presentation on gun violence

Gun Violence: Prediction, Prevention, and Policy

• Gun Violence and Crime

Gun violence is an urgent, complex, and multifaceted problem. It requires evidence-based, multifaceted solutions. Psychology can make important contributions to policies that prevent gun violence. Toward this end, in February 2013 the American Psychological Association commissioned this report by a panel of experts to convey research-based conclusions and recommendations (and to identify gaps in such knowledge) on how to reduce the incidence of gun violence — whether by homicide, suicide, or mass shootings — nationwide.

Following are chapter-by-chapter highlights and short summaries of conclusions and recommendations of the report’s authors. More information and supporting citations can be found within the chapters themselves.

Antecedents to Gun Violence: Developmental Issues

A complex and variable constellation of risk and protective factors makes persons more or less likely to use a firearm against themselves or others. For this reason, there is no single profile that can reliably predict who will use a gun in a violent act. Instead, gun violence is associated with a confluence of individual, family, school, peer, community, and sociocultural risk factors that interact over time during childhood and adolescence. Although many youths desist in aggressive and antisocial behavior during late adolescence, others are disproportionately at risk for becoming involved in or otherwise affected by gun violence. The most consistent and powerful predictor of future violence is a history of violent behavior.  P revention efforts guided by research on developmental risk can reduce the likelihood that firearms will be introduced into community and family conflicts or criminal activity.  Prevention efforts can also reduce the relatively rare occasions when severe mental illness contributes to homicide or the more common circumstances when depression or other mental illness contributes to suicide. Reducing incidents of gun violence arising from criminal misconduct or suicide is an important goal of broader primary and secondary prevention and intervention strategies. Such strategies must also attend to redirecting developmental antecedents and larger sociocultural processes that contribute to gun violence and gun-related deaths.

Antecedents to Gun Violence: Gender and Culture

Any account of gun violence in the United States must be able to explain both why males are perpetrators of the vast majority of gun violence and why the vast majority of males never perpetrate gun violence. Preliminary evidence suggests that changing perceptions among males of social norms about behaviors and characteristics associated with masculinity may reduce the prevalence of intimate partner and sexual violence. Such interventions need to be further tested for their potential to reduce gun violence. The skills and knowledge of psychologists are needed to develop and evaluate programs and settings in schools, workplaces, prisons, neighborhoods, clinics, and other relevant contexts that aim to change gendered expectations for males that emphasize self-sufficiency, toughness, and violence, including gun violence.

What Works: Gun Violence Prediction and Prevention at the Individual Level

Although it is important to recognize that most people suffering from a mental illness are not dangerous, for those persons at risk for violence due to mental illness, suicidal thoughts, or feelings of desperation, mental health treatment can often prevent gun violence. Policies and programs that identify and provide treatment for all persons suffering from a mental illness should be a national priority. Urgent attention must be paid to the current level of access to mental health services in the United States; such access is woefully insufficient. Additionally, it should be noted that behavioral threat assessment is becoming a standard of care for preventing violence in schools, colleges, and the workplace and against government and other public officials. Threat assessment teams gather and analyze information to assess if a person poses a threat of violence or self-harm, and if so, take steps to intervene.

What Works: Gun Violence Prevention at the Community Level

Prevention of violence occurs along a continuum that begins in early childhood with programs to help parents raise emotionally healthy children and ends with efforts to identify and intervene with troubled individuals who are threatening violence. The mental health community must take the lead in advocating for community-based collaborative problem-solving models to address the prevention of gun violence. Such models should blend prevention strategies in an effort to overcome the tendency within many community service systems to operate in silos. There has been some success with community-based programs involving police training in crisis intervention and with community members trained in mental health first aid. These programs need further piloting and study so they can be expanded to additional communities as appropriate. In addition, public health messaging campaigns on safe gun storage are needed. The practice of keeping all firearms appropriately stored and locked must become the only socially acceptable norm.

What Works: Policies to Reduce Gun Violence

The use of a gun greatly increases the odds that violence will lead to a fatality: This problem calls for urgent action. Firearm prohibitions for high-risk groups — domestic violence offenders, persons convicted of violent misdemeanor crimes, and individuals with mental illness who have been adjudicated as being a threat to themselves or to others — have been shown to reduce violence. The licensing of handgun purchasers, background check requirements for all gun sales, and close oversight of retail gun sellers can reduce the diversion of guns to criminals. Reducing the incidence of gun violence will require interventions through multiple systems, including legal, public health, public safety, community, and health. Increasing the availability of data and funding will help inform and evaluate policies designed to reduce gun violence.

Dewey Cornell, PhD, and Nancy G. Guerra, EdD

Gun violence is an important national problem leading to more than 31,000 deaths and 78,000 nonfatal injuries every year. Although the rate of gun homicides in the United States has declined in recent years, U.S. rates remain substantially higher than those of almost every other nation in the world and are at least seven times higher than those of Australia, Canada, France, Germany, India, Italy, Japan, South Korea, Spain, Sweden, the United Kingdom, and many others (see Alpers & Wilson).

Guns are not a necessary or sufficient cause of violence and can be used legally for a variety of sanctioned activities. Still, they are especially lethal weapons that are used in approximately two thirds of the homicides and more than half of all suicides in the United States. Every day in the United States, approximately 30 persons die of homicides and 53 persons die of suicides committed by someone using a gun (Centers for Disease Control and Prevention [CDC], 2013a). Guns also provide individuals with the capacity to carry out multiple-fatality shootings that inflict great trauma and grief on our society, and the public rightly insists on action to make our communities safer.

Gun violence demands special attention. At the federal level, President Barack Obama announced a new “Now Is the Time” plan (White House, 2013) to address firearm violence to better protect children and communities and issued 23 related executive orders to federal agencies. The importance of continued research to address firearm violence is reflected in the 2013 report of the Institute of Medicine (IOM) and the National Research Council (NRC) "Priorities for Research to Reduce the Threat of Firearm-Related Violence. "  This report calls for a public health approach that emphasizes the importance of accurate information on the number and distribution of guns in the United States, including risk factors and motivations for acquisition and use, the association between exposure to media violence and any subsequent perpetration of gun violence, and how new technology can facilitate prevention. The report also outlines a research agenda to facilitate programs and policies that can reduce the occurrence and impact of firearm-related violence in the United States.

Psychology can make an important contribution to policies that prevent gun violence. Rather than debate whether “people” kill people or “guns” kill people, a reasonable approach to facilitate prevention is that “people with guns kill people.” The problem is more complex than simple slogans and requires careful study and analysis of the different psychological factors, behavioral pathways, social circumstances, and cultural factors that lead to gun violence. Whether prevention efforts should focus on guns because they are such a powerful tool for violence, on other factors that might have equal or greater impact, or on some combination of factors should be a scientific question settled by evidence.

Toward this end, the American Psychological Association (APA) commissioned this report, with three goals. First, this report is intended to focus on gun violence, recognizing that knowledge about gun violence must be related to a broader understanding of violence. Second, the report reviews what is known from the best current science on antecedents to gun violence and effective prevention strategies at the individual, community, and national levels. Finally, the report identifies policy directions, gaps in the literature, and suggestions for continued research that can help address unresolved questions about effective strategies to reduce gun violence. For over a decade, research on gun violence has been stifled by legal restrictions, political pressure applied to agencies not to fund research on certain gun-related topics, and a lack of funding. The authors of this report believe the cost of gun violence to our society is too great to allow these barriers to remain in place.

The Role of Mental Health and Mental Illness

An important focus of this report is the role that mental health and mental illness play in why individuals commit firearm-related violence and how this can inform preventive efforts. This focus undoubtedly brings to mind shootings such as those in Newtown, Conn., Aurora, Colo., and Tucson, Ariz. However, it is important to realize that mass fatality incidents of this type, although highly publicized, are extremely rare, accounting for one tenth of 1 percent of all firearm-related homicides in the United States (CDC, 2013a). Moreover, serious mental illness affects a significant percentage of the U.S. population, with prevalence estimates in the general population as high as 5 percent (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012). This is quite significant, given that the term serious mental illness is typically reserved for the most debilitating kinds of mental disorder, such as schizophrenia, bipolar disorder, and the most severe forms of depression, but can include other mental disorders that result in acute functional impairment.

Although many highly publicized shootings have involved persons with serious mental illness, it must be recognized that persons with serious mental illness commit only a small proportion of firearm-related homicides; the problem of gun violence cannot be resolved simply through efforts focused on serious mental illness (Webster & Vernick, 2013a). Furthermore, the overwhelming majority of people with serious mental illness do not engage in violence toward others and should not be stereotyped as dangerous (Sirotich, 2008).

It also is important to recognize that for the small proportion of individuals whose serious mental illness does predispose them to violence, there are significant societal barriers to treatment. Psychiatric hospitalization can be helpful, but treatment can be expensive, and there may not be appropriate follow-up services in the community. Civil commitment laws, which serve to protect individuals from being unreasonably detained or forced into treatment against their will, can also prevent professionals from treating someone who does not recognize his or her need for treatment.

Other kinds of mental disorders that do not rise to the level of serious mental illness also are associated with gun violence and criminal behavior generally. For example, conduct disorder and antisocial personality disorder are associated with increased risk for violence. (This link is not surprising because violent behavior is counted as one of the symptoms that helps qualify someone for the diagnosis.) Nevertheless, there are well-established, scientifically validated mental health treatment programs for individuals with these disorders, such as multisystemic therapy, that can reduce violent recidivism (Henggeler, 2011). Substance abuse is another form of mental disorder that is a risk factor for violence in the general population and also increases the risk for violence among persons with serious mental illness (Van Dorn, Volavka, & Johnson, 2012).

These observations reflect the complexity of relationships among serious mental illness, mental disorders, and violence. In contrast to homicide, suicide accounts for approximately 61 percent of all firearm fatalities in the United States (CDC, 2013a), and more than 90 percent of persons who commit suicide have some combination of depression, symptoms of other mental disorders, and/or substance abuse (Moscicki, 2001). This suggests that mental health and mental illness are especially relevant to understanding and preventing suicide, the leading type of firearm-related death.

Prediction and Prevention

The prediction of an individual’s propensity for violence is a complex and challenging task for mental health professionals, who often are called upon by courts, correctional authorities, schools, and others to assess the risk of an individual’s violence. Mental health professionals are expected to take action to protect potential victims when they judge that their patient or client poses a danger to others. However, decades of research have established that there is only a moderate ability to identify individuals likely to commit serious acts of violence. Much depends on the kind of violence and the time frame for prediction. For example, there are specialized instruments for the assessment of violence risk among sex offenders, civilly committed psychiatric patients, and domestic violence offenders. However, the time frame and focus for these predictions often are broadly concerned with long-term predictions that someone will ever be violent with anyone rather than whether a person will commit a particular act of targeted violence.

Research has moved the field beyond the assessment of “dangerousness” as a simple individual characteristic applicable in all cases to recognize that predictive efforts must consider a range of personal, social, and situational factors that can lead to different forms of violent behavior in different circumstances. Moreover, risk assessment has expanded to include concepts of risk management and interventions aimed at reducing risk.

In making predictions about the risk for mass shootings, there is no consistent psychological profile or set of warning signs that can be used reliably to identify such individuals in the general population. A more promising approach is the strategy of behavioral threat assessment , which is concerned with identifying and intervening with individuals who have communicated threats of violence or engaged in behavior that clearly indicates planning or preparation to commit a violent act. A threat assessment approach recognizes that individuals who threaten targeted violence are usually troubled, depressed, and despondent over their circumstances in life. A threat assessment leads to interventions intended to reduce the risk of violence by taking steps to address the problem that underlies the threatening behavior. Such problems can range from workplace conflicts to schoolyard bullying to serious mental illness. One of the most influential threat assessment models was developed by the U.S. Secret Service (Fein et al., 2002; Vossekuil, Fein, Reddy, Borum, & Modzelski, 2002) and has been adapted for use in schools, colleges, business settings, and the U.S. military.

The limited ability to make accurate predictions of violence has led some to question whether prevention is possible. This is a common misconception, because prevention does not require prediction of a specific individual’s behavior . For example, public health campaigns have reduced problems ranging from lung cancer to motor vehicle accidents by identifying risk factors and promoting safer behaviors even though it is not possible to predict whether a specific individual will develop lung cancer or have a motor vehicle accident (Mozaffarian, Hemenway, & Ludwig, 2013). A substantial body of scientific evidence identifies important developmental, familial, and social risk factors for violence. In addition, an array of rigorously tested psychological and educational interventions facilitate healthy social development and reduce aggressive behavior by teaching social skills and problem-solving strategies. It is important that policymakers and stakeholders recognize the value of prevention.

Prevention measures also should be distinguished from security measures and crisis response plans. Prevention must begin long before a gunman comes into a school or shopping center. Prevention efforts are often conceptualized as taking place on primary, secondary, and tertiary levels:

• Primary prevention (also called universal prevention) consists of efforts to promote healthy development in the general population. An example would be a curriculum to teach all children social skills to resist negative peer influences and resolve conflicts peacefully.
• Secondary prevention (also called selective prevention) involves assistance for individuals who are at increased risk for violence. Mentoring programs and conflict-mediation services are examples of such assistance.
• Tertiary prevention (also called indicated prevention) consists of intensive services for individuals who have engaged in some degree of aggressive behavior and could benefit from efforts to prevent a recurrence or escalation of aggression. Programs to rehabilitate juvenile offenders are examples.

Throughout this report, we discuss evidence-based prevention programs relevant to the issue of firearm-related violence.

Research can help us understand and prevent gun violence. The psychological research summarized in this report can inform public policy and prevention efforts designed to promote public safety and reduce violence. Gun violence is not a simple, discrete category of crime; it shares characteristics with other forms of violence, and it can be a product of an array of cultural, social, psychological, and situational factors. Nevertheless, there is valuable psychological knowledge that can be used to make our communities safer.

Robert Kinscherff, PhD, JD; Nancy G. Guerra, EdD; and Ariel A. Williamson, MA

Youth gun violence is often sensationalized and misunderstood by the general public, in part because of increasingly public acts of violence and related media coverage (Snyder & Sickmund, 2006; Williams, Tuthill, & Lio, 2008). In truth, only a small number of juvenile offenders commit the majority of violent juvenile crimes in the United States (Williams et al., 2008). Most juvenile offenders commit “nonperson” offenses, usually in terms of property and technical (parole) violations (Sickmund, Sladky, Kang, & Puzzanchera, 2011). For example, in 2010, the majority of juvenile offenses were nonperson offenses such as property offenses (27.2 percent), drug offenses (8.4 percent), public order offenses (10.7 percent), technical violations (14.4 percent), and status offenses (4.6 percent) — that is, crimes defined by minor (under age 18) status, such as alcohol consumption, truancy, and running away from home (Sickmund et al., 2011). Additionally, young adults between the ages of 18 and 34 are the most likely to commit violent crimes like homicide and to do so using a gun, compared with individuals under 18 (Cooper & Smith, 2011).

