Crifasi 

et al. Injury Epidemiology (2023) 10:28 Injury Epidemiology

https://doi.org/10.1186/s40621-023-00439-4

SHORT REPORT Open Access

The association between permit‑to‑purchase

laws and shootings by police
Cassandra K. Crifasi1*   , Julie  Ward1, Alex D. McCourt1, Daniel Webster1 and Mitchell L. Doucette1 

Abstract 
Background  Fatal and nonfatal shootings by police are a public health issue that warrants additional research. Prior
research has documented associations between fatal shootings by police and gun ownership, legislative strength
scores, and lax concealed carry weapons laws. Despite research on other firearm-related outcomes, little is known
about the impact of permit-to-purchase (PTP) laws on shootings by police. We generated counts of fatal and nonfa-
tal OIS from the Gun Violence Archive from 2015 to 2020. We conducted cross-sectional regression modeling with a
Poisson distribution and robust standard errors. In addition to PTP, we included several state-level policies that may
be associated with shootings by police: comprehensive background check only (CBC-only) laws, concealed carry
licensing laws, stand your ground laws, violent misdemeanor prohibitions, and extreme risk protection orders (ERPO).
We controlled for state-level demographic characteristics and included a population offset to generate incidence rate
ratios (IRR).
Findings  PTP laws were associated with a 28% lower rate in shootings by police [IRR = 0.72, 95% confidence interval
(CI) 0.64–0.81]. Shall Issue (IRR = 1.34, 95% CI 1.17–1.53) and Permitless (IRR = 1.61, 95% CI 1.35–1.91) concealed carry
laws and CBC-only laws (IRR = 1.12, 95% CI 1.01–1.25) were associated with higher rates of shootings by police. Stand
your ground, violent misdemeanor prohibitions, and ERPO laws were not associated with shootings by police.
Conclusions  Our study found that PTP laws were associated with significantly lower rates of shootings by police.
Removing restrictions on civilian concealed carry was associated with significantly higher rates. State-level firearm
policies may be a lever to address shootings by police.
Keywords  Police violence, Shootings by police, Firearms, Firearms policy, Policy evaluation

Introduction source that includes information on both fatal and nonfa-

Fatal shootings by police are estimated to occur approxi- tal shootings by police.
mately 1000 times per year. These estimates are based Prior research has examined the relationship between
off of databases such as The Counted, Fatal Force, Map- proxies for gun ownership, state-level gun laws, and fatal
ping Police Violence, and the Gun Violence Archive shootings by police. Researchers have found that higher
(GVA) developed through media sources, police reports, rates of gun ownership were associated with increased
and other data requests. Currently, GVA is the only data rates of fatal shootings by police (Hemenway et al. 2019;
Nagin 2020). On average, states that made it easier for
people to carry loaded, concealed handguns in public
*Correspondence:
experienced increased rates of fatal and nonfatal shoot-
Cassandra K. Crifasi
[email protected] ings by police (Doucette et al. 2022). Additionally, states
1
Department of Health Policy and Management, Center for Gun Violence with higher legislative strength scores had lower rates
Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N.
of fatal shootings by police (Kivisto et al. 2017). Legisla-
Broadway, Suite 593, Baltimore, MD 21202, USA
tive strength scores attempt to measure how strong state

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Crifasi et al. Injury Epidemiology (2023) 10:28 Page 2 of 5

