ~ toy guns are even
more strictly regulated than real

guns®. American-made guns are not
subject to federal safety standards’^.
Although technology has been
available for over 50 years to make

guns child-resistant, incorporation of
such safety devices has been

resisted by the industry due, in part, to
concern about costs".

In 1994, 13,478 handguns were

legally sold in Santa Clara County ~
that is more than 36 guns purchased
each day, or 1.5 guns per hour^

Easy availability.of handguns is onp
factor abetting violent acts such as
homicides, assaults, and suicides.

In Santa Clara County, 240 dealers
are licensed to sell guns®. This
compares to 53 high schoois, 29
libraries, and 55 McDonalds”. Some

dealers sell guns out of their homes,

leading to concern about proximity of residential firearm dealers to sensitive sites such as schools or day care centers. Recent
legislation, which increased dealer license fees and mandated background checks, has led to a decreased number of gun
dealers in Santa Clara County ~ in a three month period during 1996 the number of dealers decreased by 26%®.

Estimated annual weapons stolen in California: 100,000 ^
Costs of Firearms to Society
Not only do guns inflict emotional and physical terror on
victims, but firearm-related deaths and injuries cost
California taxpayers over $176 million dollars annually’®.
The average cost of a gunshot wound requiring

hospitalization is $33,000’®. Of this cost, 80% is borne by
4.10. 14

taxpayers

. These are simply direct costs, and do not

take into account lost years of productivity, reduced quality
of life, or emotional burdens firearms inflict on families

and communities. When those costs are factored in, the
estimated cost per survivor of a gunshot wound due to
assault was $260,000’°.

In Santa Clara County the costs of violent injuries
totalled $13,679,360 in 1993’®. Of that sum, direct

hospitalization costs for firearm-related injuries in SCC

reached $3.6 million’®. These figures, however, do not include the cost of emergency room (ER) or trauma center (TC)
care, therefore costs for those patients treated for a gunshot wound in the ER or TC, but not admitted to the hospital, are
not included in these sums. Most of these costs fall to public funds" ’® ’".

Sources for pages 1-3.

7. California Dept, of Justice, Div. of Law Enforcement.

1. Santa Clara County Public Health Department, Disease
Control & Prevention. Data Management & Statistics.
2. State of California, California Department of Health

8. Bureau of Alcohol, Tobacco & Firearms, Licensing

Services, Death Records, 1995.

3. Passion & Policy: As facts replace feelings in the
handgun debate, more voters support efforts to reduce
access to handguns. October, 1996. EDK Associates.

4. Pacific Center for Violence Prevention. Policy Paper
‘Preventing Youth Violence."

5. Kellerman, A. & Mercy. J.(1992). Men, Vfomen, and
murder. Journal of Trauma 33:1-5.

6. Tucker, C.“Guns are a Hazard.’ Chronicle, 12/7/96.

Division, 1996.

9. California Department of Justice, AFS Section.

10. Miller & Cohen,(1995). "Costs of Penetrating Injury,"
Textbook of Penetrating Trauma, tvatury & Cayten, Eds.
Philadelphia: Lee & Civiga.

11. The Campaign to Prevent Handgun Violence Against Kids.
12. Bureau of Alcohol, Tobacco and Firearms.(1993).
Printout, BATF Office of Public Affairs,

13. Santa Clara County Public Health Department, Disease

Control & Prevention, Data Management & Statistics,

Datis Hospital Discharge Data, 1993.

14. General Accounting Office. (1991). Trama Care: Lifesaving
System Threatened by Unreimbursed Costs and Other
Factors. (GAO/HRD-91-57). Washington, DC: General
Accounting Office.

15. Brent,D., Perper.J., AIIman,C.. Morti2,G., V\ferteIla,M.,

Zelenak, J. (1991). The presence and accesibility of
firearms in the homes of adolescent suicides: a casecontrol study. JAMA,266, 2989-95.

16. Wntemute,F., VWght, M.(1992). Inftial and subsequent
hospital costs of firearm injuries. Health Affairs, 12(4):262^.
17. California Department of Justice, Homicide Fite. 1990-1995.

Arresting Facts about Firearms
SANTA CLARA COUNTY

CALIFORNIA

• A gun is purchased every 1.5 hours'.