A subgroup of youth is particularly vulnerable to violence and victimization. Minority males constitute a disproportionate number of youths arrested and adjudicated, with 60 percent of all arrested youths identifying as part of a racial/ethnic minority group (Sickmund et al., 2011). Males also outnumber females in arrest rates for every area except status offenses and technical violations. Urban African American males are at substantially greater risk for involvement in gun-related homicides as perpetrators and as victims (CDC, 2013a; Spano, Pridemore, & Bolland, 2012). However, the majority of the infrequent but highly publicized shootings with multiple fatalities, such as those at Sandy Hook Elementary School or the Aurora, Colo., movie theater, have been committed by young White males.

This presents a picture of a small number of youths and young adults who are at an increased risk for involvement in gun violence. In the United States, these youths are somewhat more likely to be males of color growing up in urban areas. But it also is important to understand that most young males of all races and ethnicities — and most people in general — are not involved in serious violence and do not carry or use guns inappropriately.

How did this small subset of youths and young adults come to be involved in serious gun violence? Is there a “cradle-to-prison” pipeline, particularly for youths of color living in poverty and in disadvantaged urban areas, that triggers a cascade of events that increase the likelihood of gun violence (Children’s Defense Fund, 2009)? A developmental perspective on antecedents to youth gun violence can help us design more effective prevention programs and strategies.

This chapter describes the biological and environmental risk factors that begin early in development and continue into adolescence and young adulthood. Developmental studies that link children’s aggressive behavior to more serious involvement in the criminal justice system suggest the accumulation and interaction of many risks in multiple contexts (Dodge, Greenberg, Malone, & Conduct Problems Prevention Research Group, 2008; Dodge & Pettit, 2003). There is no single biological predisposition, individual trait, or life experience that accounts for the development and continuity of violent behavior or the use of guns. Rather, violence is associated with a confluence of individual, family, school, peer, community, and sociocultural risk factors that interact over time during childhood and adolescence (Brennan, Hall, Bor, Najman, & Williams, 2003; Dodge & Pettit, 2003). Risk for gun violence involves similar risk processes, although the complexity and variability of individuals means there is no meaningful profile that allows reliable prediction of who will eventually engage in gun violence. Nevertheless, developmental factors beginning in utero may increase the risk of aggressive behavior and lead to gun violence — especially when guns are readily available and part of an aggressive or delinquent peer culture.

Early-Onset Aggression

Early onset of aggressive behavior significantly increases risk for later antisocial behavior problems. The most consistent and powerful predictor of future violence is a history of violent behavior, and risk increases with earlier and more frequent incidents. Longitudinal work has shown that having a first arrest between 7 and 11 years of age is associated with patterns of long-term adult offending (Loeber, 1982). Children who are highly aggressive throughout childhood and continue to have serious conduct problems during adolescence have been identified as “life-course persistent” (LCP) youths (Moffitt, 1993). Examining longitudinal data from a large birth cohort in New Zealand, Moffitt (1993) created a taxonomy of antisocial behavior that differentiates LCP youths from an “adolescence-limited” subgroup. The latter subgroup characterizes those who engage in antisocial behaviors during adolescence and usually desist by adulthood. By contrast, LCP youths display more severe early aggression in childhood and develop a pattern of chronic violence during adolescence and into adulthood.

Both biological and environmental risks during prenatal development, infancy, and early childhood contribute to the development of early-onset aggression and the LCP developmental trajectory (Brennan et al., 2003; Dodge & Pettit, 2003; Moffitt, 2005). Pre- and postnatal risks associated with early-onset aggression include maternal substance abuse during pregnancy, high levels of prenatal stress, low birth weight, birth complications and injuries (especially those involving anoxia), malnutrition, and exposure to environmental toxins like lead paint (Brennan et al., 2003; Dodge & Pettit, 2003). According to Moffitt (1993), these early developmental risks disrupt neural development and are associated with neuropsychological deficits, particularly in executive functioning and verbal abilities.

Along with neuropsychological deficits, poor behavioral control and a difficult temperament are associated with the development of early-onset aggression (Dodge & Pettit, 2003; Moffitt, 1993). Children with difficult temperaments are typically irritable, difficult to soothe, and highly reactive. These patterns of behavior often trigger negative and ineffective reactions from parents and caregivers that can escalate into early aggressive behavior (Dodge & Pettit, 2003; Wachs, 2006). Family influences, such as familial stress and negative parent–child interactions, can interact with a child’s individual characteristics, leading to increased aggressive behavior during childhood.

Family Influences

Highly aggressive children who engage in serious acts of violence during later childhood and adolescence also are exposed to continued environmental risks throughout development (Dodge et al., 2008). The family context has been found to be quite influential in the development and continuity of antisocial behavior. Particularly for early-onset aggressive youths raised in families that are under a high degree of environmental stress, aggressive child behavior and negative parenting practices interact to amplify early-onset aggression. Examples of family risk factors include low parent–child synchrony and warmth, poor or disrupted attachment, harsh or inconsistent discipline (overly strict or permissive), poor parental monitoring, the modeling of antisocial behavior, pro-violent attitudes and criminal justice involvement, and coercive parent–child interaction patterns (Dodge & Pettit, 2003; Farrington, Jolliffe, Loeber, Stouthamer-Loeber, & Kalb, 2001; Hill, Howel, Hawkins, & Battin-Pearson, 1999; Patterson, Forgatch, & DeGarmo, 2010).

Coercive parent–child interactions have been associated with the emergence of aggressive behavior problems in children (Patterson et al., 2010). In these interactions, children learn to use coercive behaviors such as temper tantrums to escape parental discipline. When parents acquiesce to these negative behaviors, they inadvertently reward children for coercive behaviors, reinforcing the idea that aggression or violence is adaptive and can be used instrumentally to achieve goals. These interaction patterns tend to escalate in their severity (e.g., from whining, to temper tantrums, to hitting, etc.) and frequency, leading to increased aggression and noncompliance (Patterson et al., 2010). Such behaviors also generalize across contexts to children’s interactions with others outside the home, including with teachers, other adults, and peers. Indeed, prevention research has shown that intervening with at-risk families to improve parenting skills can disrupt the pathway from early-onset aggressive behavior to delinquency in adolescence (Patterson et al., 2010).

Other family risk factors for youths with early predispositions to aggression may be especially relevant to increased risk for gun violence. For instance, research has shown that many families with children own firearms and do not keep them safely stored at home (Johnson, Miller, Vriniotis, Azrael, & Hemenway, 2006). Although keeping firearms at home is not a direct cause of youth gun violence, the rates of suicides, homicides, and unintentional firearm fatalities are higher for 5–14-year-olds who live in states or regions in which rates of gun ownership are more prevalent (Miller, Azrael, & Hemenway, 2002). Poor parental monitoring and supervision, which are more general risk factors for involvement in aggression and violent behaviors (Dodge et al., 2008), may be especially salient in risk for gun violence. For example, impulsive or aggressive children who are often unsupervised and live in a home with access to guns may be at risk.

The family also is an important context for socialization and the development of normative beliefs or perceptions about appropriate social behavior that become increasingly stable during early development and are predictive of later behavior over time (Huesmann & Guerra, 1997). These beliefs shape an individual’s social-cognitive understanding about whether and under what circumstances threatened or actual violence is justified. Children who develop beliefs that aggression is a desirable and effective way to interact with others are more likely to use coercion and violence instrumentally to achieve goals or solve problems (Huesmann & Guerra, 1997). Antisocial attitudes and social-cognitive distortions (e.g., problems in generating nonviolent solutions, misperceiving hostile/aggressive intent by others, justifying acts of violence that would be criminal) can also increase risk for violence (Borum & Verhaagen, 2006; Dodge & Pettit, 2003).

Families can play a role in establishing and maintaining normative beliefs about violence and gun usage. For example, pro-violence attitudes and the criminality of parents and siblings during childhood have been found to predict adolescent gang membership and delinquency (Farrington et al., 2001; Hill et al., 1999). Youths from families that encourage the use of guns for solving problems also may be exposed to such attitudes in other contexts (in communities, with peers, and in the media) and may perceive firearms to be an appropriate means to solve problems and protect themselves.

School and Peer Influences

The school setting is another important context for child socialization. Children who enter school with high levels of aggressive behavior, cognitive or neurobiological deficits, and poor emotional regulation may have difficulty adjusting to the school setting and getting along with peers (Dodge et al., 2008; Dodge & Pettit, 2003). Highly aggressive children who have learned to use aggression instrumentally at home will likely use such behavior with teachers, increasing the chances that they will have poor academic experiences and low school engagement (Patterson et al., 2010). Academic failure, low school interest, truancy, and school dropout are all correlated with increased risk for problem behavior and delinquency, including aggression and violence (Dodge & Pettit, 2003). This risk is strongest when poor academic achievement begins in elementary school and contributes to school underachievement and the onset of adolescent problem behaviors, such as substance use and drug trafficking, truancy, unsafe sexual activity, youth violence, and gang involvement (Dodge et al., 2008; Guerra & Bradshaw, 2008).

Involvement in these risk behaviors also is facilitated by affiliation with deviant peers, particularly during adolescence (Dodge et al., 2008). Research has shown that children who are aggressive, victimized, and academically marginalized from the school setting may suffer high levels of peer rejection that amplify preexisting aggressive behaviors (Dodge et al., 2008; Dodge & Pettit, 2003). Longitudinal work indicates that experiences of academic failure, school marginalization, and peer rejection interact to produce affiliations with similarly rejected, deviant, and/or gang-involved peers. Friendships between deviant peers provide youths with “training” in antisocial behaviors that reinforce and exacerbate preexisting aggressive tendencies (Dishion, Véronneau, & Meyers, 2010; Dodge et al., 2008). Peer deviancy training is a primary mechanism in the trajectory from overt, highly aggressive behaviors during childhood to more covert processes during adolescence, such as lying, stealing, substance use, and weapon carrying (Dishion et al., 2010; Patterson et al., 2010).

The larger school context also can interact with youths’ experiences of academic failure, peer rejection, and deviant peer affiliations to influence the continuity of antisocial behavior. Poorly funded schools located in low-income neighborhoods have fewer resources to address the behavioral, academic, mental health, and medical needs of their students. In addition, these schools tend to have stricter policies toward discipline, are less clinically informed about problem behaviors, and have stronger zero tolerance policies that result in more expulsions and suspensions (Edelman, 2007). This contextual factor is important, as youths who are attending and engaged in school are less likely to engage in delinquent or violent behavior, whereas marginalized and rejected youths, particularly in impoverished schools, are at increased risk for aggression and violence at school and in their communities. Schools that provide safe environments that protect students from bullying or criminal victimization support student engagement, reduce incidents of student conflict that could result in volatile or violent behavior, and diminish risks that students will bring weapons to school.

Although few homicides (< 2 percent) and suicides occur at school or during transportation to and from school (Roberts, Zhang, & Truman, 2012) and widely publicized mass school shootings are rare, research indicates that a small number of students do carry guns or other weapons. In 2011, 5.1 percent of high school students in Grades 9–12 reported carrying a gun in the 30 days prior to the survey, and 5.4 percent of students had carried a weapon (gun, knife, or club) on school grounds at least once in the 30 days prior to the survey (Eaton et al., 2012). Studies show that youths who carry guns are more likely to report involvement in multiple problem behaviors, to be affiliated with a gang, to overestimate how many of their peers carry guns, and to have a high need for interpersonal safety. For instance, student reports of involvement in and exposure to risk behaviors at school such as physical fighting, being threatened, using substances, or selling drugs on school grounds have been positively correlated with an increased likelihood of carrying weapons to school (Furlong, Bates, & Smith, 2001).

In another study of high school students, 5.5 percent of urban high school students reported that they carried a gun in the year prior to the study, but students estimated that 32.6 percent of peers in their neighborhoods carried guns, a substantial overestimation of the actual gun-carrying rates. Lawful, supervised gun carrying by juveniles is not the concern of this line of research; however, when unsupervised youths carry guns in high-violence neighborhoods, they may be more likely to use guns to protect themselves and resolve altercations. Gun-carrying youths in this study had higher rates of substance use, violence exposure, gang affiliation, and peer victimization (Hemenway, Vriniotis, Johnson, Miller, & Azrael, 2011). Additionally, many gun-carrying youths had lower levels of perceived interpersonal safety (Hemenway et al., 2011). Research has also revealed that deviant peer group affiliations during specific periods of adolescent development may increase the risk for gun violence. For example, research findings have shown that gang membership in early adolescence is significantly associated with increased gun carrying over time. This changes somewhat in late adolescence and young adulthood, when gun carrying is linked more to involvement in drug dealing and having peers who illegally own guns (Lizotte, Krohn, Howell, Tobin, & Howard, 2000).

Communities Matter

The community context is an additional source of risk for the development and continuity of antisocial behavior. Living in extremely disadvantaged, underresourced communities with high levels of crime and violence creates serious obstacles to healthy development. Recent estimates show that currently in the United States, 16.4 million children live in poverty and 7.4 million of those live in extreme poverty (i.e., an annual income of less than half of the federal poverty level; Children’s Defense Fund, 2012). One in four children under 5 years of age is poor during the formative years of brain development. In addition, 22 percent of children who have lived in poverty do not graduate from high school, compared with 6 percent of children who have never been poor (Children’s Defense Fund, 2012). For families and youths, living in poverty is associated with high levels of familial stress, poor child nutrition, elevated risks of injury, and limited access to adequate health care (Adler & Steward, 2010; Patterson et al., 2010). Ethnic minority youth in the United States are overrepresented in economically struggling communities. These environmental adversities can, in turn, compromise children’s health status and functioning in other environments and increase the risk for involvement in violent behaviors, contributing significantly to ethnic and cultural variations in the rates of violence (Borum & Verhaagen, 2006).

In a community context, the degree to which children have access to adequate positive resources (e.g., in terms of health, finances, nutrition, education, peers, and recreation), have prosocial and connected relationships with others, and feel safe in their environment can significantly affect their risk for involvement in violent behaviors. Aggressive children and adolescents who are living in neighborhoods with high levels of community violence, drug and firearm trafficking, gang presence, and inadequate housing may have increased exposure to violence and opportunities for involvement in deviant behavior. Compared with communities that have better resources, disenfranchised and impoverished communities may also lack social, recreational, and vocational opportunities that contribute to positive youth development. Youths with high levels of preexisting aggressive behavior and emerging involvement with deviant or gang-involved peers may be especially at risk for increased violent behavior and subsequent criminal justice involvement when exposed to impoverished and high-crime communities.

Exposure to violence in one’s community, a low sense of community safety, unsupervised access to guns, and involvement in risky community behaviors such as drug dealing all contribute to youths’ involvement in gun carrying and gun violence. Decreased community perceptions of neighborhood safety and higher levels of social (e.g., loitering, public substance use, street fighting, prostitution, etc.) and physical (e.g., graffiti, gang signs, and discarded needles, cigarettes, and beer bottles) neighborhood disorder have been associated with increased firearm carrying among youths (Molnar, Miller, Azrael, & Buka, 2004). A study of African American youths living in poverty found that those who had been exposed to violence prior to carrying a gun were 2.5 times more likely than nonexposed youths to begin carrying a gun at the next time point, even when controlling for gang involvement (Spano et al., 2012). This study also indicated that after exposure to violence, youths were more likely to start carrying guns in their communities (Spano et al., 2012).