guns laws are based on the number of policies a state or when an officer fired shots, but no one was wounded
has in place. However, the overall strength of a state’s or killed. We combined fatal and nonfatal shootings by
gun-related legislation does not provide policymakers or police into one outcome to increase our sample size for
other decision makers with concrete information about the analysis.
which laws they might consider to address issues of gun In addition to PTP laws, we examined stand your
violence. Therefore, it is necessary to also evaluate the ground (SYG) laws, comprehensive background check
specific policies that are associated, or not, with various laws without a purchaser licensing system (CBC-only),
forms of violence. violent misdemeanor prohibitions, extreme risk protec-
Several studies have examined the role of permit-to- tion orders (ERPO), and concealed carry weapons laws.
purchase (PTP) laws (sometimes also referred to as pur- Concealed carry laws vary across states but generally are
chaser licensing laws) on firearm-related deaths. PTP grouped into three categories: May Issue, Shall Issue, and
laws require prospective gun purchasers to first obtain Permitless). May Issue laws are those that have a set of
a license from state or local law enforcement prior to objective criteria for obtaining a license but also require
buying a gun. PTP systems access both federal and state an individual who wants to carry a loaded, concealed
records to conduct a background check, often facilitated handgun in public to have a good and substantial reason
by a fingerprint. These systems also provide law enforce- or they can be denied. Shall Issue laws also have objective
ment more time to conduct a background check, and criteria with varying degrees of criminal history or train-
require that sellers, both licensed and private, only sell to ing requirements, but no discretion. Permitless concealed
those with a valid license. Prior research has found PTP carry allows for anyone not legally prohibited from own-
laws to be associated with reductions in firearm homi- ing a gun to carry a loaded, concealed handgun in public
cide (Crifasi et  al. 2018; Hasegawa et  al. 2019; Webster without an application, background check, or training.
et  al. 2014), firearm suicide (McCourt et  al. 2020), and Variation in policies was present across states. States
fatal mass shootings (Webster et al. 2020). Research has were coded as ‘1’ if a policy was in place and ‘0’otherwise.
also found that PTP laws were associated with reduc- State laws were coded based on prior legal research con-
tions in diversion of guns for use in crime (Crifasi et al. ducted by our study team (Doucette et  al. 2022; Crifasi
2017) (e.g., straw purchasing or other illegal purchasing et al. 2018).
that contributes to the underground gun market). These We controlled for several state-level characteris-
laws are also associated with fewer law enforcement offic- tics that, based on the socioecological model and prior
ers shot in the line-of-duty (Crifasi et  al. 2015). To our research, may confound the relationship between PTP
knowledge, no research has yet assessed the association laws and shootings by police: percent of the population
of PTP laws and shootings by police. living in a metropolitan statistical area (MSA), percent of
Given the robust research documenting public safety the population who were black males aged 15–19 years,
benefits of PTP laws generally and protecting police offic- percent of the population who were white males aged
ers from being shot in the line-of-duty specifically, we 15–19 years, unemployment rate, per capita alcohol con-
sought to examine whether they were also associated sumption, incarceration rate, law enforcement officers
with fatal and nonfatal shootings by police while account- per capita, and rates of violent crime. The incarceration
ing for other firearm-related policies. rate and law enforcement officers per capita were lagged
1 year. PTP laws are designed to better identify and
Methods screen out individuals prohibited from legally purchas-
Due to the limited availability of high-quality data to ing guns. Therefore, we did not include a proxy for state-
assess this outcome, we conducted a cross-sectional anal- level gun ownership as it is likely in the causal pathway
ysis to assess the impact of PTP and other firearm laws between our primary policy variable (PTP) and our out-
on fatal and nonfatal shootings by police. come (fatal and nonfatal shootings by police).

Data and measures Analysis

We compiled counts of fatal and nonfatal shootings by To estimate the effect of PTP and other firearm laws, we
police from the GVA from 2015 to 2020. The GVA has collapsed counts of fatal and nonfatal shootings by police
been used previously to study fatal and nonfatal shoot- by half-year time periods. The data were indexed by state
ings by police (Doucette et  al. 2022). We downloaded for a total of 600 state-half-year observations from 2015
all incidents classified in the GVA as being an ‘officer- to 2020. We assessed for and did not find substantive
involved incident’ occurring between 2015 and 2020. overdispersion in the data. We ran both negative bino-
We reviewed each incident to exclude those where only mial and Poisson distribution models and found no dif-
law enforcement officers were shot as part of an incident ferences in the point estimates. As a result, we present
 Crifasi et al. Injury Epidemiology (2023) 10:28 Page 3 of 5

