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Using extreme risk protection orders to prevent violence among people experiencing homelessness in California and Colorado: a case series.

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Variation in Extreme Risk Protection Order Use Among Urban, Suburban, and Rural ZIP Codes in Maryland: A Descriptive

Mia Aassar1, Elise Omaki1,2, Lisa Geller2

  • 1Johns Hopkins Department of Health Policy and Management, Baltimore, MD, USA.

Inquiry : a Journal of Medical Care Organization, Provision and Financing
|September 16, 2025
PubMed
Summary
This summary is machine-generated.

Extreme Risk Protection Orders (ERPOs) are used more in suburban and rural areas than urban ones. While ERPO use varies by location, the types of threats addressed are similar across urbanicity, with some differences in precipitating events and petitioner types.

Keywords:
extreme risk protection orderfirearmpolicyruralsuicideviolence

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Area of Science:

  • Public Health
  • Criminology
  • Sociology

Background:

  • Extreme Risk Protection Orders (ERPOs) temporarily restrict firearm access for individuals posing a violence risk.
  • Limited research exists on how ERPO usage varies between urban and rural settings.

Purpose of the Study:

  • To analyze the variation in Extreme Risk Protection Order (ERPO) use across urban, suburban, and rural jurisdictions in Maryland.
  • To compare respondent characteristics, precipitating threats, petitioner types, and court outcomes for ERPOs based on urbanicity.

Main Methods:

  • Data from Maryland ERPO casefiles (October 2018-June 2020) were analyzed.
  • Case data were linked with ZIP code-level rurality codes and population data.
  • Statistical analyses (Chi-squared, ANOVA, logistic regression) compared ERPO use across urban, suburban, and rural categories.

Main Results:

  • ERPO use rates were higher in suburban (66% higher) and rural (1% higher) areas compared to urban areas.
  • Suicide attempts were more common in non-urban ERPO petitions, while interpersonal violence threats were more frequent in urban petitions.
  • Law enforcement initiated over twice as many rural ERPO petitions compared to urban or suburban ones.

Conclusions:

  • ERPOs are utilized in all urbanicity levels to address similar violence risks, with higher usage rates in less urbanized areas.
  • While ERPO usage patterns differ by urbanicity, the underlying reasons for their implementation show notable similarities.
  • Findings suggest tailored implementation strategies for ERPOs may be needed across different geographic settings.