Studies have shown that apart from characteristics like conduct problems and prior delinquency, youths who are involved in gang fighting and selling drugs are also more likely to use a gun to threaten or harm others (e.g., Butters, Sheptycki, Brochu, & Erikson, 2011). Involvement in drug dealing in one’s community appears to be particularly risky for gun carrying during later adolescence and early adulthood, possibly due to an increased need for self-protection (Lizotte et al., 2000). Taken together, these studies show that firearm possession may be due to interactions between the need for self-protection in violent communities and increased involvement in delinquent behaviors.

Sociocultural Context: Exposure to Violent Media

Child and adolescent exposure to violent media, a more distal, sociocultural influence on behavior, is also important when considering developmental risks for gun violence. Decades of experimental, cross-sectional, and longitudinal research have documented that exposure to violent media, in movies and television, is associated with increased aggressive behaviors, aggressive thoughts and feelings, increased physiological arousal, and decreased prosocial behaviors (e.g., Anderson et al., 2003; Anderson & Bushman, 2001; Huesmann, 2010; Huesmann, Moise-Titus, Podolski, & Eron, 2003). In light of ongoing advances in technology, research has been expanded to include violent content in video games, music, social media, and the Internet (Anderson et al., 2010; IOM & NRC, 2013).

Findings on associations between violent media exposure and aggressive behavior outcomes have held across differences in culture, gender, age, socioeconomic status, and intellect (e.g., Anderson et al., 2010; Huesmann et al., 2003). Social-cognitive theory on violent media exposure suggests that these images are part of children’s socialization experiences, similar to violence exposure in interpersonal and community contexts (Huesmann, 2010). The viewing of violent images can serve to desensitize children to violence and normalize violent behavior, particularly when children have previously developed beliefs that aggression and violence are an acceptable means of achieving goals or resolving conflicts.

It is important to note that the link between violent media exposure and subsequent violent behaviors does not demonstrate a direct causal effect but instead shows how some children may be more susceptible to this risk factor than others. For instance, Huesmann et al. (2003) found that identification with aggressive characters on television and the perception that television violence was real were robust predictors of later aggression over time. Additionally, there is no established link between violent media exposure and firearm usage in particular. However, given the substantial proportion of media that includes interactions around firearms (e.g., in video games, movies, and television shows), the IOM and NRC (2013) recently identified a crucial need to examine specific associations between exposure to violent media and use of firearms. Exposure to violent media, especially for youths with preexisting aggressive tendencies and poor parental monitoring, may be an important contextual factor that amplifies risk for violent behavior and gun use.

Summary and Conclusions

The relatively small number of youths most likely to persist in serious acts of aggression (including increased risk of gun violence) have often experienced the following:

• Early childhood onset of persistent rule-breaking and aggression
• Socialization into criminal attitudes and behaviors by parents and caretakers who themselves are involved in criminal activities
• Exposure in childhood to multiple adverse experiences in their families and communities
• Social dislocation and reduced opportunities due to school failure or underachievement
• Persisting affiliation with deviant peers or gangs engaged in delinquent/criminal misconduct and with attitudes and beliefs that support possession and use of guns
• Broad exposure to sociocultural influences such as mass media violence and depictions of gun violence as an effective means of achieving goals or status

Most youths — even those with chronic and violent delinquent misconduct — desist in aggressive and antisocial behavior during late adolescence, and no single risk factor is sufficient to generate persisting violent behavior. Still, many are disproportionately at risk for becoming perpetrators or victims of gun violence. Homicide remains the second leading cause of death for teens and young adults between the ages of 15 and 24. In 2010, there were 2,711 infant, child, and adolescent victims of firearm deaths. In that year, 84 percent of homicide victims between the ages of 10 and 19 were killed with a firearm, and 40 percent of youths who committed suicide between the ages 15 and 19 did so with a gun (CDC, 2013a). 1

There is no one developmental trajectory that specifically leads to gun violence. However, prevention efforts guided by research on developmental risk can reduce the likelihood that firearms will be introduced into community and family conflicts or criminal activity. Prevention efforts can also reduce the relatively rare occasions when severe mental illness contributes to homicide or the more common circumstances when depression or other mental illness contributes to suicide.

Reducing incidents of gun violence arising from criminal misconduct or suicide is an important goal of broader primary and secondary prevention and intervention strategies. Such strategies must also attend to redirecting developmental antecedents and larger sociocultural processes that contribute to gun violence and gun-related deaths.

1 The 2010 data shown here are available online .

Eric Mankowski, PhD

Any account of gun violence in the United States must consider both why males are the perpetrators of the vast majority of gun violence and why the vast majority of males never perpetrate gun violence. An account that explains both phenomena focuses, in part, on how boys and men learn to demonstrate and achieve manhood through violence, as well as the differences in opportunities to demonstrate manhood among diverse groups of males. Although evidence exists for human biological and social-environmental systems interacting and contributing to aggressive and violent behavior, this review focuses on the sociocultural evidence that explains males’ higher rates of gun violence.

Reducing the propensity for some males to engage in violence will involve both social and cultural change. Hence, this section reviews existing research on the relationships between sex, gender (i.e., masculinity), and the perpetration and victimization of gun violence in the United States. The intersection of gender, race/ethnicity, and economic disadvantage is also considered in explaining the rates of gun violence across diverse communities. Finally, the relationships between masculinity, gender socialization, and gun violence are analyzed to identify gender-related risk factors for gun violence that can be targeted for prevention strategies and social policy.

Sex Differences in Gun Violence

Prevalence and Risk Men represent more than 90 percent of the perpetrators of homicide in the United States and are also the victims of the large majority (78 percent) of that violence (Bureau of Justice Statistics, 2008; Federal Bureau of Investigation [FBI], 2007). Homicide by gun is the leading cause of death among Black youth, the second leading cause of death among all male youth, and the second or third leading cause of death among female youth (depending on the specific age group) (e.g., Miniño, 2010; Webster, Whitehill, Vernick, & Curriero, 2012). In addition, roughly four times as many youths visit hospitals for gun-induced wounds as are killed each year (CDC, 2013a).

Even more common than homicide, suicide is another leading cause of death in the United States, and most suicides are completed with a firearm. Males complete the large majority of suicides; depending on the age group, roughly four to six times as many males as females kill themselves with firearms (CDC, 2013a). Among youth, suicide ranks especially high as a cause of death. It is the third leading cause of death of 15–24-year-olds and the sixth leading cause of death for 5–14-year-olds. However, the rate of suicide and firearm suicide gradually increases over the lifespan. In addition to gender and age differences in prevalence, sizable differences also exist among ethnic groups. Firearm suicide generally is at least twice as high among Whites than among Blacks and other racial groups from 1980 to 2010 (CDC, 2013a), and White males over the age of 65 have rates that far exceed all other major groups.

Perpetrator–Victim Relationship and Location The prevalence of gun violence strongly depends not only on the sex of the offender but also on the offender’s relationship to the victim and the location of the violence (Sorenson, 2006). Both men and women are more likely to be killed with firearms by someone they know than by a stranger. Specifically, men are most likely to be killed in a public place by an acquaintance, whereas women are most likely to be killed in the home by a current or former spouse or dating partner (i.e., “intimate partner”). Women compared with men are especially likely to be killed by a firearm used by an intimate partner.

Women are killed by current or former intimate partners four to five times more often than men (Campbell, Glass, Sharps, Laughon, & Bloom, 2007), including by firearm. These sex differences in victimization do not appear to hold in the limited data available on same-sex intimate partner homicide; it is more common for men to kill their male partners than for women to kill their female partners (Campbell et al., 2007). Notably, these sex differences in gun violence, as a function of the type of perpetrator–victim relationships, are also found in nonfatal gun violence when emergency room visits are examined (Wiebe, 2003).

A disproportionate number of gun homicides occur in urban areas. Conversely, a disproportionate number of firearm suicides occur in rural (compared with urban) areas (Branas, Nance, Elliott, Richmond, & Schwab, 2004). Although they are highly publicized, less than 2 percent of the homicides of children occur in schools (Borum, Cornell, Modzeleski, & Jimerson, 2010; CDC, 2008, 2013b). There are even fewer “random” or “mass” school shootings in which multiple victims are killed at the same time.

Gun Access and Possession A person must own or obtain a gun to be able to commit gun violence. Research shows that there are sex differences in access to and carrying a gun. Males are roughly two to four times as likely as females to have access to a gun in the home or to possess a gun (Swahn, Hamming, & Ikeda, 2002; Vaughn et al., 2012). In turn, gun carrying is a key risk factor for gun violence perpetration and victimization. For example, gun carrying is associated with dating violence victimization among adolescents, with boys more likely to be victimized than girls (Yan, Howard, Beck, Shattuck, & Hallmark-Kerr, 2010).

Conclusions based on sex differences in access to guns should be drawn with some caution, given that there also appear to be sex differences in the reporting of guns in the home. Men report more guns in the home than do women from the same household (e.g., Ludwig, Cook, & Smith, 1998; Sorenson & Cook, 2008), a sex difference that appears to stem specifically from the substantially higher level of contact with and experience in handling and using guns among boys than girls in the same household (Cook & Sorenson, 2006). Nonetheless, the presence of guns in the home remains predictive of gun violence.

Gender and Gun Violence

Robust sex and race differences in firearm violence have been established. Examined next is how the socialization of men as well as differences in living conditions and opportunities among diverse groups of boys and men help explain why these differences occur.

Making Gender Visible in the Problem of Gun Violence Gender remains largely invisible in research and media accounts of gun violence. In particular, gender is not used to explain the problem of “school shootings,” despite the fact that almost every shooting is perpetrated by a young male. Newspaper headlines and articles describe “school shooters,” “violent adolescents,” and so forth, but rarely call attention to the fact that nearly all such incidents are perpetrated by boys and young men. Studies of risk factors for school shootings may refer accurately to the perpetrators generally as “boys” but largely fail to analyze gender (e.g., Verlinden, Hersen, & Thomas, 2000).

The large sex differences in gun violence should not be overlooked simply because the vast majority of boys and men do not perpetrate gun violence or excused as “boys will be boys.” The size of sex differences in the prevalence of gun violence differs substantially within regions of the United States (Kaplan & Geling, 1998) and across countries (e.g., Ahn, Park, Ha, Choi, & Hong, 2012), which further suggests that gender differences in sociocultural environments are needed to explain sex differences in gun violence.

Masculinity, Power, and Guns Status as a “man” is achieved by the display of stereotypically masculine characteristics, without which one’s manhood is contested. Although the particular characteristics defining manhood and the markers of them can vary across subcultural contexts (Connell, 1995), masculinity has, historically, generally been defined by aggressive and risk-taking behavior, emotional restrictiveness (particularly the vulnerable emotions of fear and sadness, and excepting anger), heterosexuality, and successful competition (Brannon, 1976; Kimmel, 1994; O’Neil, 1981). Such normative characteristics of traditional masculinity are in turn directly related to numerous factors that are associated with gun violence. For example, risk taking is associated with adolescent males’ possession of and access to guns (Vittes & Sorenson, 2006).

Social expectations and norms, supported by social and organizational systems and practices, privilege boys who reject or avoid in themselves anything stereotypically feminine, act tough and aggressive, suppress emotions (other than anger), distance themselves emotionally and physically from other men, and strive competitively for power. Men of color, poor men, gay men, and men from other marginalized groups differ substantially in their access to opportunities to fulfill these manhood ideals and expectations in socially accepted ways. For example, men with less formal educational and economic opportunity, who in the United States are disproportionately Black and Latino, cannot fulfill expectations to be successful breadwinners in socially acceptable ways (e.g., paid, legal employment) as easily as White men, and gay men have less ability to demonstrate normative heterosexual masculinity where they cannot legally marry or have children.

At the same time, higher levels of some forms of violence victimization and perpetration (including suicide) are found among these disadvantaged groups. For example, gay youth are more likely than heterosexual males to commit suicide, and African American male youth are disproportionately the victims of gun violence. Such structural discrimination can be seen reflected in implicit cognitive biases against these group members. Virtual simulations of high-threat incidents, such as those used to train police officers, reliably demonstrate a “shooter bias” in which actors are more likely to shoot Black male targets than those from other race-gender groups (i.e., Black women, White men, and White women) (Plant, Goplen, & Kunstman, 2011).

Even to the extent that it is achieved, manhood status is theorized as precarious, needing to be protected and defended through aggression and violence, including gun violence, in order to avoid victimization from (mostly) male peers (Connell, 1995). Paradoxically, as in all competition, the more convincingly manhood is achieved, the more vulnerable it becomes to challenges or threats and thus requires further defending, often with increasing levels and displays of toughness and violence. The dynamic of these expectations of manhood and their enforcement is like a tight box (Kivel, 1998). Boys and men are either trapped inside this box or, in violating the expectations by stepping out of the box, risk being targeted by threats, bullying, and other forms of violence.

Adherence to stereotypic masculinity, in turn, is commonly associated with stress and conflict, poor health, poor coping and relationship quality, and violence (Courtenay 2000; Hong, 2000). Men’s gender role stress and conflict are directly associated with various forms of interpersonal aggression and violence, including the perpetration of intimate partner violence and suicide (Feder, Levant, & Dean, 2010; Moore & Stuart, 2005; O’Neil, 2008). Men with more restricted emotionality and more restricted affection with other men are more likely to be aggressive, coercive, or violent (O’Neil, 2008). These dimensions of masculinity also are related to a number of other harmful behaviors that are, in turn, associated directly with gun violence and other forms of aggression (see O’Neil, 2008, for a review). For example, the effect of alcohol consumption on intimate partner violence is greater among men than women (Moore, Elkins, McNulty, Kivisto, & Handsel, 2011), and alcohol consumption may be associated with lethal male-to-male violence at least partly because it is associated with carrying a gun (Phillips, Matusko, & Tomasovic, 2007).

In addition, accumulating research evidence indicates a relationship between gender and many of the factors that are associated with suicide (e.g., substance abuse, unemployment; Payne, Swami, & Stanistreet, 2008). Beliefs in traditional masculinity are related to suicidal thoughts, although differently across age cohorts (Hunt, Sweeting, Keoghan, & Platt, 2006). Men’s historic role as economic providers in heterosexual families typically ends with their retirement from the workforce. Suicide rates, including firearm suicide, increase dramatically at precisely this point in the life course (i.e., age 65 and older), whereas they decrease among women this age. The increase in suicide rates among White men at age 65 and older does not occur among Black men, who as a group have much higher levels of unemployment throughout their lives and consequently may not experience the same sense of loss of meaning or entitlement. Male firearm suicide also increases dramatically in adolescence and early adulthood, precisely the years during which young men’s sense of manhood is developing.

Beliefs about gender and sexual orientation also help explain sex differences in fatal hate crimes involving guns. Key themes in male gender role expectations are anti-femininity (Brannon, 1976) and homophobia (Kimmel, 1994). Boys are expected to rid themselves of stereotypically feminine characteristics (e.g., “you throw like a girl,” “big boys don’t cry”). Gun violence against lesbian, gay, bisexual, and transgendered persons can be understood in this context. One explanation of these hate crimes is that they are perpetrated to demonstrate heterosexual masculinity to male peer group members. These homicides, compared with violent crimes in which the victim is (or is perceived to be) heterosexual, often are especially brutal and are more commonly perpetrated by groups of men rather than individual men or women. However, such homicides appear to be perpetrated less often using firearms, which suggests motives beyond a desire to kill — for example, expressing intense hatred or transferring negative affect directly onto the victim (Gruenwald, 2012).

