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BACKGROUND

Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership.

METHODS

We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns).

RESULTS

A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition.

CONCLUSIONS

Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.)

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New England Journal of Medicine
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Yifan Zhang
Sonja A. Swanson
Jonathan A. Rodden
Erin E. Holsinger
Matthew J. Spittal
Garen G. Wintemute
Matthew Miller
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2020
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In 1963 the United States and Europe (EU) were engaged in the infamous Chicken War over new tariffs introduced in Europe. Five decades later, tensions over chicken, now relating to food safety issues, still plague U.S.-EU trade relations in agriculture, and are playing an unfortunate role in influencing European public opinion in the debate about a Transatlantic Trade and Investment Partnership (TTIP). At first glance it would appear that there is nothing new under the sun in U.S.-EU trade relations in the field of food and agriculture.

 

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Timothy E. Josling
Stefan Tangermann
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For 14 years, Mariano-Florentino Cuéllar has been a tireless Stanford professor who has strengthened the fabric of university’s interdisciplinary nature. Joining the faculty at Stanford Law School in 2001, Cuéllar soon found a second home for himself at the Freeman Spogli for International Studies. He held various leadership roles throughout the institute for several years – including serving as co-director of the Center for International Security and Cooperation. He took the helm of FSI as the institute’s director in 2013, and oversaw a tremendous expansion of faculty, research activity and student engagement. 

An expert in administrative law, criminal law, international law, and executive power and legislation, Cuéllar is now taking on a new role. He leaves Stanford this month to serve as justice of the California Supreme Court and will be succeeded at FSI by Michael McFaul on Jan. 5.

 As the academic quarter comes to a close, Cuéllar took some time to discuss his achievements at FSI and the institute’s role on campus. And his 2014 Annual Letter and Report can be read here.

You’ve had an active 20 months as FSI’s director. But what do you feel are your major accomplishments? 

We started with a superb faculty and made it even stronger. We hired six new faculty members in areas ranging from health and drug policy to nuclear security to governance. We also strengthened our capacity to generate rigorous research on key global issues, including nuclear security, global poverty, cybersecurity, and health policy. Second, we developed our focus on teaching and education. Our new International Policy Implementation Lab brings faculty and students together to work on applied projects, like reducing air pollution in Bangladesh, and improving opportunities for rural schoolchildren in China.  We renewed FSI's focus on the Ford Dorsey Program in International Policy Studies, adding faculty and fellowships, and launched a new Stanford Global Student Fellows program to give Stanford students global experiences through research opportunities.   Third, we bolstered FSI's core infrastructure to support research and education, by improving the Institute's financial position and moving forward with plans to enhance the Encina complex that houses FSI.

Finally, we forged strong partnerships with critical allies across campus. The Graduate School of Business is our partner on a campus-wide Global Development and Poverty Initiative supporting new research to mitigate global poverty.  We've also worked with the Law School and the School of Engineering to help launch the new Stanford Cyber Initiative with $15 million in funding from the Hewlett Foundation. We are engaging more faculty with new health policy working groups launched with the School of Medicine and an international and comparative education venture with the Graduate School of Education. 

Those partnerships speak very strongly to the interdisciplinary nature of Stanford and FSI. How do these relationships reflect FSI's goals?

The genius of Stanford has been its investment in interdisciplinary institutions. FSI is one of the largest. We should be judged not only by what we do within our four walls, but by what activity we catalyze and support across campus. With the business school, we've launched the initiative to support research on global poverty across the university. This is a part of the SEED initiative of the business school and it is very complementary to our priorities on researching and understanding global poverty and how to alleviate. It's brought together researchers from the business school, from FSI, from the medical school, and from the economics department.  

Another example would be our health policy working groups with the School of Medicine. Here, we're leveraging FSI’s Center for Health Policy, which is a great joint venture and allows us to convene people who are interested in the implementation of healthcare reforms and compare the perspective and on why lifesaving interventions are not implemented in developing countries and how we can better manage biosecurity risks. These working groups are a forum for people to understand each other's research agendas, to collaborate on seeking funding and to engage students. 

