Dr. Cassandra Crifasi never planned to go into public health. She ended up in the field as, in her words, a “med school reject.”
But Crifasi, who is now the Co-Director of the Center for Gun Violence Solutions at Johns Hopkins University, began to recognize the power of public health early in her graduate training. “I heard a lecture on injury prevention, and there was a [speaker] talking about her work on keeping people from getting hurt in the first place. My mind was blown,” she recounted. So she stuck with it.
Crifasi’s PhD research centered around a topic she had personal experience with: guns. “I personally own firearms. I’ve owned firearms for a very long time,” she said.
She encountered few other researchers interested in guns from a public health perspective. “When I entered the field in 2010, 2011… I think you could count on less than two hands the number of people who were spending all of their time in public health thinking about this,” she said.
It was not that the issue was unimportant. In 2010, over 30,000 people died from firearm injuries. But interested researchers were stymied by the 1996 Dickey Amendment, a spending bill provision which prohibited Center for Disease Control (CDC) funds from being used to promote or advocate for gun control policy. In addition, Congress reallocated all 2.6 million dollars of funding that had previously been used to research firearm injuries and deaths. As a result, researchers steered clear of the field for over two decades.
The amendment was revised in 2018 to allow the CDC and other government organizations to resume gun violence research. Since then, research efforts have intensified, but gun violence rates have remained high. Congress has struggled to address the issue through legislation, and evidence-based policies have only taken hold in Democrat-controlled states.
Understanding why the amendment’s clarification has not led to a reduction in gun violence requires a trip back to its origins. In the 1990s, the CDC began to investigate the effects of firearms on public health. The National Rifle Association (NRA) objected, loudly. “The first thing they did, they told all their members, ‘If you let this research go on… every single one of you will lose all your guns,’ ” said Dr. Mark Rosenberg, who led the CDC’s firearm research program at the time. “It wasn’t true, but this is what they told everybody.”
The NRA also advertised that household guns protected families, but Rosenberg found that the opposite was true. His team discovered that guns increased the risk of death in the home by over 200%.
In response to Rosenberg’s study, the NRA stepped up their game. In a 1996 congressional hearing, the organization enlisted Representative Jay Dickey (R-AR) to “lead the attack” on the CDC. “They gave him a lot of questions to ask us. And they took things out of context, they made things up. It was truly an ambush,” he said.
The hearing led to the enactment of the Dickey Amendment later that year, which prohibited the CDC from using funds for gun control advocacy and slashed existing funding for firearm injury research. Rosenberg and others felt this sent a clear message.
“The CDC was [already] forbidden from lobbying for any legislation. We never did that… But this amendment put people on warning,” said Rosenberg. He explained that the amendment gave members of Congress the ability to send letters to research centers and accuse them of violating the amendment. A response could take months of time and effort.
“[The amendment] put people on notice that, if you do this kind of research, we can really harass you,” Rosenberg said.
The passage of the Dickey Amendment had a “chilling effect on the willingness of administrators to invest funds in this kind of research,” said Dr. Andrew Morral, Director of the National Collaborative on Gun Violence Research at RAND Corporation. “It sent a strong signal that [the CDC] would need to do firearm violence research at risk of their budget and that any future research might be interpreted as policy advocacy… People didn’t feel it was safe to do research.”
Morral cited a 2017 study which determined that the quantity of firearm injury studies published in academic journals represented less than 5% of the volume expected for a public health issue with a death rate of its magnitude. “There was not a volume of research commensurate with the size of the problem,” he said.
Dr. Alexander McCourt, an Assistant Professor in the Department of Health Policy and Management at the Johns Hopkins School of Public Health, noted that the Dickey Amendment also dissuaded new professionals from entering the field.
“We had new doctoral students that didn’t want to do this type of research because there was no government funding attached,” McCourt said. “Especially for students and younger researchers, it’s hard when… you don’t have the resources to go gather [data] yourself.”
Rosenberg saw the link between the Dickey Amendment and the lack of firearm research. He made it his mission to fix the problem. Eventually, he got the Dickey Amendment revised through the help of an unlikely ally: Jay Dickey himself.
Shortly following Rosenberg’s 1996 hearing with Dickey, a legislative assistant from Dickey’s office invited Rosenberg to discuss Rosenberg’s data. Rosenberg did not expect to meet directly with Dickey. But when the two got a chance to talk, they steered clear of guns. Instead, they focused on their children.
“The next thing I knew, he had invited my son and his whole class to come up and tour Congress,” Rosenberg said.
Rosenberg returned the favor by helping Dickey’s daughter get a job in Atlanta. The two began to trust one another.
“We actually came to like each other, and actually came to love each other,” Rosenberg said of their relationship. “And Jay Dickey decided that he had made a mistake.”
Dickey began to work with Rosenberg to restore gun violence research. The pair co-wrote multiple op-eds in the Washington Post.
Dickey died in 2017, but he left Rosenberg with an important lesson. “He taught me that people who owned guns were afraid that the research would lead to taking away all their guns. And he taught me that you need to let people know that that’s not our goal.”
Working alongside Dickey’s ex-wife, Betty, Rosenberg finally managed to clarify the Dickey Amendment in 2018. The revised version still prohibited gun control advocacy, but it explicitly protected the CDC’s right to investigate gun violence prevention. Congressional funding for CDC research resumed.