Male role expectations for achievement of success and power, combined with restricted emotionality, may have dangerous consequences, particularly for boys who suffer major losses and need help. A majority of the males who have completed homicides at schools had trouble coping with a recent major loss. Many had also experienced bullying or other harassment (Vossekuil et al., 2002). Such characteristics cannot and should not be used to develop risk profiles of attackers because school shootings are such rare events, and so many men who share these same characteristics never will perpetrate gun violence. However, when male gender and characteristics associated with male gender are highly common among attackers, it is responsible to ask how male gender contributes to school shootings and other forms of gun violence.

In their case studies of male-perpetrated homicide-suicides at schools, Kalish and Kimmel (2010) speculated that a sense of “aggrieved entitlement” may be common among the shooters. In this view, the young men see suicide and revenge as appropriate, even expected, responses for men to perceived or actual victimization. Related findings emerged from a similar analysis of all “random” school shootings (those with multiple, nontargeted victims) from 1982 to 2001 (Kimmel & Mahler, 2003). With a small number of exceptions, the vast majority were committed by White boys (26 of 28) in suburban or rural (not urban) areas (27 of 28). Many of these boys also had experienced homophobic bullying.

Masculinity and Beliefs About Guns Sex differences in beliefs about guns may begin at an early age as a function of parental socialization and attitudes. Fathers, particularly White fathers, are more permissive than mothers of their children, particularly sons, playing with toy guns (Cheng et al., 2003). Through the socialization of gender, boys and men may come to believe that displaying a gun will enhance their masculine power. Carrying a weapon is, in fact, instrumental in fulfilling male gender role expectations. Estimates of a person’s physical size and muscularity are greater when they display a gun (or large knife) than other similarly sized and shaped objects (e.g., drill, saw), even when the person is only described and not visible. This perception persists despite no apparent correlation between actual gun ownership and size or muscularity (Fessler, Holbrook, & Snyder, 2012). Guns symbolically represent some key elements of hegemonic masculinity — power, hardness, force, aggressiveness, coldness (Connell, 1995; Stroud, 2012).

Implications for Prevention and Policy

Sex Differences in Attitudes Toward Gun Policies Policies and laws addressing the manufacture, purchase, and storage of guns have been advocated in response to the prevalence of gun violence. Perhaps reflecting their differential access to firearms and differential perpetration and victimization rates, men and women hold different attitudes about such gun control policies. Females are generally much more favorable toward gun restriction and control policies (e.g., Vittes, Sorenson, & Gilbert, 2003).

Prevention Programs Addressing Gender The foregoing analysis of the link between gender and gun violence suggests the potential value of addressing gender in efforts to define the problem of gun violence and develop preventive responses. Preliminary evidence suggests that correcting and changing perceptions among men of social norms regarding beliefs about behaviors and characteristics that are associated with stereotypic masculinity may reduce the prevalence of intimate partner and sexual violence (Fabiano, Perkins, Berkowitz, Linkenbach, & Stark, 2003; Neighbors et al., 2010). However, the effect of such interventions in specifically reducing gun violence remains to be tested. The skills and knowledge of psychologists are needed to develop and evaluate programs and settings in schools, workplaces, prisons, neighborhoods, clinics, and other relevant contexts that aim to change gendered expectations for males that emphasize self-sufficiency, toughness, and violence, including gun violence.

Robert Kinscherff, PhD, JD; Arthur C. Evans Jr., PhD; Marisa R. Randazzo, PhD; and Dewey Cornell, PhD

A natural starting point for the prevention of gun violence is to identify individuals who are at risk for violence and in need of assistance. Efforts focused on at-risk individuals are considered secondary prevention because they are distinguished from primary or universal prevention efforts that address the general population. Secondary prevention strategies for gun violence can include such actions as providing prompt mental health treatment for an acutely depressed and suicidal person or conducting a threat assessment of a person who has threatened gun violence against a spouse or work supervisor.

To be effective, strategies to prevent gun violence should be tailored to different kinds of violence. One example is the distinction between acts of impulsive violence (i.e., violence carried out in the heat of the moment, such as an argument that escalates into an assault) and acts of targeted or predatory violence (i.e., acts of violence that are planned in advance of the attack and directed toward an identified target). The incidents of mass casualty gun violence that have garnered worldwide media attention, such as the shootings at Sandy Hook Elementary School in Newtown, Conn., at a movie theater Aurora, Colo., at the Fort Hood military base, and at a political rally in a shopping center in Tucson, Ariz., are all examples of targeted or predatory violence. Distinguishing between impulsive violence, targeted/predatory violence, and other types of violence is important because they are associated with different risk factors and require different prevention strategies.

Predicting and Preventing Impulsive Gun Violence

Research on impulsive violence has enabled scientists to develop moderately accurate predictive models that can identify individuals who are more likely than other persons to engage in this form of violence. These models cannot determine with certainty whether a particular person will engage in violence — just whether a person is at greater likelihood of doing so. This approach is known as a violence risk assessment or clinical assessment of dangerousness . A violence risk assessment is conducted by a licensed mental health professional who has specific training in this area. The process generally involves comparing the person in question with known base rates for those of the same age/gender who have committed impulsive violence and then determining whether the person in question has individual risk factors that would increase that person’s likelihood of engaging in impulsive violence. In addition, the process involves examining individual protective factors that would decrease the person’s overall likelihood of engaging in impulsive violence. Research that has identified risk and protective factors for impulsive violence is limited in that more research has been conducted on men than women and on incarcerated or institutionalized individuals than on those in the general population. Nevertheless, this approach can be effective for determining someone’s relative likelihood of engaging in impulsive violence.

Some risk factors for impulsive violence are static — for example, race and age — and cannot be changed. But those factors that are dynamic — for example, unmet mental health needs for conditions linked with violence to self (such as depression) or others (such as paranoia), lack of mental health care, abuse of alcohol — are more amenable to intervention and treatment that can reduce the risk for gun violence. Secondary prevention strategies to prevent impulsive gun violence can include having a trained psychologist or other mental health professional treat the person’s acute mental health needs or substance abuse needs. There must be a vigorous and coordinated response to persons whose histories include acts of violence, threatened or actual use of weapons, and substance abuse, particularly if they have access to a gun. This response should include a violence risk assessment by well-trained professionals and referral for any indicated mental health treatment, counseling and mediation services, or other forms of intervention that can reduce the risk of violence.

Youths and young adults who are experiencing an emerging psychosis should be referred for prompt assessment by mental health professionals with sufficient clinical expertise with psychotic disorders to craft a clinical intervention plan that includes risk management. In some cases, secondary prevention measures may include a court-ordered emergency psychiatric hospitalization where a person can receive a psychiatric evaluation and begin treatment. Criteria for allowing such involuntary evaluations vary by state but typically can occur only when someone is experiencing symptoms of a serious mental illness and, as a result, potentially poses a significant danger to self or others. There is an urgent need to improve the effectiveness of emergency commitment procedures because of concerns that they do not provide sufficient services and follow-up care.

Predicting and Preventing Targeted or Predatory Gun Violence

Acts of targeted or predatory violence directed at multiple victims, including crimes sometimes referred to as rampage shootings and mass shootings, 2 occur far less often in the United States than do acts of impulsive violence (although targeted violence garners far more media attention). Acts of targeted violence have not been subject to study that has developed statistical models like those used for estimating a person’s likelihood of impulsive violence. Although it seems appealing to develop checklists of warning signs to construct a profile of individuals who commit these kinds of crimes, this effort, sometimes described as psychological profiling, has not been successful. Research has not identified an effective or useful psychological profile of those who would engage in multiple casualty gun violence. Moreover, efforts to use a checklist profile to identify these individuals fail in part because the characteristics used in these profiles are too general to be of practical value; such characteristics are also shared by many nonviolent individuals.

Because of the limitations of a profiling approach, practitioners have developed the behavioral threat assessment model as an alternative means of identifying individuals who are threatening, planning, or preparing to commit targeted violence. Behavioral threat assessment also emphasizes the need for interventions to prevent violence or harm when a threat has been identified, so it represents a more comprehensive approach to violence prevention. The behavioral threat assessment model is an empirically based approach that was developed largely by the U.S. Secret Service to evaluate threats to the president and other public figures and has since been adapted by the U.S. Secret Service and U.S. Department of Education (Fein et al., 2002; Vossekuil et al., 2002) and others (Cornell, Allen, & Fan, 2012) for use in schools, colleges and universities, workplaces, and the U.S. military. Threat assessment teams are typically multidisciplinary teams that are trained to identify potentially threatening persons and situations. They gather and analyze additional information, make an informed assessment of whether the person is on a pathway to violence — that is, determine whether the person poses a threat of interpersonal violence or self-harm — and if so, take steps to intervene, address any underlying problem or treatment need, and reduce the risk for violence.

Behavioral threat assessment is seen as the emerging standard of care for preventing targeted violence in schools, colleges, and workplaces, as well as against government officials and other public figures. The behavioral threat assessment approach is the model currently used by the U.S. Secret Service to prevent violence to the U.S. president and other public officials, by the U.S. Capitol Police to prevent violence to members of Congress, by the U.S. State Department to prevent violence to dignitaries visiting the United States, and by the U.S. Marshals Service to prevent violence to federal judges (see Fein & Vossekuil, 1998). The behavioral threat assessment model also is recommended in two American national standards: one for higher education institutions (which recommends that all colleges and universities operate behavioral threat assessment teams; see ASME-Innovative Technologies Institute, 2010) and one for workplaces (which recommend s similar teams to prevent workplace violence; see ASIS International and Society for Human Resource Management, 2011). In addition, a comprehensive review conducted by a U.S. Department of Defense (2010) task force following the Fort Hood shooting concluded that threat assessment teams or threat management units (i.e., teams trained in behavioral threat assessment and management procedures) are the most effective tool currently available to prevent workplace violence or insider threats like the attack at Fort Hood.

Empirical research on acts of targeted violence has shown that many of those attacks were carried out by individuals motivated by personal problems who were at a point of desperation. In their troubled state of mind, these individuals saw no viable solution to their problems and could envision no future. The behavioral threat assessment model is used not only to determine whether a person is planning a violent attack but also to identify personal or situational problems that could be addressed to alleviate desperation and restore hope. In many cases, this includes referring the person to mental health services and other sources of support. In some of these cases, psychiatric hospitalization may be needed to address despondence and suicidality. Nonpsychiatric resources also can help alleviate the individual’s problems or concerns. Resources such as conflict resolution, credit counseling, job placement assistance, academic accommodations, veterans’ services, pastoral counseling, and disability services all can help address personal problems and reduce desperation. When the underlying personal problems are alleviated, people who may have posed a threat of violence to others no longer see violence as their best or only option.

Predicting and Preventing Violence by Those With Acute Mental Illness

When treating a person with acute or severe mental illness, mental health professionals may encounter situations in which they need to determine whether their patient (or client) is at risk for violence. Typically, they would conduct a violence risk assessment if the clinician’s concern is about risk for impulsive violence, as discussed previously. Clinicians also can conduct — or work with a team to help conduct — a threat assessment if their concern involves targeted violence. The available research suggests that mental health professionals should be concerned when a person with acute mental illness makes an explicit threat to harm someone or is troubled by delusions or hallucinations that encourage violence, but even in these situations, violence is far from certain. Although neither a violence risk assessment nor a threat assessment can yield a precise prediction of someone’s likelihood of violence, it can identify high-risk situations and guide efforts to reduce risk. It is important to emphasize that prevention does not require prediction; interventions to reduce risk can be beneficial even if it is not possible to determine who would or would not have committed a violent act.

When their patients (or clients) pose a risk of violence to others, mental health professionals have a legal and ethical obligation to take appropriate action to protect potential victims of violence. This obligation is not easily carried out for several reasons. First, mental health professionals have only a modest ability to predict violence, even when assisted by research-validated instruments. Mental health professionals who are concerned that a patient is at high risk for violence may be unable to convince their patient to accept hospitalization or some other change in treatment. They can seek involuntary hospitalization or treatment, but civil commitment laws (that vary from state to state) generally require convincing evidence that a person is imminently dangerous to self or others. There is considerable debate about the need to reform civil commitment laws in a manner that both protects individual liberties and provides necessary protection for society.

There is no guarantee that voluntary or involuntary treatment of a potentially dangerous individual will be effective in reducing violence risk, especially when the risk for violence does not arise from a mental illness but instead from intense desperation resulting from highly emotionally distressing circumstances or from antisocial orientation and proclivities for criminal misconduct. When individuals with prior histories of violence are released from treatment facilities, they typically need continued treatment and monitoring for potential violence until they stabilize in community settings. Jurisdictions vary widely in the resources available to achieve stability in the community and in the legal ability to impose monitoring or clinical care on persons who decline voluntary services.

Furthermore, if unable to obtain civil commitment to a protective setting, mental health professionals must consider other protective actions permitted in their jurisdictions, which may include warning potential victims that they are in danger or alerting local law enforcement, family members, employers, or others. Whether their particular jurisdiction mandates a response to “warn or protect” potential victims or leaves this decision to the discretion of the clinician, mental health professionals are often reluctant to take such actions because they are concerned that doing so might damage the therapeutic relationship with their patient and drive patients from treatment or otherwise render effective treatment impossible.

Another post-hospitalization strategy is to prohibit persons with mental illness from acquiring a firearm. The Gun Control Act of 1968 prohibited persons from purchasing a firearm if they had been involuntarily committed to a psychiatric inpatient unit. The Brady Handgun Violence Act (1994), known as the Brady Law, began the process of background checks to identify individuals who might attempt to purchase a firearm despite prohibitions. There is some evidence that rates of gun violence are reduced when these procedures are adequately implemented, but research, consistent implementation, and refinement of these procedures are needed (Webster & Vernick, 2013a).

Predicting and Preventing Gun-Based Suicide

Suicide accounts for approximately 61 percent of all firearm fatalities in the United States — 19,393 of the 31,672 firearm deaths reported by the CDC for 2010 (Murphy, Xu, & Kochanek, 2013). When there is concern that a person may be suicidal, mental health professionals can conduct suicide screenings and should rely on structured assessment tools to assess that person’s risk to self. Behavioral threat assessment also may be indicated in such situations if the potentially suicidal individual may also pose a threat to others.

More than half of suicides are accomplished by firearms and most commonly with a firearm from the household (Miller, Azrael, Hepburn, Hemenway, & Lippmann, 2006). More than 90 percent of persons who commit suicide had some combination of symptoms of depression, symptoms of other mental disorders, and/or substance abuse (Moscicki, 2001). Ironically, although depression is the condition most closely associated with attempted or completed suicide, it is also less likely than schizophrenia or other disorders to prompt an involuntary civil commitment or other legal triggers that can prevent some persons with mental illness from possessing firearms. As in behavioral threat assessment, suicide risk may be reduced through identifying and providing support in solving the problems that are driving a person to consider suicide. In many cases the person may need a combination of psychological treatment and psychiatric medication.

