THE MPPGV LEADERSHIP SURVEY:

 KNOWLEDGE, ATTITUDES, AND BELIEFS ABOUT GUN VIOLENCE AMONG PUBLIC HEALTH, MEDICAL, AND LAW PROFESSIONALS

Marc A. Zimmerman, Ph.D. Susan Morrel-Samuels, MPH Karen J. Rowe, MPH Richard H. Price, Ph.D. Steven A. Broyles, MPH  University of Michigan School of Public Health

Executive Summary

The purpose of the Michigan Partnership to Prevent Gun Violence (MPPGV) Leadership Survey was to examine the knowledge, attitudes, and beliefs of leaders in the fields of law, medicine, and public health and to identify factors within, and between these professions that could facilitate or hinder collaboration in gun violence prevention The sample was designed to include comprehensive groups of leaders within the target professions. Five hundred and thirty-four out of a total sample of 754 Michigan professionals completed interviews, resulting in a response rate of seventy-two percent.

 This study revealed that the respondents have both a professional and personal interest in the problem of gun violence in Michigan. Many of these individuals work on gun violence issues as a regular part of their professional responsibilities. Many are gun owners, and a surprising number have had direct or indirect personal experiences with gun violence victimization.

The results of the study indicate that leaders in the professions of public health, law and medicine:

• are involved with gun violence issues at work, but do not receive commensurate formal or continuing education;
• do not collaborate with members of the other professions on gun violence issues in most cases;
• believe gun violence in Michigan has multiple causes, but differ about the importance of specific causes;
• believe no single type of policy will be sufficient to reduce gun violence;
• possess a high degree of optimism about the potential for reducing gun violence statewide;
• believe that their own professional organizations can do more to prevent gun violence;
• believe a gun violence prevention coalition of public health, law and medical organizations can be influential and effective;
• are prepared to participate actively in such a coalition.

While differences of opinion exist between the professions, none appear to be so fundamental as to preclude cooperation in the development of common goals and strategies for preventing gun violence. Insofar as multiple tactics are necessary to influence gun violence, the differences across professions could actually be used to bring the groups together to form a comprehensive strategy that all could support.

The MPPGV Leadership Survey

The Michigan Partnership to Prevent Gun Violence Leadership Survey was a statewide survey of leading professionals in the fields of public health, law, and medicine. Funded by the Joyce Foundation, the survey was conducted during February and March of 1996 by the University of Michigan School of Public Health with assistance from the Project for Urban and Regional Affairs, UM Flint. The purpose of the survey was to examine the knowledge, attitudes, and beliefs of leaders in these professional fields and to identify factors within, and between the professions that could facilitate or hinder collaboration in gun violence prevention. This information will be used to help guide the work of the Partnership.

HOW WAS THE SURVEY DEVELOPED?

In preparation for this study, an exploratory survey of fifty individuals chosen on the basis of their leadership positions in the target professions, was conducted in the fall of 1995. The exploratory survey consisted of an open-ended, written questionnaire. The responses to the questionnaire were analyzed and used to develop many of the survey items for the study described in this report. The items relating to the causation and prevention of gun violence in the survey instrument were generated through a content analysis of the responses to the open-ended questionnaire.

WHAT TOPICS DID THE SURVEY COVER?

Interviews were conducted by phone, using a protocol consisting of eighty questions which explored the following topics:

• Gun violence education and experience
• Current professional collaboration
• Beliefs about the causation of gun violence
• Opinions about the prevention of gun violence
• Knowledge about gun violence demographics
• Beliefs about gun ownership
• Personal experience with gun ownership and gun violence victimization
• Opinions about professional policies and practices
• Attitudes about the potential effectiveness of a gun violence prevention coalition

HOW DID THE SURVEY DEFINE GUN VIOLENCE?

For the purposes of the survey, gun violence was defined as: "the firing of a gun with the intent to cause injury to another person or to one’s self, or the use of a gun to threaten or coerce another individual." This definition was repeated to all respondents once during the introduction to the questions and again about mid-way through the interview.

WHO PARTICIPATED IN THE SURVEY?

The sample was selected from sixteen professional groups that were divided into three broad categories: public health, law, and medicine. The sample was designed to include comprehensive groups of leaders within the target professions, focusing on those segments of the professions most directly involved with gun violence issues (e.g. physician and nurse members of the MI Trauma Coalition, prosecutors, sheriffs, health officers). Wherever possible, all members of a particular group of leaders were included. A random selection procedure was used to identify police chiefs and hospital CEOs because these groups are composed of large numbers of individuals. The total sample included 754 professionals: 111 in public health, 343 in law and law enforcement, and 300 in medicine. Up to 15 attempts were made to reach each respondent.