• Firearms have surpassed motor
vehicle crashes and diseases as the

• Firearm assaults are the third leading
killer of Santa Clara County females

• Most children unintentionally kill them

selves or other children while playing

number one killer in the age group of

with a gun they found in their home or

15-24 years old'.

the home of a family member or friend”.

aged 15 to 44 yearsl

• Carrying a concealed handgun can be
a misdemeanor ora felony. However,

• Overall, firearms are used in over

half of all suicides in the county^
• In 1993 and 1994, over half(58%)of
all homicides were committed using
firearmsl

• Over half of all handgun owners keep
their guns loaded at least some of the

carrying a knife or other less fatal

time'l In one study, 53% of gun

weapon is punishable as a felony.

owners surveyed did not keep their
guns locked up'L

• The leading contributing circumstance
• In 1992, about 78% of murder victims

for homicides is argument.

were killed by someone they knew®.

• Between 1993-1994, 76% of youth

• Firearm injuries cost California tax

(<21 years)homicides were
committed using firearms'.

payers over $177 million annually® '®.
• A gun in the home is 43 times more

their homes'.

and homicides”. In 1990, 3,165

likely to kill a family member or friend

youths aged 15-24 killed themselves

than it is to be used in self-defense'.

with guns. Guns are now used in

• There are 240 gun dealers in the

county, many of whom sell guns from

leading cause of
death for adolescents and young

adults in the US, after car crashes

UNITED STATES

• Hospitalization costs for firearm
injuries totaled $3.6 million'.

• Suicide is the

about 60% of all teenage suiddes'®.
• Three times more people are
murdered during arguments than
robberies®.

• More firearm murders occurred in two

years, than deaths in the 9 year
Vietnam War'®.

• An estimated 30% of all unintentional

shootings could be prevented by the
presence of two safety features;

trigger locks and loading indicators®.

• The average medical cost of a

gunshot wound is $33,000. Eighty
percent of those costs are borne by
taxpayers’'.

• Few guns have trigger locks and
loading indicators because no law
requires them’®.

What you can do to prevent further firearm injuries and deaths...
• Write, telephone, fax or e-mail

• If you are a parent or teacher:

your local, state, and national
representatives to let them know
your concerns about the toll firearms

take on your community.

• Express your views to your
elected official on the following:
- ban sales of handguns from

- get a trigger lock and loading

media. Explain to them that although
TV doesn’t show the consequences,

- store ammunition separately from

guns do cause pain, death, and

- take a gun safety course

television or in movies is not real life.

- advocate for stricter regulation of
the firearm industry

Sources (for information on this page):

- ban the sale of Saturday Night

2.

1.

California Department of Justice, Division of Law

Santa Clara County Public Health Dept., Disease Control
& Prevention, Data Mgmt & Statistics.

Bureau of Alcohol, Tobacco and Firearms, Licensing
1996.

4.

people working for gun dealers

State of California, California Department of Health
Services, Death Records, 1995.

5.

- require trigger locks

California Department of Justice, Bureau of Criminal
Statistics.

6.

Pacific Center for Violence Prevention, Policy Paper
■Preventing Youth Violence."

7.

For more information contact:
Violence Prevention Program
Santa Clara County
Public Health Department

Kellerman, A. & Reay, D. (1986). Protection or Peril?
New England Journal of Medicine. 314:1557-60.

8.

FBI, (1993). Crime in the US. Uniform Crime Reports.
1992. Washington D.C.: US Department of Justice.

9.

U.S. General Accounting Office (1991). Accidental

Shootings: Many Deaths and Iniirries Cau.seri hy
Fireamis Could Be Prevented Vlfashington D.C.: US

1-408-885-4202

General Accounting Office.
2/97

the firearm

10. Wintemute, G., Hancock. M., Loftin, C., McGuire, A.,
Pertschuk, M., Teret, S. (1992). Policy Options

Improving the Health nf the Poor: SlralRnis^ for

.Prevention,
(pp 79-96). Menlo Park, CA: Kaiser Family
Foundation.

Enforcement.

3.

- require back ground checks on

indicator

disability. Remind your children/
students that what they see on

residential dealers

Specials in your area

• If you are a gun owner:

Sensitize yourself and your children
or students to violent images in the

on

Firearm Violence. In Samuels, S. and Smith M. (Eds).