Tragic shootings like the ones at Sandy Hook Elementary School and the movie theater in Aurora, Colo., spark intense debate as to whether specific gun control policies would significantly diminish the number of mass shooting incidents. This debate includes whether or how to restrict access to firearms, especially with regard to persons with some mental illnesses. Another line of debate concerns whether to limit access to certain types of firearms (e.g., reducing access to high-capacity magazines). Empirical evidence documents the efficacy of some firearms restrictions, but because the restrictions often are not well implemented and have serious limitations, it is difficult to conduct the kind of rigorous research needed to fairly evaluate their potential for reducing gun violence.

The often-debated Brady Law (1994) does not consistently prevent persons with mental illness from acquiring a firearm. The prohibition applies only to persons with involuntary commitments and omits both persons with voluntary admissions and those with no history of inpatient hospitalization. The law does not prevent a person with a history of involuntary commitment from obtaining a previously owned firearm or one possessed by a friend or relative. Additional problems with implementing the Brady Law include incomplete records of involuntary commitments, background checks limited to purchases from licensed gun dealers, and exceptions from background checks for firearms purchased during gun shows.

Despite these limitations and gaps, there is some scientific evidence that background checks reduce the rate of violent gun crimes by persons whose mental health records disqualify them from legally obtaining a firearm. A study of one state (Connecticut) found that the risk of violent criminal offending among persons with a history of involuntary psychiatric commitment declined significantly after the state began reporting these individuals to the National Instant Criminal Background Check System (Swanson et al., 2013). This study supports the value of additional research to investigate strategies for limiting access to firearms by persons with serious mental illness.

In contrast, access to appropriate mental health treatment can work to reduce violence at the individual level. For example, one major finding of the MacArthur Risk Assessment study (Monahan et al., 2001) was that getting continued mental health treatment in the community after release from a psychiatric hospitalization reduced the number of violent acts by those who had been hospitalized. In other studies, outpatient mental health services, including mandated services, have been effective in preventing or reducing violent and harmful behavior (e.g., New York State Office of Mental Health, 2005; N.Y. Mental Hygiene Law [Kendra’s Law], 1999; O’Keefe, Potenza, & Mueser, 1997; Swanson et al., 2000).

There is abundant scientific research demonstrating the effectiveness of treatment for persons with severe mental illness such as schizophrenia and bipolar disorder. However, there are social, economic, and legal barriers to treatment. First, there is a persistent social stigma associated with mental illness that deters individuals from seeking treatment for themselves or for family members. Public education to increase understanding of and support for persons with serious mental illness and to encourage access to treatment is needed.

Second, mental health treatment, especially inpatient hospitalization, is expensive, and persons with mental illness often cannot access this level of care or afford it. Commercial insurers often have limitations on hospital care or do not cover intensive services that are alternatives to inpatient admission. Public sector facilities such as community mental health centers and state-operated psychiatric hospitals have experienced many years of shrinking government support; demand for their services exceeds their capacity. Many mental health providers limit their services to the most acute cases and cannot extend services after the immediate crisis has resolved.

Third, there are complex legal barriers to the provision of mental health services when an individual does not desire treatment or does not believe he or she is in need of treatment. A severe mental illness can impair an individual’s understanding of his or her condition and need for treatment, but a person with mental illness may make a rational decision to refuse treatment that he or she understandably regards as ineffective, aversive, or undesirable for some reason (e.g., psychiatric medications can produce unpleasant side effects and hospitalization can be a stressful experience).

When an individual refuses to seek treatment, it may be difficult to determine whether this decision is rational or irrational. To protect individual liberties, laws throughout the United States permit involuntary treatment only under stringent conditions, such as when an individual is determined to be imminently dangerous to self or others due to a mental illness. People who refuse treatment but are not judged to be imminently dangerous (a difficult and ambiguous standard) fall into a “gray zone” (Evans, 2013). Some individuals with serious mental illness pose a danger to self or others that is not imminent, and often it is not possible to monitor them adequately or determine precisely when they become dangerous and should be hospitalized on an involuntary basis. In other situations, the primary risk posed by the individual does not arise from mental illness but from his or her willingness to engage in criminal misconduct for personal gain.

Furthermore, when a person is committed to a psychiatric hospital on an involuntary basis, treatment is limited in scope. Once the person is no longer regarded as imminently dangerous (the criteria differ across states), he or she must be released from treatment even if not fully recovered; that person may be vulnerable to relapse into a dangerous state. In some cases of mass shootings, persons who committed the shooting were known to have a serious mental illness, but authorities could not require treatment when it was needed. In other cases, authorities were not aware of an individual’s mental illness before the attempted or actual mass shooting incident.

A related problem is that the onset or recurrence of serious mental illness can be difficult to detect. Symptoms of mental illness may emerge slowly, often in late adolescence or early adulthood, and may not be readily apparent to family members and friends. A person hearing voices or experiencing paranoid delusions may hide these symptoms and simply seem preoccupied or distressed but not seriously ill. A person who has been treated successfully for a serious mental illness may experience a relapse that is not immediately recognized. There is a great need for public education about the onset of serious mental illness, recognition of the symptoms of mental illness, and increased emphasis on the importance of seeking prompt treatment.

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2 The FBI (n.d.) defines mass murder as incidents that occur in one location (or in closely related locations during a single attack) and that result in four or more casualties. Mass murder shootings are much less common than other types of gun homicides. They are also not a new phenomenon. Historically, most mass murder shootings occurred within families or in criminal activities such as gang activity and robberies. Rampage killings is a term used to describe some mass murders that involve attacks on victims in unprotected settings (such as schools and colleges, workplaces, places of worship) and public places (such as theaters, malls, restaurants, public gatherings). However, these shootings are often planned well in advance and carried out in a methodical manner, so the term rampage is a misnomer.

Ellen Scrivner, PhD, ABPP; W. Douglas Tynan, PhD, ABPP; and Dewey Cornell, PhD

Prevention of violence occurs along a continuum that begins in early childhood with programs to help parents raise healthy children and ends with efforts to identify and intervene with troubled individuals who threaten violence. A comprehensive community approach recognizes that no single program is sufficient and there are many opportunities for effective prevention. Discussion of effective prevention from a community perspective should include identification of the community being examined. Within the larger community, many stakeholders are affected by gun violence that results in a homicide, suicide, or mass shooting.

Such stakeholders include community and public safety officials, schools, workplaces, neighborhoods, mental health and public health systems, and faith-based groups. When it comes to perpetrating gun violence, however, a common thread that exists across community groups is the recognition that someone, or possibly several people, may have heard something about an individual’s thoughts and/or plans to use a gun. Where do they go with that information? How do they report it so that innocent people are not targeted or labeled unfairly — and how can their information initiate a comprehensive and effective crisis response that prevents harm to the individual of concern and the community?

To date, there is little research to help frame a comprehensive and effective prevention strategy for gun violence at the community level. One of the most authoritative reviews of the body of gun violence research comes from the National Research Council of the National Academy of Sciences (see Wellford, Pepper, & Petrie, 2004). In reviewing a range of criminal justice initiatives designed to reduce gun violence, such as gun courts, enhanced sentencing, and problem-based policing, Wellford et al. concluded that problem-oriented policing, also known as place-based initiatives or target policing, holds promise, particularly when applied to “hot spots” — areas in the community that have high crime rates. They included studies on programs such as the Boston Gun Project (see Kennedy, Braga, & Piehl, 2001), more commonly known as Operation Ceasefire, in their review and concluded that although many of these programs may have reduced youth homicides, there is only modest evidence to suggest that they effectively lowered rates of crime and violence, given the confounding factors that influence those rates and are difficult to control. In other words, the variability in the roles of police, prosecutors, and the community creates complex interactions that can confound the levels of intervention and affect sustainability.

Wellford et al.’s (2004) conclusions were supported by the findings of the 2011 Firearms and Violence Research Working Group (National Institute of Justice, 2011), which also questioned whether rigorous evaluations are possible given the reliability and validity of the data. Wellford et al. advocated for continued research and development of models that include collaboration between police and community partners and for examination of different evaluation methodologies.

There are varied prevention models that address community issues. When it comes to exploring models that specifically address preventing the recent episodes of gun violence that have captured the nation’s attention, however, the inevitable conclusion is that there is a need to develop a new model that would bring community stakeholders together in a collaborative, problem-solving mode, with a goal of preventing individuals from engaging in gun violence, whether directed at others or self-inflicted. This model would go beyond a single activity and would blend several strategies as building blocks to form a workable systemic approach. It would require that community service systems break their tendencies to operate in silos and take advantage of the different skill sets already available in the community — for example:

• Police are trained in crisis intervention skills with a primary focus on responding to special populations such as those with mental illness.
• Community members are trained in skilled interventions such as Emotional CPR  and Mental Health First Aid — consumer-based initiatives that use neighbor-to-neighbor approaches that direct people in need of care to appropriate mental health treatment.
• School resource officers are trained to show a proactive presence in schools.

Each group may provide a solution to a piece of the problem, but there is nothing connecting the broad range of activities to the type of collaborative system needed to implement a comprehensive, community-based strategy to prevent gun violence. From a policy and practice perspective, no one skill set or one agency can provide the complete answer when it comes to developing a prevention methodology. However, some models developed through the community policing reform movement may be relevant because they are generally acknowledged to have been useful in reducing violence against women and domestic violence and in responding to children exposed to violence. These community policing models involve collaborative problem solving as a way to safeguard the community as opposed to relying only on arrest procedures. Moreover, they engage the community in organized joint efforts to produce public safety (Peak, 2013).

Another initiative, Project Safe Neighborhoods ( PSN ), is also relevant. PSN, a nationwide program that began in 2001 and was designed specifically to reduce gun violence, has some similarity to the community policing model. PSN involved the 94 U.S. attorneys in cities across the country in a prominent leadership role, ensured flexibility across jurisdictions, and required cross-agency buy-in, though there seems to have been less formalized involvement with mental health services. Nevertheless, it used a problem-solving approach that was aimed at getting guns off the streets, and the results of varied outcome assessments demonstrate that it was successful in reducing gun violence, particularly when the initiatives were tailored to the gun violence needs of specific communities (McGarrell et al., 2009).

A common approach used by PSN involved engaging the community to establish appropriate stakeholder partnerships, formulating strategic planning on the basis of identification and measurement of the community problem, training those involved in PSN, providing outreach through nationwide public service announcements, and ensuring accountability through various reporting mechanisms. The PSN problem-solving steps, with some adaptations, could provide a useful strategy for initiating collaborative problem solving with relevant community stakeholders in the interest of reducing gun violence and victimization through prevention.

The models discussed here illustrate how community engagement and collaboration helped break new ground in response to identified criminal justice problems, but they could be strengthened considerably by incorporating the involvement of professional psychology. The need for collaboration was again highlighted at a Critical Issues in Policing meeting (Police Executive Research Forum, 2012) as part of a discussion on connecting agency silos by building bridges across systems. Because police and mental health workers often respond to the same people, there is a need for collaboration on the best way to do this without compromising their roles. This emphasis takes the discussion beyond the student/school focus and expands it to include the use of crisis intervention teams (CIT) and community advocacy groups as additional resources for achieving the goal of preventing violence in the community.

The CIT model was another result of community policing reform that brought police and mental health services together to provide a more effective response to the needs of special populations, particularly mental health-related cases. Developed in Memphis in 1988 but now deployed in many communities across the country, the CIT model trains CIT officers to deescalate situations involving people in crises and to use jail diversion options, if available, rather than arrests. Although research on the effectiveness of CITs is generally limited to outcome studies in select cities, the model continues to gain prominence. In fact, the National Alliance on Mental Illness ( NAMI ) has established a NAMI CIT Center and is promoting the expansion of CIT nationwide. Studies by Borum (2000), Steadman, Deane, Borum, and Morrissey (2000), and Teller, Munetz, Gil, and Ritter (2006) have illustrated that high-risk encounters between individuals with mental illness and police can be substantially improved through CIT training, particularly when there are options such as drop-off centers, use of diversion techniques, and collaborations between law enforcement, mental health, and family members. Each plays a significant role in ensuring that city or county jails do not become de facto institutions for those in mental health crises.

Crisis intervention teams were also a major focus of a 2010 policy summit (International Association of Chiefs of Police [IACP], 2012). The summit, hosted by SAMHSA, the Bureau of Justice Assistance, and IACP, produced a 23-item action agenda. Although the summit focused on decriminalizing the response to persons with mental illness and was not directed specifically at dealing with people who perpetrate gun violence, some of their recommendations did apply. The central theme of the agenda encouraged law enforcement and mental health service systems to engage in mutually respectful working relationships, collaborate across partner agencies, and establish local multidisciplinary advisory groups. These partnerships would develop policy, protocols, and guidelines for informing law enforcement encounters with persons with mental illness who are in crisis, including a protocol that would enable agencies to share essential information about those individuals and whether the nature of the crisis could provoke violent behavior. They further recommended that these types of protocols be established and maintained by the multidisciplinary advisory group and that training be provided in the community to sensitize community members to signs of potential danger and how to intervene in a systematic way.

A Police Foundation (2013) roundtable on gun violence and mental health reported that some police departments have reached out to communities and offered safe storage of firearms when community members have concern about a family member’s access to firearms in the home. As a service to the community, the police would offer to keep guns secured in accessible community locations until the threat has subsided and the community member requests the return. The police would also confer with mental health practitioners regarding a designated family or community member on an as-needed basis. This strategy is consistent with a community threat assessment approach in which law enforcement authorities engage proactively with the community to reduce the risk of violence when an individual poses a risk.

Gun Violence in Schools

Gun violence in schools has been a national concern for more than two decades. Although school shootings are highly traumatic events and have brought school safety to the forefront of public attention, schools are very safe environments compared with other community settings (Borum et al., 2010). Less than 2 percent of homicides of school-aged children occur in schools. Over a 20-year period, there have been approximately 16 shooting deaths in U.S. schools each year (Fox & Burstein, 2010), compared with approximately 32,000 shooting deaths annually in the nation as a whole (Hoyert & Xu, 2012).

The Gun-Free Schools Act of 1994 made federal education funding contingent upon states requiring schools to expel for at least one year any student found with a firearm at school. This mandate strengthened the emerging philosophy of zero tolerance as a school disciplinary policy. According to the APA Zero Tolerance Task Force (2008), this policy was predicated on faulty assumptions that removing disobedient students would motivate them to improve their behavior, deter misbehavior by other students, and generate safer school conditions. The task force found no scientific evidence to support these assumptions and, on the contrary, concluded that the practice of school suspension had negative effects on students and a disproportionately negative impact on students of color and students with disabilities.