here the findings from the cross-sectional Poisson distri- et al. 2020). PTP laws intervene at the point of acquir-
bution model with robust standard errors and a popula- ing a handgun. All purchasers are required to first get
tion offset to generate incidence rate ratios (IRR) and 95% a license and all sellers, both licensed and private, can
confidence intervals (95% CI). We included the policy only legally sell to someone with a valid license. As a
variables and covariates detailed above in one model result, these laws provide a more robust system for
to estimate adjusted IRRs. The analysis was conducted identifying and screening out prohibited individuals,
using Stata version 17.0. This research was deemed not can deter straw purchasing, or delay impulsive acqui-
human subjects by the Johns Hopkins Bloomberg School sition of a firearm (Crifasi et  al. 2017; Webster et  al.
of Public Health Institutional Review Board. 2013) all of which can impact the availability of fire-
arms during the commission of a crime or when inter-
Results acting with law enforcement. Even after controlling
PTP laws were associated with a 28% lower rate of for the presence of other firearm laws, our findings are
shootings by police relative to there being no PTP consistent with prior research finding generally harm-
law (IRR  =  0.72, 95% CI 0.64–0.81) (Table  1). Shall ful effects of lowering standards for concealed carry
Issue (IRR  =  1.34, 95% CI 1.17–1.53) and Permitless (Doucette et al. 2022). As states make it easier for peo-
(IRR = 1.61, 95% CI 1.35–1.91) concealed carry laws were ple to legally carry loaded, concealed firearms in public,
both associated with significantly higher rates of shoot- this could increase the likelihood that officers engage
ings by police. CBC-only laws were also associated with with more people who are armed and anticipate that
a higher rate of shootings by police, though the 95% CI more encounters will involve individuals with firearms
was close to 1.00 (IRR = 1.12, 95% CI 1.01–1.25). Violent (Donohue et al. 2022). Additionally, removing the per-
misdemeanor prohibitions, stand your ground laws, and mitting requirement entirely may increase access to
extreme risk protections orders were not associated with guns via theft from cars and more illegal gun carrying
shootings by police. due to reductions in proactive policing on guns (Dono-
hue et  al. 2022). More research is needed to under-
Discussion stand the interplay between expanded gun access and
Our analysis found significantly lower rates of shoot- carrying and shootings by police. For example, survey
ings by police in states with PTP laws and significantly and/or qualitative work to understand how these poli-
higher rates in states with fewer restrictions on civilian cies impact officer perceptions is a necessary piece to
concealed carry after controlling for factors associated understanding any causal mechanisms.
with lethal violence. These findings are consistent with Our analysis found that CBC-only laws were associ-
prior research demonstrating protective effects of PTP ated with higher rates of shootings by police. CBC-only
laws (Crifasi et al. 2018; Hasegawa et al. 2019; Webster laws may have been passed in response to higher rates of
firearm homicide or other firearm violence, which would
lead to greater law enforcement activities and increased
Table 1 Cross-sectional analysis examining the associations interactions with potentially armed individuals. Based on
between firearm laws and fatal and nonfatal shootings by police, prior research finding evidence of an endogenous rela-
2015–2020 tionship between CBC-only laws and firearm homicide
Policy IRRa p-value 95% at the county level (Crifasi et  al. 2018), we hypothesize
confidence that may be the case in this analysis as well. However,
interval
(CI) given the cross-sectional nature of this analysis because
of limited data availability, we were not able to directly
Permit-to-purchase 0.72 < 0.001 0.64, 0.81 assess for endogeneity in this analysis. It is important to
Comprehensive background check 1.12 0.029 1.01, 1.25 note this study cannot assess the impact of policy change,
only
but this is a finding that warrants additional research
Shall issue* 1.34 < 0.001 1.17, 1.53
with more robust analyses. Importantly, ERPO laws were
Permitless* 1.61 < 0.001 1.35, 1.91
not associated with higher rates of shootings by police.
Stand your ground 0.93 0.098 0.86, 1.01
In many states, despite several eligible petitioners, law
Violent misdemeanor prohibitions 1.02 0.576 0.93, 1.13
enforcement is often the petitioner and/or the group
Extreme risk protection orders 0.98 0.663 0.88, 1.08
responsible for serving an ERPO (Pallin et al. 2020; Zeoli
a
IRRs with a p-value < 0.05 are indicated in bold. *‘May Issue’ as reference in et al. 2021; Rowhani-Rahbar et al. 2020). Given the rela-
three-level categorical variable. The model included the following covariates
indexed by state-half-year: unemployment rate, alcohol consumption rate, tive newness of these policies, more research is needed.
incarceration rate, rate of law enforcement employment, and percent state living However, this analysis finds that the availability of ERPO
in metropolitan statistical area, black males aged 15–20 years, and white males
aged 15–20 years. The model included robust standard errors and had 600 state-
laws as a tool to temporarily separate people from their
half-year indexes
Crifasi et al. Injury Epidemiology (2023) 10:28 Page 4 of 5