Of the initial sample, sixteen were removed for various reasons (e.g., could not be traced, deceased). Of the remaining 738 individuals, 534 professionals completed interviews, for an overall response rate of 72%. Response rates varied across professions, with 84% of the public health professionals , 76% of the law professionals, and 64% of the medical professionals completing interviews. Within the sixteen professional groups response rates ranged from 40% (American Academy of Pediatrics Officers) to 89% (Public Health Academics).

In cases where the identified respondent was unavailable to complete the interview, or felt that another individual in their organization was more informed in this area, the original respondent was allowed to name a designee within their organization to complete the survey. Fourteen percent of the interviews were conducted with designees (n=72).

The professional groupings in the sample were validated by questions asking respondents to self-report their professions and job titles. The responses to these questions led to re-coding in five cases. In three cases designees were re-coded from medicine to law. In each of these instances hospital CEOs designated Directors of Hospital Security to complete the interview. These individuals self-identified their profession as law, and were placed in a newly created law sub-category (hospital security directors). Two other cases of re-coding occurred when physicians reported their profession as public health and their job title as administrators in public health departments. They were re-coded as public health professionals.

 Each professional group shared certain characteristics, but distinct demographic differences were also found. Respondents' average age ranged from 46 years for medical professionals to 48.3

years for law. The sample was predominantly white and male. Medicine had the largest percentage of non-white professionals (10.2%), and law the smallest (2.3%). Public health professionals included the largest percentage of females (46.7%), while law professionals were almost all males (97.7%).

 Tenure on the job was similar across professions. Years of professional experience ranged from an average of 16.8 for public health, to 18.7 for law. The status of these individuals as professional leaders was validated by the fact that over half of the respondents held at least one office in a national, state or local professional organization within the last five years.

Table1.
Demographic Characteristics of MPPGV Leadership Survey Respondents  

Gun Violence Education and Experience

Respondents were asked whether they had received formal or continuing education about gun violence and whether their current professional responsibilities involved work related to gun violence. Not surprisingly, law professionals were the most likely to have had formal or continuing education and work responsibilities connected to gun violence, followed by medical and public health professionals. In each group, however, the relationship between formal and continuing gun violence education and professional responsibilities related to gun violence is similar. Less than half of each professional group received any formal education about gun violence as a part of the training for their professional degree. Somewhat larger percentages report having received continuing education, ranging from 71.9 % of law to 46.2 % of public health professionals. An even larger group, (94.3 % of law, 69.3 % of medical, and 51.6 % of public health respondents) report that their professional responsibilities involve work related to gun violence. As a result, one out of every six people interviewed (16.3%) who say that their jobs involve gun violence responsibilities do not report any training on the topic.

Current Professional Collaboration

When asked whether they currently collaborated with members of the other target professions on gun violence issues, relatively few of those interviewed reported such collaboration. Law and medicine appear to work together most frequently: 41.6% of law professionals reported working with medical professionals, while 43.9% of medical professionals report work with law enforcement, and 30.6% with other law professionals on gun violence issues. It is notable that 44.6% of public health professionals report working with medical professionals, while only 27.2% of medical professionals report working with public health. This apparent discrepancy points to the need to gather more information about current collaboration between public health and medical professionals. This study may have failed to reach segments of the medical community most involved with public health violence prevention efforts.

Beliefs About Causation of Gun Violence

Respondents rated the extent to which they believed a variety of social factors contribute to gun violence on a five point scale (1 = "no extent"; 5 = "a very great extent") . Drug trafficking was the only item receiving an average rating of over 4. The means for low regard for human life, substance abuse, easy availability of guns, media portrayals of violence, and social acceptance of violence were grouped between 3.5 and 3.9. Weak sentencing for gun crimes, poverty and single parent households received the lowest ratings, ranging from 3.2 to 1.9.

Table 2.
Beliefs about the Causation of Gun Violence

Opinions About Prevention of Gun Violence

Respondents were asked to rate the extent to which a variety of policies might be effective in reducing injuries and deaths caused by guns using the same five point scale as above. Violence prevention education, reduction of violence in the media, stricter penalties for criminals who use guns, and drug abuse prevention and treatment received mean ratings between 3.5 and 4. Increased educational opportunities, restricting the availability of guns, and increased economic opportunities had mean ratings of between 3 and 3.4. Firearm safety training was rated as the least effective prevention strategy with mean of 2.8.