Rosenberg felt it was important that the Dickey Amendment was not fully repealed. “For congresspeople, representatives, senators who wanted to support the research but didn’t want their constituents to think they were promoting gun control, the Dickey Amendment was the perfect thing to protect them,” he said.
With the amendment clarified, gun violence research accelerated. “By summer [2022], I estimated there were a hundred funded projects that were collecting data and analysis,” said Morral.
He highlighted a couple new studies. One project, funded by the NIH, selected random vacant lots in Philadelphia and beautified them at a low cost. The study determined that gun violence was reduced in these greened areas. Similar greening movements in other cities across the U.S. have achieved comparable results.
Another study of firearm purchase records in California found that suicide rates for firearm owners were much higher than expected when controlling for demographic variables. The difference was especially large for women and new gun owners. Although researchers have long suspected an association between gun ownership and suicide, Morral felt that this study confirmed the relationship. “This is stuff we didn’t know [before],” he said.
Morral claimed these new studies were a direct consequence of the changes to the Dickey Amendment. “There are some studies that an economist working at a desk with available data can do,” he said. “But randomized control trials… cannot be done without [external] funding.”
In November 2022, Morral helped the National Collaborative on Gun Violence hold its first National Research Conference on Gun Injury Prevention. The conference attracted over 600 attendees, including Crifasi. “There were 300 presentations,” Morral said. “It was like nothing that we’d seen before.”
With all of this new research activity, gun reform activists around the country are newly equipped to advocate for stronger legislation. One such activist is Sari Kaufman ’24, the co-founder of the Students Demand Action chapter at Yale and a survivor of the 2018 Marjory Stoneman Douglas High School shooting. She told The Politic that the amendment’s clarification has led to new publications and data which have bolstered the work of gun reform advocates.
“The CDC has been able to start this research up again, and now it’s clear that guns are the leading cause of death for children and teens,” she said. She added that new research has quantified the impact of gun violence for activists in ways that were not possible in the past.
But newly-informed activism has led to few gun policy changes on a federal level. The only notable piece of legislation is the 2022 Bipartisan Safer Communities Act, which enhances federal background checks and incentivizes states to adopt red flag laws. It was the first gun control bill to pass Congress since 1994.
Movement at the national level might be slow, but evidence-based policy solutions for gun violence prevention are finding a home in state legislatures, according to McCourt.
“We’re seeing more states adopting laws that are really rooted in evidence,” he said. He mentioned a recent permit-to-purchase law in Oregon. He and Crifasi have found that laws like the one in Oregon reduce “multiple types of gun violence, including homicide, suicide and mass shootings.”
Crifasi added that state legislatures in Washington and Delaware are debating similar permit-to-purchase laws. “It will take time for these policies to take effect, but things are happening,” she said. “Things are moving, more so in the past few years than they did in the 30 years prior.”
But not all states are moving towards evidence-based policies, according to Morral. He described recent legislative activity as “bifurcated.”
“There’s mostly red states that are changing their laws rapidly to make gun restrictions more permissive, and there’s mostly blue coastal states that are making legislation in the opposite direction,” he said.
Morral added that the Supreme Court’s 2022 decision on New York State Rifle & Pistol Association v. Bruen, which declared concealed carry permit requirements unconstitutional, has impacted legislative action in some Democratic states. “New York, Rhode Island, Connecticut and California… are scrambling to rewrite their laws in a way that is going to compensate for the risks of having more permissive concealed carry rules,” he said.
Polarization at the state level makes the national future of the gun violence prevention movement unclear. But Crifasi has stayed optimistic.
“You have to be optimistic working in gun violence prevention,” she said. “It’s a hard field to work in. You have to feel like there is a chance for real change.”
Crifasi feels that her unique perspective as a gun owner and researcher puts her in an excellent position to connect with those on both sides. “I can engage with gun owners to discuss research topics that I might not have been able to if I didn’t [understand]… why some people might choose to own guns,” she said.
Like Crifasi, Kaufman remains hopeful. She is encouraged by recent legislative reforms. “Seeing the Bipartisan Safer Communities Act pass this summer showed me that progress and change is incremental, but it can happen,” she said.
“The sad truth is that gun violence isn’t going to stop,” Kaufman conceded. But, in her view, “these little tiny things add up.”
Kaufman acknowledged that the politicization of the CDC and government-funded research, especially in the wake of the coronavirus pandemic, has made progress challenging. However, she feels that the observable impact of the gun violence crisis overrides this distrust.
“The difference here is that it’s not an issue that’s abstract,” Kaufman said. “Because we can see the impacts firsthand as an average citizen in the United States, it speaks to the volumes of the statistics and the research that’s coming out.”
Rosenberg sees the problem differently. “I think we just learned from the anti-vaccine movement that… it’s not enough to know the truth and say the truth,” he said. “You have to have an active engagement and dialogue with the people who are skeptical and who question the science.”
He stressed that research by itself is not enough to change minds.
“It’s not enough to publish the results,” he said. “We have to go to the community and talk to people to share the findings, to explain the findings and to let them know the steps we’ve taken to make sure that it’s valid scientific research and not biased advocacy.”
He emphasized that the high stakes require action. “We can do this,” he said. “Because our lives depend on it.”