After the 1999 shooting at Columbine High School, both the FBI (O’Toole, 2000) and the U.S. Secret Service (Vossekuil et al., 2002) conducted studies of school shootings and concluded that schools should not rely on student profiling or checklists of warning signs to identify potentially violent students. They cautioned that school shootings were statistically too rare to predict with accuracy and that the characteristics associated with student shooters lacked specificity, which means that numerous nonviolent students would be misidentified as dangerous. Both law enforcement agencies recommended that schools adopt a behavioral threat assessment approach, which, as noted earlier, involves assessment of students who threaten violence or engage in threatening behavior and then individualized interventions to resolve any problem or conflict that underlies the threat. One of the promising features of threat assessment is that it provides schools with a policy alternative to zero tolerance. Many schools across the nation have adopted threat assessment practices. Controlled studies of the "Virginia Student Threat Assessment Guidelines" have shown that school-based threat assessment teams are able to resolve student threats safely and efficiently and to reduce school suspension rates (Cornell et al., 2012; Cornell, Gregory, & Fan, 2011; Cornell, Sheras, Gregory, & Fan, 2009).

The Role of Health and Mental Health Providers in Gun Violence Prevention

The health care system is an important point of contact for families regarding the issue of gun safety. Physicians’ counseling of individuals and families about firearm safety has in some cases proven to be an effective prevention measure and is consistent with other health counseling about safety. According to the 2012 policy statement of the American Academy of Pediatrics (AAP):

The AAP supports the education of physicians and other professionals interested in understanding the effects of firearms and how to reduce the morbidity and mortality associated with their use. HHS should establish a program to support gun safety training and counseling programs among physicians and other medical professionals. The program should also provide medical and community resources for families exposed to violence.

The AAP’s Bright Futures practice guide urges pediatricians to counsel parents who possess guns that storing guns safely and preventing access to guns reduce injury by as much as 70 percent and that the presence of a gun in the home increases the risk for suicide among adolescents. A randomized controlled trial indicates that health care provider counseling, when linked with the distribution of cable locks, has been demonstrated to increase safer home storage of firearms (Barkin et al., 2008). The removal of guns or the restriction of access should be reinforced for children and adolescents with mood disorders, substance abuse (including alcohol), or a history of suicide attempts (Grossman et al., 2005). Research is needed to identify the best ways to avoid unintended consequences while achieving intended outcomes.

In recent years, legal and legislative challenges have emerged that test the ability of physicians and other medical professionals to provide guidance on firearms. For example, in 2011 the state of Florida enacted the Firearm Owners’ Privacy Act, which prevented physicians from providing such counsel under threat of financial penalty and potential loss of licensure. The law has been permanently blocked from implementation by a U.S. district court. Similar policies have been introduced in six other states: Alabama, Minnesota, North Carolina, Oklahoma, Tennessee, and West Virginia. The fundamental right of all health and mental health care providers to provide counseling to individuals and families must be protected to mitigate risk of injury to people where they live, work, and play.

It is apparent that long before the events at Sandy Hook Elementary School, many public health and public safety practitioners were seeking strategies to improve responses to violence in their communities and have experienced some success through problem-solving projects such as PSN and CIT. Yet there is still a need to rigorously evaluate and improve these efforts. In the meantime, basic safety precautions must be emphasized to parents by professionals in health, education, and mental health.

Public health messaging campaigns around safe storage of firearms are needed. The practice of keeping firearms stored and locked must be encouraged, and the habit of keeping loaded, unlocked weapons available should be recognized as dangerous and rendered socially unacceptable. To keep children and families safe, good safety habits have to become the only socially acceptable norm.

Susan B. Sorenson, PhD, and Daniel W. Webster, ScD, MPH

The use of a gun greatly increases the odds that violence will result in a fatality. In 2010, the most recent year for which data are available, an estimated 17.1 percent of the interpersonal assaults with a gunshot wound resulted in a homicide, and 80.7 percent of the suicide attempts in which a gun was used resulted in death (CDC, 2013a). By contrast, the most common methods of assault (hands, fists, and feet) and suicide attempt (ingesting pills) in 2010 resulted in death in only 0.009 percent and 2.5 percent of the incidents, respectively (CDC, 2013a). 3

As shown in Figure 1, in the past 30 years, the percentage of deaths caused by gunfire has stabilized to about 68 percent for homicides and, as drug overdoses have increased, dropped to 50 percent for suicide. There are more gun suicides than gun homicides in the United States. In 2010, 61.2 percent (19,392) of the 31,672 gun deaths in the United States were suicides (CDC, 2013a).

Figure 1. Deaths Attributed to Firearms, 1981–2010

Note: Data are from the Web-Based Injury Statistics Query and Reporting System (WISQARS™), Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2013. Retrieved from http://www.cdc.gov/injury/wisqars/fatal.html.

Much of the public concern about guns and gun violence focuses on interpersonal violence, and public policy mirrors this emphasis. Although there is no standard way to enumerate each discrete gun law, most U.S. gun laws focus on the user of the gun. Relatively few focus on the design, manufacture, distribution, advertising, or sale of firearms (Teret & Wintemute, 1993). Fewer yet address ammunition.

The focus herein is on the lifespan of guns — from design and manufacture to use — and the policies that could address the misuse of guns. It is critical to understand how policies create conditions that affect access to and use of guns. Because they constitute the largest portion of guns used in homicides (FBI, 2012a), handguns are the focus of most laws. Despite the substantial human and economic costs of gun violence in the United States and the ongoing debate about the effectiveness of gun regulations, scientifically rigorous evaluations are not available for many of these policies (Wellford et al., 2004). The dearth of such research on gun policies is due, in part, to the lack of government funding on this topic because of the political influences of the gun lobby (e.g., Kellermann & Rivara, 2013).

Design and Manufacture

The type of handguns manufactured in the United States has changed. Pistols overtook revolvers in manufacturing in the mid-1980s. In addition, the most widely sold pistol went from a .22 caliber in 1985 to a 9 mm or larger (e.g., .45 caliber pistols) by 1994 (Wintemute, 1996), with smaller, more concealable pistols favored by permit holders as well as criminals. This shift has been described as increasing the lethality of handguns, although, according to our review, no research has examined whether the change in weapon design has led to an increased risk of death. Such research may not be feasible given that the aforementioned weapons — that is, small, concealable pistols — still likely constitute a small portion of the estimated 283 million guns in civilian hands in the United States (Hepburn, Miller, Azrael, & Hemenway, 2007). The disproportionate appearance of such pistols among guns that were traced by law enforcement following their use in a crime has been attributed to the ease with which smaller guns can be concealed and their low price point (Koper, 2007; Wright, Wintemute, & Webster, 2010).

Ammunition, by contrast, is directly related to lethality. Hollow-point bullets are used by hunters because, in part, they are considered a more humane way to kill. The physics of hollow-point bullets are such that, upon impact, they will tumble inside the animal and take it down. Some bullets have been designed to be frangible, that is, to break apart upon impact and thus cause substantial internal damage. By contrast, the physics of full metal jacket bullets are such that, unless they hit a bone, they are likely to continue on a straight trajectory and pass through the animal, leaving it wounded and wandering. Hollow-point bullets are used by law enforcement to reduce over-penetration (i.e., when a bullet passes through its intended target and, thus, risks striking others).

Some design features would substantially reduce gun violence. One of the most promising ideas is that of “smart guns” that can be fired only by an authorized user. For example, young people, who are prohibited due to their age from legally purchasing a firearm, typically use a gun from their own home to commit suicide (Johnson, Barber, Azrael, Clark, & Hemenway, 2010; Wright, Wintemute, & Claire, 2008) and to carry out a school shooting (CDC, 2003). If personalized to an authorized adult in the home, the gun could not be operated by the adolescent or others in the home, thus rendering it of little use to the potential suicide victim or school shooter. During the Clinton administration, the federal government made a modest investment in the research and development of personalized firearms. There also was considerable private investment in technologies that would prevent unauthorized users from being able to fire weapons. Efforts to create these “smart guns” have resulted in multiple patent applications. Armatix GmbH, a German company, has designed and produced a personalized pistol that is being sold in several Western European nations and has been approved for importation to the United States. Although the cost of this new personalized gun is very high, it is believed that personalized guns can be produced at a cost that would be affordable by many (Teret & Merritt, 2013).

The assault weapons ban (the Violent Crime Control and Law Enforcement Act), enacted for a 10-year period beginning in 1994, provided a good opportunity to assess the effectiveness of restricting the manufacturing, sale, and possession of a certain class of weapons. “Assault weapons,” however, are difficult to conceal and are used rarely in most street crime or domestic violence. Assault weapons are commonly used in mass shootings in which ammunition capacity can determine the number of victims killed or wounded. Because multiple bullets are not an issue in suicide, one would not expect changes in such deaths either. Perhaps not surprisingly, an effect of the ban could not be detected on total gun-related homicides (Koper, 2013; Koper & Roth, 2001).

Unfortunately, prior research on the effects of the federal assault weapons ban did not focus on the law’s effects on mass shootings or the number of persons shot in such shootings. Assault weapons or guns with large-capacity ammunition feeding devices account for half of the weapons used in mass shootings such as at Sandy Hook Elementary School (see Follman & Aronson , 2013). Mass shootings with these types of weapons result in about 1.5 times as many fatalities as those committed with other types of firearms (Roth & Koper, 1997).

Distribution

The distribution of guns is largely the responsibility of a network of middlemen between gun manufacturers and gun dealers. When a gun is recovered following its use (or suspected use) in a crime, law enforcement routinely requests that the gun be traced — that is, the serial number is reported to the manufacturer, who then contacts the distributor and/or dealer who, in turn, reviews records to determine the original purchaser of a specific weapon. The number of gun traces is such that the manufacturers get many calls about their guns each day. One researcher estimated that Smith and Wesson, with about 10 percent of market share, received a call every seven to eight minutes about one of their guns (Kairys, 2008). Thus, one could reasonably expect that manufacturers would have some knowledge of which distributors sell guns that are disproportionately used in crime, and distributors would, in turn, know which retailers disproportionately sell guns used in crime.

Following in the footsteps of cities and states that had successfully sued the tobacco industry under state consumer protection and antitrust laws for costs the public incurred in caring for smokers, beginning in the late 1990s cities and states began to file claims against firearm manufacturers in an attempt to recover the costs of gun violence they incurred. In response, in 2005, Congress enacted and President George W. Bush signed the Protection of Lawful Commerce in Arms Act, which prohibits civil liability lawsuits against “manufacturers, distributors, dealers, or importers of firearms or ammunition for damages, injunctive or other relief resulting from the misuse of their products by others” ( 15 U.S.C. §§ 7901-7903 ). Thus, the option of using litigation, a long-standing and sometimes controversial tool by which to address entrenched public health problems (e.g., Lytton, 2004), was severely restricted.

Advertising

Advertisements for guns have largely disappeared from classified ads in newspapers. By contrast, advertising in magazines, specifically gun magazines, is strong (Saylor, Vittes, & Sorenson, 2004). Such advertising is subject to the same Federal Trade Commission (FTC) regulations as other consumer products. In 1996, several organizations filed a complaint with the FTC after documenting multiple cases of what they asserted to be false and misleading claims about home protection (for specific examples, see Vernick, Teret, & Webster, 1997). As of November 1, 2013, the FTC had not ruled on the complaint. However, the firearm industry changed its practices such that by 2002, self-protection was an infrequent theme in advertisements for guns (Saylor et al., 2004). To our knowledge, current advertising has not been studied. New issues relevant to the advertising of guns include online advertisements by private sellers who are not obligated to verify that purchasers have passed a background check, online ads from prohibited purchasers seeking to buy firearms, the marketing of military-style weapons to civilians, and the marketing of firearms to underage youth (for examples and more information, see Kessler & Trumble, 2013; Mayors Against Illegal Guns, 2013; McIntire, 2013; Violence Policy Center, 2011).

Sales and Purchases

Gun sales have been increasing in the United States. The FBI reported a substantial jump in background checks (a proxy for gun sales) in the days following the Sandy Hook Elementary School shootings. In fact, of the 10 days with the most requests for background checks since the FBI started monitoring such information, 7 of them were within 8 days of Sandy Hook (FBI, 2013). Guns can be purchased from federally licensed firearm dealers or private, unlicensed sellers in a variety of settings, including gun shows, flea markets, and the Internet.

Responsible sales practices (for examples, see Mayors Against Illegal Guns, n.d.) rely heavily on the integrity of the seller. And usually that responsibility is well placed: Over half (57 percent) of the guns traced (i.e., submitted by law enforcement, usually in association with a crime, to determine the original purchaser of the weapon) were originally sold by only 1.2 percent of federally licensed firearm dealers (Bureau of Alcohol, Tobacco and Firearms [ATF], 2000). However, there are problems. Sometimes a person who is prohibited from purchasing a gun engages someone else, who is not so prohibited, to purchase a gun for him or her. The person doing the buying is called a “straw purchaser.” Straw purchase attempts are not uncommon; in a random sample of 1,601 licensed dealers and pawnbrokers in 43 states, two thirds reported experiencing straw purchase attempts (Wintemute, 2013b).

Two studies tested the integrity of licensed firearm dealers by calling the dealers and asking whether they could purchase a handgun on behalf of someone else (in the studies, a boyfriend or girlfriend), a straw purchase transaction that is illegal. In the study of a sample of gun dealers listed in telephone directories of the 20 largest U.S. cities, the majority of gun dealers indicated a willingness to sell a handgun under the illegal straw purchase scenario (Sorenson & Vittes, 2003). In a similar study of licensed gun dealers in California, a state with relatively strong regulation and oversight of licensed gun dealers, one in five dealers expressed a willingness to make the illegal sale (Wintemute, 2010). Programs such as the ATF and National Sports Shooting Council’s “Don’t Lie for the Other Guy,” which provides posters and educational materials to display in gun stores as well as tips for gun dealers on how to identify and respond to straw purchase attempts, have not been evaluated.

It is important to be able to identify high-risk dealers because, in 2012, the ATF had insufficient resources to monitor federally licensed gun dealers (Horwitz, 2012); there were 134,997 unlicensed gun dealers in April 2013 (ATF, 2013). Some states have recognized the limited capacity of the ATF and the weaknesses of federal laws regulating gun dealers and enacted their own laws requiring the licensing, regulation, and oversight of gun dealers (Vernick, Webster, & Bulzacchelli, 2006) and, when enforced, these laws appear to reduce the diversion of guns to criminals shortly after a retail sale (Webster, Vernick, & Bulzacchelli, 2009). Undercover stings and lawsuits against gun dealers who facilitate illegal straw sales have also been shown to reduce the diversion of guns to criminals (Webster, Bulzacchelli, Zeoli, & Vernick, 2006; Webster & Vernick, 2013b).

To help ensure that guns are not sold to those who are prohibited from purchasing them, the National Instant Criminal Background Check System ([NICS], part of the Brady Law) was developed so that the status of a potential purchaser could be checked immediately by a federally licensed firearm dealer. Prohibited purchasers include, but are not limited to, convicted felons, persons dishonorably discharged from the military, those under a domestic violence restraining order, and, in the language of the federal law, persons who have been adjudicated as mentally defective or have been committed to any mental institution (see 18 U.S.C. § 922(g) (1)-(9) and (n)). About 0.6% of sales have been denied on the basis of these criteria since NICS was established in 1998 (FBI, 2012b).