Table 3.
Opinions About the Effectiveness of Prevention Policies  

Differences Between Professions In Beliefs About Causation

Most differences about causation occurred between law professionals and professionals from medicine and public health: public health and medical professionals were more likely to report that easy availability of guns, drug trafficking, substance abuse, poverty, and social acceptance of violence contribute to firearm violence than were law professionals. Medical professionals, however, are more likely to rate weak sentencing for gun crimes as an important contributor to violence than either their law or public health counterparts. No differences between the three professions were found for single parent households, media portrayals of violence and low regard for human life as being causes of gun violence.

Differences Between Professions In Opinions About Prevention

The professional groups differed in their perceptions about the effectiveness of different prevention policies. Consistent with their beliefs about causation, public health and medical professionals were more likely than law professionals to rate policies restricting the availability of firearms and policies increasing economic opportunities as effective. Medical professionals favored stricter penalties for gun crimes to a greater extent than law professionals. Law professionals gave lower ratings to drug abuse prevention and treatment, reduction of violence in the media, and promotion of educational opportunities than public health professionals. No differences between the professional groups were found for the effectiveness of violence prevention education and firearm safety training. All respondents generally agreed that violence prevention education would be somewhat effective and that firearm safety training would have little effect.

Professional's beliefs about the effectiveness of various policies for preventing gun violence were not always consistent with their beliefs about causation. Although substance abuse was identified as one of the most important contributors to gun violence, drug abuse prevention and treatment was not considered to be one of the most effective prevention strategies. Similarly, while violence in the media was not rated among the top causes of gun violence, it was considered to be one of the most effective prevention policies. No single policy, however, was judged capable of reducing gun violence to a great extent as evidenced by the fact that no policy received a rating of 4 or above.

Opinions About Gun Laws

Respondents were asked to give their opinions concerning current or potential firearms legislation on a scale from 1 (strongly oppose) to 5 (strongly support) with 3 indicating neither support or opposition. Differences were found between the groups in degree of support or opposition for specific laws. In no case, however, did one profession support a measure that another opposed. Law, public health and medical professionals opposed allowing all citizens to carry concealed weapons (M=1.71; SD=1.17). They supported a ban on the manufacture and sale of assault weapons (M=3.8; SD=1.5) and a five day waiting period and background check for handgun purchases (M=4.4; SD=1.03). They generally supported the registration of all guns (M=3.88; SD=1.5). Respondents provided some support for the establishment of a firearm fatality reporting system which would provide detailed information about weapons used (M=3.54; SD=1.31). All three groups opposed a ban on private handgun ownership (M=2.15; SD=1.37).

Members of all three professions agreed that the second amendment to the U.S. Constitution protects the right of private citizens to own guns (M=3.95; SD=1.39). Public health professionals were less likely than law professionals to believe that the Constitution protects private gun ownership.

Knowledge About Gun Violence Demographics

Regardless of inter-professional differences regarding gun violence education, most respondents appear to be equally informed about some basic gun violence statistics. No differences in accuracy between the responses of each professional group to a series of questions concerning victims and perpetrators of gun violence were found. Misconceptions about the extent to which the firearm homicide rate in Michigan has changed since the mid-eighties were found. The majority of those interviewed (72%) believed that the rate of firearm homicide in Michigan has increased since 1985, but it has not changed. The Michigan firearm homicide rate in 1985 was 7.5 per 100,000 (out of a total homicide rate of 11.7), while in 1994 (the most recent year for which statistics are available), the firearm homicide rate was 7.7 per 100,000 (out of a total homicide rate of 10.8) (Source: Division of Health Statistics, Michigan Department of Community Health).

Beliefs About the Risks of Gun Ownership

Respondents from the three professions agreed that risks are associated with handgun ownership. All groups believed that the presence of a handgun in the home raises the risk of homicide and suicide. The majority of respondents disagreed with the statement: "Carrying a concealed weapon is an effective protection against violent attack". Most of those interviewed believed that research has demonstrated that owning a hand gun raises the risk of firearm death.

Personal Gun Ownership

Respondents to this survey were asked a series of questions concerning their personal gun ownership, questions which were also included in the 1992 Michigan Behavioral Risk Factor Survey (BRFS). The BRFS is an annual, random telephone survey of the adult population. Table 4 compares gun ownership, and the primary purpose for gun ownership, among the professionals interviewed for this study to the general population of Michigan.

