Article Text

other Versions

Download PDFPDF
Association of state-level intoxicated driving laws with firearm homicide and suicide
  1. Robert A Tessler1,2,
  2. Miriam Joan Haviland2,
  3. Andrew Bowen2,
  4. Deidre Bowen2,3,
  5. Frederick P Rivara2,4,5,
  6. Ali Rowhani-Rahbar2,4,5
  1. 1Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
  3. 3School of Law, Seattle University, Seattle, Washington, USA
  4. 4Department of Epidemiology, University of Washington, Seattle, Washington, USA
  5. 5Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
  1. Correspondence to Dr Robert A Tessler, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; robert.tessler{at}


Objectives To determine if an association exists between the number of driving under the influence (DUI) convictions required to activate federal firearms prohibitions and annual firearm homicide and suicide rates by state.

Methods Ecological cross-sectional study of all US states from 2013 to 2017. We collected DUI law data from Thomson Reuters Westlaw database and firearm mortality data from the Centers for Disease Control and Prevention Vital Statistics programme.

Results Five states had laws such that one or two DUI convictions could result in prohibitions to firearms access according to federal law. Four states had no legal framework that would restrict firearms access because of DUI convictions; the remaining states could activate federal restrictions at three or more DUI convictions. Firearm-specific homicide (victimisations) rates were 19% lower among women in states where federal restrictions of firearms access occurred after one or two DUI offences (incidence rate ratio (IRR) 0.81; 95% CI 0.64 to 1.01) and 18% lower in states with firearm prohibitions after three or more offences (IRR 0.82; 95% CI 0.71 to 0.95) compared with the states with no legal framework for prohibiting firearms after DUI convictions. There was no association between number of DUI activations and overall, or firearm-specific, suicide among the entire population (men and women) or among only women, or only men.

Conclusions DUI penalties that activate federal firearms prohibitions may be one pathway to reduce firearm homicide of female victims.

  • legislation
  • firearm
  • motor vehicle - non traffic
  • suicide/self-harm
  • violence
  • alcohol

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @RobertTessler

  • Contributors RT, AR-R and FPR formulated the idea; MJH performed the analysis; AB and DB gathered data. RT wrote the manuscript. All authors contributed meaningfully in edits and re-writes.

  • Funding Supported by funding from the state of Washington.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study used publicly available de-identified data and thus was exempt from the Institutional Review Board at the University of Washington.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. All data on state laws were obtained from All mortality data were obtained from the CDC Vital Statistics Program.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.