I could tell a similar story about our Mexico Initiative.  We organize these groups so that they cut across generations of scholars so that they engage people who are experienced researchers but also new fellows, who are developing their own agenda for their careers. Sometimes it takes resources, sometimes it takes the engagement of people, but often what we've found at FSI is that by working together with some of our partners across the university, we have a more lasting impact.

Looking at a growing spectrum of global challenges, where would you like to see FSI increase its attention? 

FSI's faculty, students, staff, and space represent a unique resource to engage Stanford in taking on challenges like global hunger, infectious disease, forced migration, and weak institutions.  The  key breakthrough for FSI has been growing from its roots in international relations, geopolitics, and security to focusing on shared global challenges, of which four are at the core of our work: security, governance, international development, and  health. 

These issues cross borders. They are not the concern of any one country. 

Geopolitics remain important to the institute, and some critical and important work is going on at the Center for International Security and Cooperation to help us manage the threat of nuclear proliferation, for example. But even nuclear proliferation is an example of how the transnational issues cut across the international divide. Norms about law, the capacity of transnational criminal networks, smuggling rings, the use of information technology, cybersecurity threats – all of these factors can affect even a traditional geopolitical issue like nuclear proliferation. 

So I can see a research and education agenda focused on evolving transnational pressures that will affect humanity in years to come. How a child fares when she is growing up in Africa will depend at least as much on these shared global challenges involving hunger and poverty, health, security, the role of information technology and humanity as they will on traditional relations between governments, for instance. 

What are some concrete achievements that demonstrate how FSI has helped create an environment for policy decisions to be better understood and implemented?

We forged a productive collaboration with the U.N. High Commissioner for Refugees through a project on refugee settlements that convened architects, Stanford researchers, students and experienced humanitarian responders to improve the design of settlements that house refugees and are supposed to meet their human needs. That is now an ongoing effort at the UN Refugee Agency, which has also benefited from collaboration with us on data visualization and internship for Stanford students. 

Our faculty and fellows continue the Institute's longstanding research to improve security and educate policymakers. We sometimes play a role in Track II diplomacy on sensitive issues involving global security – including in South Asia and Northeast Asia.  Together with Hoover, We convened a first-ever cyber bootcamp to help legislative staff understand the Internet and its vulnerabilities. We have researchers who are in regular contact with policymakers working on understanding how governance failures can affect the world's ability to meet pressing health challenges, including infectious diseases, such as Ebola.

On issues of economic policy and development, our faculty convened a summit of Japanese prefectural officials work with the private sector to understand strategies to develop the Japanese economy.  

And we continued educating the next generation of leaders on global issues through the Draper Hills summer fellows program and our honors programs in security and in democracy and the rule of law. 

How do you see FSI’s role as one of Stanford’s independent laboratories?

It's important to recognize that FSI's growth comes at particularly interesting time in the history of higher education – where universities are under pressure, where the question of how best to advance human knowledge is a very hotly debated question, where universities are diverging from each other in some ways and where we all have to ask ourselves how best to be faithful to our mission but to innovate. And in that respect, FSI is a laboratory. It is an experimental venture that can help us to understand how a university like Stanford can organize itself to advance the mission of many units, that's the partnership point, but to do so in a somewhat different way with a deep engagement to practicality and to the current challenges facing the world without abandoning a similarly deep commitment to theory, empirical investigation, and rigorous scholarship.

What have you learned from your time at Stanford and as director of FSI that will inform and influence how you approach your role on the state’s highest court?

Universities play an essential role in human wellbeing because they help us advance knowledge and prepare leaders for a difficult world. To do this, universities need to be islands of integrity, they need to be engaged enough with the outside world to understand it but removed enough from it to keep to the special rules that are necessary to advance the university's mission. 

Some of these challenges are also reflected in the role of courts. They also need to be islands of integrity in a tumultuous world, and they require fidelity to high standards to protect the rights of the public and to implement laws fairly and equally.  

This takes constant vigilance, commitment to principle, and a practical understanding of how the world works. It takes a combination of humility and determination. It requires listening carefully, it requires being decisive and it requires understanding that when it's part of a journey that allows for discovery but also requires deep understanding of the past.

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Mariano-Florentino Cuéllar, a Stanford law professor and expert on administrative law and governance, public organizations, and transnational security, will lead the university’s Freeman Spogli Institute for International Studies.