A substantial portion of firearm sales and transfers, however, is not required to go through a federally licensed dealer or a background check requirement; this includes, in most U.S. states, private party sales including those that are advertised on the Internet and those that take place at gun shows where licensed gun dealers who could process background checks are steps away. Some evidence suggests that state policies regulating private handgun sales reduce the diversion of guns to criminals (Vittes, Vernick, & Webster, 2013; Webster et al., 2009; Webster, Vernick, McGinty, & Alcorn, 2013).

The ability to check the background of a potential purchaser nearly instantly means that in many states, someone who is not a prohibited purchaser can purchase a gun within a matter of minutes. Ten states and the District of Columbia have a waiting period (sometimes referred to as a “cooling-off” period) for handguns ranging from 3 (Florida and Iowa) to 14 (Hawaii) days (Law Center to Prevent Gun Violence, 2012). The efficacy of waiting periods has received little direct research attention.

With the exception of misdemeanor domestic violence assault, federal law and laws in most states prohibit firearm possession of those convicted of a crime only if the convictions are for felony offenses in adult courts. Research has shown that misdemeanants who were legally able to purchase handguns committed crimes involving violence following those purchases at a rate 2–10 times higher than that of handgun purchasers with no prior convictions (Wintemute, Drake, Beaumont, & Wright, 1998). Wintemute and colleagues (Wintemute, Wright, Drake, & Beaumont, 2001) examined the impact of a California law that expanded firearm prohibitions to include persons convicted of misdemeanor crimes of violence. In their study of legal handgun purchasers with criminal histories of misdemeanor violence before and after the law, denial of handgun purchases due to a prior misdemeanor conviction was associated with a significantly lower rate of subsequent violent offending.

Persons who are legally determined to be a danger to others or to themselves as a result of mental illness are prohibited by federal law from purchasing and possessing firearms. A significant impediment to successful implementation of this law is that the firearm disqualifications due to mental illness often are not reported to the FBI’s background check system. As mentioned earlier, in 2007 Connecticut began reporting these disqualifications to the background check system. In a ground-breaking study, Swanson and colleagues (2013) studied the effects of this policy change on individuals who would most likely be affected — that is, those who were legally prohibited from possessing firearms due solely to the danger posed by their mental illnesses. They found that the rate of violent crime offending was about half as high among those whose mental illness disqualification was reported to the background system compared with those whose mental illness disqualification was not reported.

Federal law allows an individual to buy several guns, even hundreds, at once; the only requirement is that a multiple-purchase form be completed (18 U.S.C. § 923(g)(3)(A)(2009)). Large bulk purchases have been linked to gun trafficking (Koper, 2005). Policies such as one-handgun-a-month have rarely been enacted. Evaluations of these laws document mixed findings (Webster et al., 2009, 2013;Weil & Knox, 1996).

The United States was one of the signers of the Geneva Convention, which prohibits the use of hollow-point bullets in war (the goal being to wound but not kill wartime enemies), but hollow-point bullets are available to civilians in the United States. A hunting license is not a prerequisite for the purchase of hollow-point bullets in the United States. California passed a law requiring a thumbprint for ammunition purchases; the law was ruled “unconstitutionally vague” by a Superior Court judge in 2011, but some municipalities (e.g., Los Angeles, Sacramento) have similar local ordinances in effect.

In 2004, a national survey found that 20 percent of the U.S. adult population reported they own one or more long-guns (shotguns or rifles), and 16 percent reported they own a handgun (Hepburn et al., 2007). Self-protection was the primary reason for owning a gun. Most people who have a gun have multiple guns, and half of gun owners reported owning four or more guns. In fact, 4 percent of the population is estimated to own 65 percent of the guns in the nation.

Nationally representative studies suggest that the mental health of gun owners is similar to that of individuals who do not own guns (Miller, Barber, Azrael, Hemenway, & Molnar, 2009; Sorenson & Vittes, 2008). However, gun owners are more likely to binge drink and drink and drive (Wintemute, 2011).

In perhaps the methodologically strongest study to date to examine handgun ownership and mortality, Wintemute and colleagues found a strong association between the purchase of a handgun and suicide: “In the first year after the purchase of a handgun, suicide was the leading cause of death among handgun purchasers, accounting for 24.5 percent of all deaths” (Wintemute, Parham, Beaumont, Wright, & Drake, 1999). The risk of suicide remained elevated (nearly twofold and sevenfold, respectively, for male and female handgun purchasers) at the end of the 6-year study period. Men’s handgun purchase was associated with a reduced risk of becoming a homicide victim (0.69); women’s handgun purchase, by contrast, was associated with a 55 percent increase in risk of becoming a homicide victim. A waiting period may reduce immediate risk but appears not to eliminate short- or long-term risk for suicide.

Risk can extend to others in the home. Efforts to educate children about guns (largely to stay away from them), when tested with field experiments, indicate they are generally ineffective (e.g., Hardy, 2002). Child Access Prevention (CAP) laws focus on the responsibilities of adults; adults are held criminally liable for unsafe storage of firearms around children. CAP laws have been associated with modest decreases in unintentional shootings of children and the suicides of adolescents (Webster & Starnes, 2000; Webster, Vernick, Zeoli, & Manganello, 2004).

Most gun-related laws focus on the user of the gun (e.g., increased penalties for using a gun in the commission of a crime). Some research suggests that having been threatened with a gun, as well as the perpetrator’s having access to a gun and using a gun during the fatal incident, is associated with increased risk of women becoming victims of intimate partner homicide (Campbell et al., 2003). Regarding sales, note that persons with a domestic violence misdemeanor or under a domestic violence restraining order are prohibited by federal law from purchasing and possessing a firearm and ammunition. Research to date indicates that firearm restrictions for persons subject to such laws have reduced intimate partner homicides by 6 percent to 19 percent (Vigdor & Mercy, 2006; Zeoli & Webster, 2010).

As with initial discussions about motor vehicle safety, which focused on what was then referred to as the “nut behind the wheel,” current discussions about gun users sometimes involve terms such as “good guys” and “bad guys.” Although intuitively appealing, such categories seem to assume a static label and do not take into account the fact that “good guys” can become “bad guys” and “bad guys” can become “good guys.” One way an armed “good guy” can become a “bad guy” is to use a gun in a moment of temporary despondence or rage (Bandeira, 2013; Wintemute, 2013a).

Research on near-miss suicide attempts among young adults indicates that impulsivity is of concern. About one fourth of those whose suicide attempt was so severe they most likely would have died reported first thinking about suicide five minutes before attempting it (Simon et al., 2001). Although an estimated 90 percent of those who attempt suicide go on to die of something else (i.e., they do not subsequently kill themselves; for a review, see Bostwick & Pankratz, 2000), for those who use a gun, as noted in opening paragraph of this chapter, there generally is not a second chance.

Given the complexity of the issue, a multifaceted approach will be needed to reduce firearm-related violence (see, for example, Chapman & Alpers, 2013). Not all ideas that on the surface seem to be useful actually are. For example, gun buyback programs may raise awareness of guns and gun violence in a community but have not been shown to reduce mortality (Makarios & Pratt, 2012). Such data can inform policy. President Obama’s January 2013 executive orders about gun violence include directing the CDC to research the causes and prevention of gun violence. The federal government has since announced several funding opportunities for research related to gun violence. And the recent Institute of Medicine and National Research Council (2013) report called for lifting access restrictions on gun-related administrative data (e.g., data related to dealers’ compliance with firearm sales laws, gun trace data) that could be used to identify potential intervention and prevention points and strategies. So perhaps more data will be available to inform and evaluate policies designed to reduce gun violence.

The focus of this section has largely been on mortality. The scope of the problem is far greater, however. For every person who dies of a gunshot wound, there are an estimated 2.25 people who are hospitalized or receive emergency medical treatment for a nonfatal gunshot wound (Gotsch, Annest, Mercy, & Ryan, 2001). And guns are used in the street and in the home to intimidate and coerce (e.g., Sorenson & Wiebe, 2004; Truman, 2011).

Single policies implemented by themselves have been shown to reduce certain forms of gun violence in the United States. Adequate implementation and enforcement as well as addressing multiple intervention points simultaneously may improve the efficacy of these laws even more. After motor vehicle safety efforts expanded to include the vehicle, roadways, and other intervention points (vs. a focus on individual behavior), motor vehicle deaths dropped precipitously and continue to decline (CDC, 1999, 2013a). A multifaceted approach to reducing gun violence will serve the nation well.

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APA Panel of Experts

Dewey Cornell, PhD Clinical Psychologist and Professor of Education Curry School of Education University of Virginia

Arthur C. Evans Jr., PhD Commissioner Department of Behavioral Health and Intellectual disAbility Services Philadelphia, Pa.   Nancy G. Guerra, EdD (Coordinating Editor) Professor of Psychology Associate Provost for International Programs Director, Institute for Global Studies University of Delaware   Robert Kinscherff, PhD, JD Associate Vice President for Community Engagement Massachusetts School of Professional Psychology Senior Associate National Center for Mental Health and Juvenile Justice   Eric Mankowski, PhD Professor of Psychology Department of Psychology Portland State University

Marisa R. Randazzo, PhD Managing Partner SIGMA Threat Management Associates Alexandria, Va.   Ellen Scrivner, PhD, ABPP Executive Fellow Police Foundation Washington, D.C.   Susan B. Sorenson, PhD Professor of Social Policy / Health & Societies Senior Fellow in Public Health University of Pennsylvania

W. Douglas Tynan, PhD, ABPP Professor of Pediatrics Jefferson Medical College Thomas Jefferson University   Daniel W. Webster, ScD, MPH Professor and Director Center for Gun Policy and Research Johns Hopkins Bloomberg School of Public Health

We are grateful to the following individuals for their thoughtful reviews and comments on drafts of this report:   Louise A. Douce, PhD Special Assistant, Office of Student Life Adjunct Faculty, Department of Psychology The Ohio State University   Joel A. Dvoskin, PhD, ABPP Department of Psychiatry University of Arizona   Ellen G. Garrison, PhD Senior Policy Advisor American Psychological Association   Melissa Strompolis, MA Doctoral Candidate University of North Carolina at Charlotte   Mathilde Pelaprat, PsyD , provided writing and research assistance on Chapter 2.

Rhea Farberman, APR Executive Director Public and Member Communications American Psychological Association

Editorial and Design Services Deborah C. Farrell, Editor │ Elizabeth F. Woodcock, Designer

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Home > Topics > Gun Violence: The Impact on Society

Infographics

Gun Violence: The Impact on Society

Social Determinants of Health

Published on: January 16, 2024. Updated on: February 15, 2024.

This infographic explores the rapidly increasing health and economic costs of gun violence across the United States.

The number of firearm deaths grew by nearly 43% between 2010 and 2020 - reaching over 45,000 deaths by the end of the decade. Suicide by firearms have also continued to rise alarmingly. For every person who dies by firearm, more than two survive.

Gun violence is a public health problem: American Public Health Association, Gun Violence is a Public Health Crisis, 2021

42,967 total gun deaths : Gun Violence Archive, Gun Violence Archive 2023, January 2024

43% increase from 2010 to 2020 : John Gramlich, Pew Research Center, What the data says about gun deaths in the U.S., February 2022

327 people are shot each day : The Brady Campaign to Prevent Gun Violence, Key Statistics, December 2023

Average yearly breakdown : The Brady Campaign to Prevent Gun Violence, Gun Violence in the United States, December 2023

For every one person who dies by firearm, more than two survive : The Educational Fund to Stop Gun Violence, Nonfatal Gun Violence, July 2020

Expensive and long-term mental and physical injuries : Alice Miranda Ollstein and Nicholas Wu, Politico , “Health costs of gun violence exceed $1 billion a year, GAO says”, July 2021

Gun violence has significant health and economic consequences, especially among child and adolescent survivors. Gun violence can place a strain on health care systems, with survivors increasing hospitalizations and spending by 1,449% and 1,713% respectively.

Health outcomes following non-fatal firearm injury : Zirui Song et al., in Health Affairs, Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members, Vol. 42, No. 11, November 2023

Gun violence in the US has steep economic consequences, totaling $557 billion in 2022. Most significant are the quality-of-life costs, which include the value of pain and well-being lost by survivors of firearm injuries, decedents, and their families.

$557 billion - Zirui Song, JAMA, The Business Case for Reducing Firearm Injuries, 2022

Economic cost of gun violence : Everytown Research, The Economic Cost of Gun Violence, July 2022

Price Per Individual and Taxpayers : Everytown Research, How does gun violence impact the communities you care about?, 2023

Medicaid and other public programs : Zirui Song et al., Annals of Internal Medicine, Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members, June 2022

Recent studies and cost per person post-injury:

Source 1 : Zirui Song et al., Annals of Internal Medicine, Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members, June 2022

Source 2 : Zirui Song et al., Health Affairs, Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members, November 2023

Between 2018 and 2023, there was a yearly average of around 603 mass shooting events. While mass shootings are often the most publicized events, they are not the primary source of gun violence.

As of February 15, 2024, there have been nearly 50 mass shootings this year alone, resulting in 88 deaths and over 170 injuries.

656 mass shootings in 2023 : Gun Violence Archive, Gun Violence Archive 2023, January 2024

Gun violence definition : Gun Violence Archive, General Methodology, 2022

Mass shootings January 1 - December 31 (2019 - 2022) : Gun Violence Archive, Past Summary Ledgers, December 2023

Historically, mass shootings typically occur in the latter half of the year : Shayanne Gal and Madison Hall, Insider , “The US has had 214 mass shootings so far in 2022. Here's the full list.”, May 2022

Mass shootings account for less than 2% of gun deaths: Gun Violence Archive, Past Summary Ledgers, January 2024

More typical acts of gun violence: German Lopez, The New York Times , “America’s Gun Problem”, May 2022

Prior to 2020, motor vehicle accidents were consistently the leading cause of death for children and adolescents in the US. Since then, gun-related deaths have remained the leading cause of death among this age group.

In response to the number of deaths and injuries caused by motor vehicle accidents, numerous legislative steps have been taken to improve car and motor vehicle safety over time. Until recently, there had not been any widespread federal legislation in response to gun violence since 1994.

Guns are the leading cause of death for American children and adolescents : Jason E Goldstick et al., New England Journal of Medicine , Current Causes of Death in Children and Adolescents in the United States, May 2022

Note: Children and adolescents are defined as persons 1 to 19 years old.

For the first time, guns surpassed motor vehicle accidents as cause of death : Daniel J Flannery and Ruth W Begun, “Guns surpass motor vehicles as top cause of death for U.S. children: What parents should know”, Case Western Reserve University, Jack, Joseph, and Morton Mandel School of Applied Social Sciences

Guns have remained the leading cause of death:

Source 1: Bailey K. Roberts et al., American Academy of Pediatrics, Trends and Disparities in Firearm Deaths Among Children, August 2023

Source 2 : The Children’s Defense Fund, The State of America’s Children, 2023 Gun Violence, December 2023

Firearm vs. motor vehicle deaths : Dan Keating, The Washington Post , “Guns killed more young people than cars did for the first time in 2020”, May 2022

Data in the above article is from the Centers for Disease Control and Web-based Injury Statistics Query and Reporting System ( WISQARS ).