11. Wintemute, G, Terel, S. and Kraus, J.(1987). When
Children Shoot Children, 88 unintended deaths in
California. Journal of the American Medical As.snniatinn
267; 1557-1560.

ir
12 The Gallup Organization. (1991). Handgun Ownership in
America. Princeton NJ. Distributed by the Los Angeles
Times Syndicate, May 29, 1991.

13. Weil, D. and Hemenway, 0.(1992). Loaded guns in the
home: Analysis of a national random survey of gun
Owners. Journal of the American Medical M

iation.

276: 3033-3037.

14. Fingerhut, L.. National Center for Health Statistics.
Personal Communication, 1991 data.

15. Fingerhut, L.(1993). Firearm mortality among children,
youth, and young adults 1-34 years of age, trends, and
current status: United States, 1985-1990. Advance Data

from Vital and Health Statistics No. 231. Hyattsville, MD'
National Center for Health Statistics.

16. Vietnam War Almanac; FBI Crime Reports.

17. Miller & Cohen, 1995. “Costs of Penetrating Injury,'
Textbook of Penetrating Trauma. Ivatury & Cayten Eds
Philadelphia: Lee & Civiga.

18. Wintemute.F, Whght, M.(1992). Initial and subsequent
hospital costs offirearm injuries. Health Affairs, 12(4):262-4.

SANTA CLARA COUNTY PUBLIC HEALTH DEPARTMENT
VIOLENCE PREVENTION PROGRAM

PROGRAM DESCRIPTION

In May, 1996, the Public Health Department received a two year grant from the David and Lucile Packard
Foundation for work in the violence prevention area. Project HALT(Health z\pproach Lessens the) Violence.

The mission of Project HALT Violence is to help change the culture of violence in our community and to help reduce

crime in Santa Clara County.

The Santa Clara County Public Health Department in concert with numerous other project partners believes that
violence within our county community can be reduced through a multi-faceted, mid- and long-term preventive
approach. The Public Health Department is committed to working with existing groups which are addressing
violence prevention and will support and complement their efforts by contributing the strengths of a public health
perspective.

Specifically, Project HALT Violence’s objectives include the following:
♦

Establish an identified role for Public Health in the area of violence prevention

♦

Compile a broad-based resource inventory in order to identify strengths/services ,

♦

Assess gaps in services in the community

♦
♦

Initiate a population-wide community education project for violence prevention
Participate in community coalitions to promote collaboration and enhanced efforts
Work with the community to develop a community action plan for violence prevention

♦

Plan and advoeate for public policy to control the incidence and impact of violence.

♦

CURRENT PROGRAM EFFORTS AND COMMUNITY COLLABORATION

In July, 1996, the Public Health Department hired a Violence Prevention Coordinator, to organize and facilitate the
project’s activities under the direction of the Deputy Director of Public Health. The Department has identified four
major areas where violence prevention work needs to be initiated and /or better coordinated:
♦

Reducing and Preventing Firearm Violence -Public Health is currently working with Supervisor Jim
Beall’s Office, the Mayor Hammer’s Office, the Police Chiefs Association, and others to convene a series of
meetings designed to educate the community about the need to reduce and prevent firearm violence.

♦

Developing and promoting a comprehensive approach to school/community-based violence
prevention programs, working through the Domestic Violence Council, Child Abuse Council, and Office
of Human Relations.

♦

Expanding efforts to educate the community about the need to decrease children’s exposure to media
violence. Public Health is working with the Medical Association, Catholic Diocese and others to present a
symposium on media literacy in the fall, 1997.

♦

Creating a framework for ongoing collection and analysis of violence-related data. As part of ongoing
data collection efforts. Public Health has compiled an inventory of violence prevention resources available
in Santa Clara County.

In addition, active participation has been established in other coalitions, such as the Mayor’s Gang Task Force and

the Domestic Violence Council. In the near future. Public Health plans to partner with the Drug and Alcohol Bureau

and others to address the prevention of alcohol-related violence through an initiative designed to reduce youth access

to alcohol.
2/13/97

VIOLENCE PREVENTION PROGRAM
FIREARMS

Why is Public Health focusing on firearms when it is not that big of a problem in Santa Clara County?
The Public Health Department Violence Prevention Program is taking a broad approach to violence
prevention, and reducing access to firearms is only one aspect of a comprehensive program.
Additional aspects include the development ofa data surveillance system and resource inventory to
assess community needs and strengths, assessment and support of effective school and community
based violence prevention programs including PeaceBuilders, working with the Domestic Violence
Council and Child Abuse Council to promote and support prevention aspects, working with other