The announcement was made in Feb. 11 by Provost John Etchemendy and Ann Arvin, Stanford’s vice provost and dean of research.

“Professor Cuéllar brings a remarkable breadth of experience to his new role as FSI director, which is reflected in his many achievements as a legal scholar and his work on diverse federal policy initiatives over the past decade,” Arvin said. “He is deeply committed to enhancing FSI’s academic programs and ensuring that it remains an intellectually rich environment where faculty and students can pursue important interdisciplinary and policy-relevant research.”

Known to colleagues as “Tino,” Cuéllar starts his role as FSI director on July 1.

Cuéllar has been co-director of FSI’s Center for International Security and Cooperation (CISAC) since 2011, and has served in the Clinton and Obama administrations. In his role as FSI director, he’ll oversee 11 research centers and programs – including CISAC – along with a variety of undergraduate and graduate education initiatives on international affairs.  His move to the institute's helm will be marked by a commitment to build on FSI’s interdisciplinary approach to solving some of the world’s biggest problems.

“I am deeply honored to have been asked to lead FSI. The institute is in a unique position to help address some of our most pressing international challenges, in areas such as governance and development, health, technology, and security,” Cuéllar said. “FSI’s culture embodies the best of Stanford – a commitment to rigorous research, training leaders and engaging with the world – and excels at bringing together accomplished scholars from different disciplines.”

Cuéllar, 40, is a senior fellow at FSI and the Stanley Morrison Professor of Law at the law school, where he will continue to teach and conduct research. He succeeds Gerhard Casper, Stanford’s ninth president and a senior fellow at FSI.

“We are deeply indebted to former President Casper for accomplishing so much as FSI director this year and for overseeing the transition to new leadership so effectively,” Arvin said.

Casper was appointed to direct the institute for one year following the departure of Coit D. Blacker, who led FSI from 2003 to 2012 and oversaw significant growth in faculty appointments and research.

Casper, who chaired the search for a new director, said Cuéllar has a “profound understanding of institutions and policy issues, both nationally and internationally.”

“Stanford is very fortunate to have persuaded Tino to become director of the Freeman Spogli Institute for International Studies,” Casper said. “He will not only be an outstanding fiduciary of the institute, but with his considerable imagination, energy, and tenacity will develop collaborative and multidisciplinary approaches to problem-solving.”

Cuéllar – who did undergraduate work at Harvard, earned his law degree from Yale and received his PhD in political science at Stanford in 2000 – has had an extensive public service record since he began teaching at Stanford Law School in 2001.

Taking a leave of absence from Stanford during 2009 and 2010, he worked as special assistant to the president for justice and regulatory policy at the White House, where his responsibilities included justice and public safety, public health policy, borders and immigration, and regulatory reform.  Earlier, he co-chaired the presidential transition team responsible for immigration.

After returning to Stanford, he accepted a presidential appointment to the Council of the Administrative Conference of the United States, a nonpartisan agency charged with recommending improvements in the efficiency and fairness of federal regulatory programs.

Cuéllar also worked in the Treasury Department during the Clinton administration, focusing on fighting financial crime, improving border coordination and enhancing anti-corruption measures.

Since his appointment as co-director of CISAC, Cuéllar worked to expand the center’s agenda while continuing its strong focus on arms control, nuclear security and counterterrorism. During Cuéllar’s tenure, the center launched new projects on cybsersecurity, migration and refugees, as well as violence and governance in Latin America. CISAC also added six fellowships; recruited new faculty affiliates from engineering, medicine, and the social sciences; and forged ties with academic units across campus.

He said his focus as FSI’s director will be to strengthen the institute’s centers and programs and enhance its contributions to graduate education while fostering collaboration among faculty with varying academic backgrounds.

“FSI has much to contribute through its existing research centers and education programs,” he said. “But we will also need to forge new initiatives cutting across existing programs in order to understand more fully the complex risks and relationships shaping our world.”

In addition to Casper, the members of the search committee were Michael H. Armacost, Francis Fukuyama, Philip W. Halperin, David Holloway, Rosamond L. Naylor, Douglas K. Owens, and Elisabeth Paté-Cornell.

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