Table 4.
Gun Ownership of MPPGV Survey Respondents and the Michigan Population  

The percentage of public health and medical professionals in this study who reported keeping guns in the home was similar to that of the general population. As would be expected, law professionals are more likely to report gun ownership; half of this group keep a gun at home (primarily for work). All three professional groups, however, were much less likely than members of the general population to report protection as their primary reason for gun ownership.

Experience With Gun Violence Victimization

Respondents to the survey were asked whether they, their co-workers, family members or friends had ever personally experienced gun violence. The definition of gun violence given in the introduction to this report was repeated at this point in the interview. Table 5 summarizes the responses of the three professional groups to this series of questions:

Table 5.
Gun Violence Victimization of MPPGV Survey Respondents and Intimates

The levels of gun violence victimization of family, friends or co-workers reported by these respondents is surprisingly high. It is noteworthy that the definition of gun violence victimization for this study includes self-inflicted harm and threatened harm. Regardless of the nature of the victimization, however, it is remarkable that about half of those interviewed have experienced firearm violence, either personally, or indirectly through intimates.

Optimism About Reduction of Gun Violence

Despite the pervasiveness of gun violence and the complexity of its causes, respondents from all three professions were optimistic that gun violence in Michigan can be reduced and that their own profession can make an important contribution to the achievement of this goal. Using a five point scale with 1 equaling "strongly disagree" and 5 equaling "strongly agree" all three professions disagreed (M=1.65, SD=.95) that "...it is unrealistic to believe that gun violence in Michigan can be significantly reduced." They also expressed strong disagreement (M=1.97, SD=1.12) with the statement: "Members of my profession can do little to prevent gun violence."

Support For Professional Collaboration

While the respondents appeared to be optimistic about the potential for gun violence reduction, they did not believe their own professional organizations have played leadership roles in this area. In general, none of the three groups felt that their professional organizations have developed very effective gun violence prevention policies. Law professionals rated the effectiveness and leadership of their organizations somewhat more highly than did public health or medical professionals.

Respondents in each of the three groups strongly agree that their professional organizations should participate in a coalition of medical, public health and law organizations to develop strategies to reduce gun violence. Respondents all supported the idea that their profession should form a coalition with the other two professions to help prevent gun violence. They also agreed that a coalition could influence gun violence policies at the state level, and result in more effective gun violence prevention activities within their own professional organizations.

Respondents identified sharing data and information, the development of common goals and objectives, public awareness, professional education and legislative advocacy as important ways in which the professions could work together. Inter-professional meetings and inter-disciplinary research were identified as lower priorities.

Willingness to Participate in Gun Violence Prevention Activities

Support for collaborative work is paralleled to a great extent by the willingness of respondents to become directly involved in gun violence prevention activities: Over 65% of those interviewed said that they would be interested in participating in professional education programs concerning gun violence prevention; 44% of public health, 45% of medical, and 63% of law professionals are interested in becoming involved in strategic planning and policy development activities; and 65% of public health, 63% of medical, and 76% of law professionals indicated a willingness to participate in public awareness and community education about gun violence prevention.

Conclusion

The respondents interviewed for this study have both a professional and personal interest in the problem of gun violence in Michigan. Many of these individuals work on gun violence issues as a regular part of their professional responsibilities. Many are gun owners, and a surprising number have had direct or indirect personal experiences with gun violence victimization.

The results of this study indicate that leaders in the professions of public health, law and medicine are involved with gun violence issues at work, but do not receive commensurate formal or continuing education. Only a minority of each professional group collaborates with members of the other professions on gun violence issues. Respondents believe gun violence in Michigan has multiple causes, but the professional groups differ about the importance of specific causes. As a group, respondents believe no single type of policy will be sufficient to reduce gun violence to a great extent.

Nevertheless, these professionals possess a high degree of optimism about the potential for reducing gun violence statewide. They believe that their own professional organizations can do more to prevent gun violence and that a gun violence prevention coalition of public health, law and medical organizations can be influential and effective. A large majority of respondents in each profession are prepared to participate actively in such a coalition.

While differences of opinion exist between the professions, none appear to be so fundamental as to preclude cooperation in the development of common goals and strategies for preventing gun violence. Insofar as multiple tactics are necessary to influence gun violence, the differences across professions could actually be used to bring the groups together to form a comprehensive strategy that all could support.