firearms during a time of crisis is not associated with GVA Gun Violence Archive
IRR Incidence rate ratio
greater risk of shootings by police. MSA Metropolitan statistical area
This study is among the first to examine the impacts of PTP Permit-to-purchase
PTP and other firearm laws on fatal and nonfatal shoot- SYG Stand your ground
ings by police. However, it is not without limitations. Acknowledgements
There are limitations inherent in the outcome data. We Not applicable.
were reliant on a database driven by media reports which
Author contributions
may represent an undercounting of the true burden CKC and DWW conceptualized the study. JAW gathered and cleaned the
of the issue. However, shootings by police have gener- data. ADM conducted the legal analysis. MLD conducted the data analysis.
ated increased levels of community and media attention All authors contributed to the interpretation of the results. CKC drafted the
manuscript. All authors provided substantive revisions and approved the final
which may reduce this concern. Our study was restricted manuscript.
to a cross-sectional analysis due to the availability of data
and a lack of change in our main variable of interest, PTP, Funding
This research was supported by grants from the Joyce Foundation and the
across the study period, which prevented us from assess- New Venture Fund to the Johns Hopkins Center for Gun Violence Solutions.
ing policy change. Nor could we assess for any endogene- Julie Ward acknowledges support from the National Institute of Child Health
ity that has been seen in prior studies of CBC-only laws. and Human Development (T32-HD 094687). Funders had no role in the
study design, statistical analyses, interpretation of data, or drafting of this
However, we controlled for state-level covariates used in manuscript.
prior research and included other firearm-related poli-
cies that could have been associated with our outcome Availability of data and materials
The outcome data are not currently available but will be made available in
to address selection bias. We did not include a proxy future. Please contact the corresponding author for additional information.
of state-level gun ownership because,  for  some poli-
cies included in the study, a gun ownership proxy could Declarations
mediate the relationship between gun policies and our
outcome. This could bias our findings of policy effects. Ethics approval and consent to participate
This research was reviewed and deemed not human subjects research by the
To our knowledge, there are no national, systematically Johns Hopkins Bloomberg School of Public Health Institutional Review Board.
collected data to measure or estimate police–citizen
interactions by state. In an attempt to account for police Consent for publication
Not applicable.
presence, we included measures for law enforcement
officers per capita and the violent crime rate. However, Competing interests
these may not be the best measures of police–citizen The authors declare that they have no competing interests.
interactions that might expose individuals to situations
that  could  lead to a shooting by police. Our study also Received: 14 March 2023 Accepted: 15 June 2023
aggregated fatal and nonfatal shootings by police at the
state level. However, there may be unique characteristics
of communities at smaller geographic units contribut-
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