Comprehensive firearm background checks

Evidence Rating  
Some Evidence
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Decision Makers

Federal law requires licensed firearm dealers to conduct background checks of potential handgun purchasers’ criminal histories via the National Instant Criminal Background Check System (NICS) which includes fugitive status, court restraining orders, and some information regarding severe mental illness. States can require collection and review of a broader set of disqualifying criteria (e.g., in-state criminal records of misdemeanor convictions, domestic violence restraining orders, juvenile court records, and histories of substance abuse or mental health issues), expanding prohibitions on purchase. Comprehensive checks can be adopted with other efforts to strengthen background checks such as universal background checks and regulations that require licenses to purchase or own firearms1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced homicide

  • Reduced suicide

  • Reduced intimate partner violence

What does the research say about effectiveness? This strategy is rated some evidence.

There is some evidence that comprehensive background checks reduce firearm homicide and suicide, as well as intimate partner homicides2, 3. Additional evidence is needed to confirm effects4.

Comprehensive background check laws can decrease homicide and suicide rates more than the narrower requirements of the federal background check5. Prohibiting firearm possession by those with domestic violence restraining orders via comprehensive checks can reduce intimate partner violence rates2. Comprehensive background checks may protect against fatal violence by keeping firearms from high-risk individuals6; adding checks for mental health concerns may reduce firearm suicide rates more than checks of criminal history alone5.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

As of October 2015, seven states (California, Illinois, Massachusetts, Minnesota, Oregon, Pennsylvania, and Washington) require comprehensive checks, searching in-state mental health records of prospective purchasers during the background check process. Three states (Pennsylvania, Utah, and Wisconsin) prohibit firearm sales for individuals with juvenile court records and two states (Massachusetts and Wisconsin) prohibit firearm sales for individuals with domestic violence protective orders against them1.

Most states prevent local governments from enacting gun laws via state preemption legislation7; as of 2015, only seven states (California, Connecticut, Hawaii, Illinois, Massachusetts, New Jersey, and New York) allow local governments to enact gun laws.

Implementation Resources

Everytown-State gun law strength - Everytown for Gun Safety Support Fund (Everytown). 2022 Everytown gun law rankings.

RAND-Firearm law database - Cherney S, Morral AR, Schell TL, Smucker S, Hoch E. RAND state firearm law database. Santa Monica: RAND Corporation; 2022.

GLC - Giffords Law Center to Prevent Gun Violence (GLC). Save lives from gun violence.

JHCGPR - Johns Hopkins Center for Gun Policy and Research (JHCGPR). Reducing gun-related injuries and deaths.

Firearms research - Firearms Research. Prevalence, patterns, and prevention of firearm violence.

US DOJ-ATF - US Department of Justice (US DOJ). Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF).


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1 GLC - Giffords Law Center to Prevent Gun Violence (GLC). Save lives from gun violence.

2 Webster 2015 - Webster DW, Wintemute GJ. Effects of policies designed to keep firearms from high-risk individuals. Annual Review of Public Health. 2015;36:21-37.

3 Santaella-Tenorio 2016 - Santaella-Tenorio J, Cerda M, Villaveces A, Galea S. What do we know about the association between firearm legislation and firearm-related injuries? Epidemiologic Reviews. 2016;38(1):140-157.

4 Lang 2016 - Lang M. State firearm sales and criminal activity: Evidence from firearm background checks. Southern Economic Journal. 2016;83(1):45-68.

5 Sen 2012 - Sen B, Panjamapirom A. State background checks for gun purchase and firearm deaths: An exploratory study. Preventive Medicine. 2012;55(4):346–350.

6 Swanson 2016 - Swanson JW, Easter MM, Robertson AG, et al. Gun violence, mental illness, and laws that prohibit gun possession: Evidence from two Florida counties. Health Affairs. 2016;35(6):1067-1075.

7 Grassroots Change - Grassroots Change: Connecting for better health. Preemption Watch.

Date Last Updated