organizations on addressing media violence, and working with the San Jose Gang Prevention Task
Force and Latino Youth Forum in the area of youth violence. We are using the State Attorney
General’s Report, Violence Prevention: A Vision of Hope,as one of the sources that guide action
planning from a comprehensive perspective, consistent with the public health approach.
Why do we need any firearm violence prevention effort in Santa Clara County when we don’t have a
significant problem with violence?
A core tenet of the public health approach is PREVENTION. We do not want to wait until we have

more injuries and deaths to take action. Any amount of violence carries a significant emotional toll,
as well as cost to the medical and judicial systems. See Santa Clara County Firearm Facts for
more detail on specific data.

Why not wait for the State to pass legislation regarding firearm control?
The State Legislature has not taken action to pass effective legislation, despite having bills introduced
each year. The effects of violence and costs are mostly felt at the local level, and local action is
necessary.

Have any other eounties or areas taken such actions in relation to firearms?
Alameda and Contra Costa Counties have taken county-wide action to control firearm violence, as

part ofthe East Bay Publie Safety Corridor. Consistent ordinances are being passed by cities within
those jurisdictions. Also, similar efforts are occurring throughout the State and nation to reduce
injuries and deaths resulting from guns.
Do ordinances work in reducing injuries and deaths due to firearms?

The passage of ordinances to control firearm violence has occurred relatively recently, not allowing
for longitudinal studies to be conducted yet. Preliminary data from Alameda and Contra Costa
Counties indicate a reduction in firearm-related crime, injuries and deaths. In Boston, a

comprehensive violence prevention community plan has led to a 80% decrease in the number of
young people murdered with guns between 1990-1995.
What are the parameters of the model ordinances that will be considered across Santa Clara County
cities?

The ordinance addresses the following issues:

Banning the sales of Saturday Night Special “junk” guns
Requiring trigger locks at point of sale
Requiring background checks on employees of gvm dealers
Ban residential gun dealers

Are the model ordinances consistent with State and Federal law?

Yes. The Legal Community Against Violence(LCAV)has thoroughly researched the legality ofthe
local ordinances and confident that they are consistent with and supplement existing State and
Federal law. LCAV has offered to do pro-bono work to support local jurisdictions.
Why is it necessary to have county-wide effort when some areas do not have high crime rates?
Having uniform ordinances in all 15 cities and the County will prevent gun dealers or purchasers
from moving from one jurisdiction to another within the County to avoid regulation. In addition,
firearms are the leading vehicle for suicide among men, a tragedy that occurs in all areas of the
county.

Can the County pass ordinances that affect the cities?

No. The County ordinances will only affect the unincorporated areas of Santa Clara County.
How many licensed gun dealers are there in Santa Clara County?

As of February, 1997, there are 240 licensed gun dealers in the County. This number represents a
decrease from 323 registered in 1996, with the drop probably being due to new regulations and fees
in the National Crime Bill and the Brady Bill.

How does the Firearm Violence Prevention effort and the ordinances affect sporting/recreational use
of firearms?

It does not affect responsible recreational or sporting firearm use.
How can you enforce these ordinances and how much will it cost?
It is not anticipated that there will be any significant cost associated with enforcement. Enforcement

ofthe ordinances will occur within each jurisdiction as with other regulations such as seat belt law

and sales of tobacco. There are already lists of“junk guns” established and available through the
State law enforcement agencies.

How does the public feel about regulating firearm availability?
A recent public opinion poll, conducted by EDK Associates, surveyed 300 registered voters in Santa

Clara County and found that, upon understanding the issues involved, the majority of people support
firearm regulations and would be motivated to contact an elected official to express their concern..
What is or can be the role of the Public Safety and Justice Committee with this effort?

Public Health would be very interested in participating on the Public Safety and Justice Committee to
add a health perspective to the existing focus on law and justice. The causes of violence are complex,
and, therefore, the necessary solutions will also need to be complex, with many parts of the
community working together. The Committee can enhance collaborative efforts in the community by
promoting the County agencies working closely in partnership with each other, and with community
organizations in all areas of the continuum, prevention - intervention - treatment - suppression.

4/4/97

Prepared by Public Health Department/DD