Half of all gun deaths occurred in 10 states : The Children’s Defense Fund, The State of America’s Children, 2023 Gun Violence, December 2023

Breakdown of gun deaths Bailey K. Roberts et al., American Academy of Pediatrics, Trends and Disparities in Firearm Deaths Among Children, August 2023

Overall, incidents of gunfire on school grounds have been on the rise since 2013. Across the US, Texas has the highest number of gunfire occurrences on school grounds in this timeframe, resulting in 65 deaths and 88 injuries.

This year alone, there have been 25 incidents of gunfire on school grounds, responsible for over 10 deaths (as of February 15, 2024) .

At least 1,165 cases of gunfire on school grounds : Everytown, Gunfire on School Grounds in the United States, January 2024

School shootings over time : Everytown, Gunfire on School Grounds in the United States, January 2024

Only high-income country in which guns are the leading cause of child and adolescent deaths: Matt McGough, Krutika Amin, Nirmita Panchal, and Cynthia Cox, KFF, Child and Teen Firearm Mortality in the US and Peer Countries, July 2023

Firearm deaths account for 20% of all child deaths : Matt McGough, Krutika Amin, Nirmita Panchal, and Cynthia Cox, KFF, Child and Teen Firearm Mortality in the US and Peer Countries, July 2023

Mental illness is often stigmatized as being the cause of gun violence. However, only a minority of mass shooters have experienced serious mental illness. It is estimated that 96% of the common violence that occurs would continue even if the elevated risk of violence among people with mental illness was eliminated.

Mental Illness is not a predictor of violence towards others : Mental Health Alliance, Gun Deaths, Violence, and Mental Health, 2022

Mental illness is not a significant risk factor for gun violence : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Mental illness is blamed as the cause : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Only a minority of mass shooters have experienced serious mental illness : Jennifer Skeem and Edward Mulvey, Criminology and Public Policy , “What role does serious mental illness play in mass shootings, and how should we address it?”, December 2019

People with mental illness are more likely to be victims of violence : Katie O’Connor, Psychiatric News , “Mental Illness Too Often Wrongly Associated With Gun Violence”, June 2021

Gun violence may cause mental health issues : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Suicide among those with a diagnosis is rare:

Source 1 : Deborah M. Stone et al., Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015, June 2018

Source 2 : Joseph C. Franklin et al., American Psychological Association, Psychological Bulletin, Risk Factors for Suicidal Thoughts and Behaviors: A Meta-Analysis of 50 Years of Research, 2017

Increased risk of suicide with a gun in the home : Matthew Miller and David Hemenway, The New England Journal of Medicine, Guns and Suicide in the United States, 2008

Nearly half of all suicides involve a gun : Wojciech Kaczkowski et al., Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Notes from the Field: Firearm Suicide Rates, by Race and Ethnicity — United States, 2019–2022, December 2023

United States rates of mental illness vs. gun violence compared to other countries : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Comparison to other high-income countries : Institute for Health Metrics and Evaluation, On gun violence, the United States is an outlier, May 2022

Deaths per 100,000 population by country:

Source 1 : Wisevoter, Gun Deaths by Country, December 2023

Source 2 : Katherine Leach-Kemon and Rebecca Sirull, University of Washington, The Institute for Health Metrics and Evaluation, On gun violence, the United States is an outlier, October 2023

25 times as often : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

On June 25, 2022, President Biden signed the bipartisan gun safety bill. This new legislation aims to improve mental health support and school safety, restrict firearm access for domestic violence offenders, enable states to put in place laws that will allow authorities to take weapons from those deemed “dangerous,” and toughen background checks for young gun buyers.

A 2022 US Supreme Court ruling has been interpreted by lower courts in such a way as to call some of these aspects of legislation into question. Clarification on whether these and similar restrictions are Constitutionally permissible is likely to come in June 2024.

Bipartisan Safer Communities Act : Congress.Gov, S.2938 - Bipartisan Safer Communities Act, June 2022

Most significant federal legislation since 1994 : Executive Office of the President, Office of Management and Budget, Statement of Administration Policy: S.2938 - Bipartisan Safer Communities Act, June 2022

Expanded background checks, “boyfriend loophole”, red flag laws, and illegal gun purchases : Stephanie Lai and Emily Cochrane, The New York Times , “Here’s what is in the Senate’s gun bill - and what was left out.”, June 2022

Federally licensed gun dealers: Aaron Sanchez-Guerra, The News & Observer , “How the Senate’s bipartisan gun bill would affect firearm buyers and sellers in NC”, June 2022

Mental health and school safety: Kelsey Snell, NPR , “Senators reach final bipartisan agreement on a gun safety bill”, June 2022

2023 Court Rulings

New York State Rifle & Pistol Association Inc. v. Bruen : Oyez, New York State Rifle & Pistol Association Inc. v. Bruen, 597 U.S. 1 (2022)

United States v. Rahimi : SCOTUS Blog, United States v. Rahimi, 61 F. 4 th 443 (5 th Cir. 2023), cert. granted 143 S.Ct. 2688 (2023)

This infographic was reviewed by:

• Paul Helmke, JD, P rofessor of Practice at Indiana University's O'Neill School of Public and Environmental Affairs and Founding Director of the Civic Leaders Living-Learning Center
• Zirui Song, MD, PhD, Associate Professor of Health Care Policy and Medicine at Harvard Medical School (HMS) and Massachusetts General Hospital and Director of Research at the HMS Center for Primary Care

To learn more about covering important health care and public health topics, such as gun violence, read the recent work by NIHCM Grantee, Association for Health Care Journalists .

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Office of Gun Violence   Prevention

In September 2023, President Biden established the first-ever White House Office of Gun Violence Prevention to reduce gun violence, which has ravaged communities across the country, and implement and expand upon key executive and legislative action which has been taken to save lives.   The Office of Gun Violence Prevention is overseen by Vice President Harris, who has been a been a key leader in the Biden-Harris Administration’s effort to end our nation’s gun violence epidemic. Stefanie Feldman, a longtime policy advisor to President Biden on gun violence prevention, serves as Director of the Office of Gun Violence Prevention, alongside leading gun violence prevention advocates Greg Jackson and Rob Wilcox, who joined the Administration as Deputy Directors of the Office of Gun Violence Prevention.

The Office of Gun Violence Prevention builds on historic actions taken by President Biden to end gun violence in our country: including signing the Bipartisan Safer Communities Act, the most significant legislative action in nearly 30 years aimed at doing so, and taking more meaningful executive action than any other president to make our schools, churches, grocery stores, and communities safer.   The Biden-Harris Administration has worked to implement the Bipartisan Safer Communities Act, the most significant gun violence prevention legislation in nearly 30 years. This legislation is already saving lives by keeping guns out of the hands of individuals under 21 who are prohibited from purchasing firearms, empowering the Justice Department with new authorities to prosecute firearms traffickers, improving access to mental health services in our schools to help young people deal with the trauma and grief resulting from gun violence, and investing in community violence interventions.   The Biden-Harris Administration has announced dozens of executive actions to: keep especially dangerous weapons and repeat shooters off our streets; hold rogue gun dealers and gun traffickers accountable; provide law enforcement with the tools and resources they need to reduce gun violence; and address the root causes of gun violence.  Most recently, the Justice Department’s Bureau of Alcohol, Tobacco, Firearms, and Explosives – a critical leader in work to reduce gun violence – proposed a rule to reduce the number of guns sold without background checks and keep guns out of the hands of criminals.   President Biden continues to call on Congress to take additional action, including by:

• Banning assault weapons and high-capacity magazines;
• Requiring safe storage of firearms;
• Requiring background checks for all gun sales;
• Eliminating gun manufacturers’ immunity from liability; and
• Enacting his Safer America Plan, which would put more police officers on our streets for accountable, community policing and invest in gun violence prevention and intervention.

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• About Firearm Injury and Death
• Facts and Stats
• Funded Research
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• Firearm violence and injuries are a serious public health problem that impact the health and safety of Americans.
• Firearm injuries and deaths are preventable—not inevitable—and everyone has a role to play in prevention.

A firearm injury is a wound or penetrating injury from a weapon that uses a powder charge to fire a projectile. Weapons that use a powder charge include handguns, rifles, and shotguns.

Injuries from air- and gas-powered guns, BB guns, and pellet guns are not considered firearm injuries. This is because these types of guns do not use a powder charge to fire a projectile.

There are many types of firearm injuries, which can be fatal or nonfatal:

• Intentionally self-inflicted: suicide or nonfatal self-harm injury from a firearm.
• Unintentional: fatal or nonfatal firearm injuries that happen while someone is cleaning or playing with a firearm or other incidents of an accidental firing without evidence of intentional harm.
• Interpersonal violence: homicide or nonfatal assault injury from a firearm.
• Legal intervention: firearm injuries inflicted by the police or other law enforcement agents acting in the line of duty. For example, firearm injuries that occur while arresting or attempting to arrest someone, maintaining order, or ensuring safety. [A]
• Undetermined intent: firearm injuries where there is not enough information to determine whether the injury was intentionally self-inflicted, unintentional, the result of legal intervention, or from an act of interpersonal violence.

Defensive gun use‎

Although definitions of defensive gun use vary, it is generally defined as the use of a firearm to protect and defend oneself, family, other people, and/or property against crime or victimization.

Estimates of defensive gun use vary depending on the questions asked, populations studied, timeframe, and other factors related to study design. Given the wide variability in estimates, additional research is necessary to understand defensive gun use prevalence, frequency, circumstances, and outcomes.

What CDC is doing

CDC's Injury Center has been the nation's leading public health authority on violence and injury prevention for over 30 years. Firearm violence has tremendous impact on Americans' overall safety and wellbeing.

Important gaps remain in our knowledge about the problem and ways to prevent it. Addressing these gaps is an important step toward keeping individuals, families, schools, and communities safe from firearm violence and its consequences.

Using a public health approach is essential to addressing firearm violence and keeping people safe and healthy. CDC's approach to preventing firearm injuries focuses on three elements:

• Providing data to inform action.
• Conducting research and applying science to identify effective solutions.
• Promoting collaboration across multiple sectors to address the problem.
• The term legal intervention is a commonly used external cause of injury classification. It does not indicate the legality of the circumstances surrounding the death.

Firearm Injury and Death Prevention

Firearm injury and death is a serious public health problem that impacts the health and safety of Americans. CDC works to understand the problem of firearm injury and death and prevent it.

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Meet the public health researchers trying to rein in america's gun violence crisis.

Christine Spolar

A digital illustration of a circle of hands extending from the edge of the image, each holding a sheet of paper. The papers overlap in the center and, like a puzzle, come together to reveal a drawing of a handgun. Oona Tempest/KFF Health News hide caption

A digital illustration of a circle of hands extending from the edge of the image, each holding a sheet of paper. The papers overlap in the center and, like a puzzle, come together to reveal a drawing of a handgun.

Gun violence has exploded across the U.S. in recent years — from mass shootings at concerts and supermarkets to school fights settled with a bullet after the last bell.

Nearly every day of 2024 so far has brought more violence. On Feb. 14, gunfire at the Super Bowl parade in Kansas City, Missouri, killed one woman and wounded 22 other people. Most events draw little attention — while the injuries and toll pile up.

Gun violence is among America's most deadly and costly public health crises. But unlike other big killers — diseases like cancer and HIV or dangers like automobile crashes and cigarettes — sparse federal money goes to studying or preventing it.

That's because of a one-sentence amendment tucked into the 1996 Congressional budget bill: "None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control."

Its author was Jay Dickey, an Arkansas Republican who called himself the "point man" for the National Rifle Association on Capitol Hill. And for nearly 25 years the amendment was perceived as a threat to, and all but paralyzed, the CDC's support and study of gun violence.

Goats and Soda

How the u.s. gun violence death rate compares with the rest of the world.

Even so, a small group of academics have toiled to document how gun violence courses through American communities with vast and tragic outcomes. Their research provides some light as officials and communities develop policies mostly in the dark.

It has also inspired a fresh generation of researchers to enter the field – people who grew up with mass shootings and are now determined to investigate harm from firearms. There is momentum now, in a time of rising gun injury and death, to know more.

The reality is stark:

Gun sales reached record levels in 2019 and 2020. Shootings soared. In 2021, for the second year , more people died from gun incidents — 48,830 — than in any year on record, according to a Johns Hopkins University analysis of CDC data. Guns became the leading cause of death for children and teens. Suicides accounted for more than half of those deaths, and homicides were linked to 4 in 10.

Gun deaths hit their highest level ever in 2021, with 1 person dead every 11 minutes

Black people are nearly 14 times as likely to die from firearm violence as white people — and guns were responsible for half of all deaths of Black teens ages 15 to 19 in 2021, the data showed.

Harvard research published in JAMA in 2022 estimated gun injuries translate into economic losses of $557 billion annually , or 2.6% of the U.S. gross domestic product.

With gun violence touching nearly every corner of the country, surveys show that Americans — whatever their political affiliation or whether they own guns or not — support policies that could reduce violence .

Quashing a quest for knowledge

It is no secret that many strategies for reducing harm from guns proposed today — from school metal detectors to enhanced policing, to the optimal timing and manner of safely storing guns, to restrictions on gun sales — have limited scientific ballast because of a lack of data.

It could have been otherwise.

U.S. firearm production surged in the late 1980s , flooding communities with more than 200 million weapons . In that era, Mark Rosenberg was the founding director of the CDC's National Center for Injury Prevention and Control and his agency, over time, was pivotal in helping to fund research on gun violence and public health.

Mark Rosenberg, one of the nation's top authorities on gun violence and public health, was the founding director of the National Center for Injury Prevention and Control at the CDC. Oona Tempest/KFF Health News hide caption

Rosenberg thought then that gun violence could go the way of car crashes. The federal government spent $200 million a year on research to redesign roadways and cars beginning in the 1970s, he said, and had seen death rates plummeted.

"We said, 'Why can't we do this with gun violence?'" Rosenberg said. "They figured out how to get rid of car crashes — but not cars. Why can't we do the same thing when it comes to guns?"

The Dickey Amendment sidelined that dream.

A study published in 1993 concluded that "guns kept in the home are associated with an increase in the risk of homicide," a finding on risk factors that prompted an uproar in conservative political circles. To newly elected representatives in the midterm "Republican Revolution" of 1994, the research was a swipe at gun rights. The NRA stepped up lobbying, and Congress passed what's known as the Dickey Amendment in 1996.

Some Democrats, such as the influential John Dingell of Michigan (a onetime NRA board member who received the group's " legislative achievement award "), would join the cause. Dingell proposed his own bills, detailed last summer by The New York Times .

Under heavy political pressure, the CDC ousted Rosenberg in 1999. Soon after, some CDC administrators began alerting the NRA to research before publication.

"It was clearly related to the work we were doing on gun violence prevention," Rosenberg, now 78, said of his job loss. "It was a shock."

Gun researchers who persevered

The quarter-century spending gap has left a paucity of data about the scope of gun violence's health effects: Who is shot and why? What motivates the violence? With what guns? What are the injuries? Can suicides, on the rise from gunfire, be reduced or prevented with safeguards? Does drug and alcohol use increase the chances of harm? Could gun safeguards reduce domestic violence? Ultimately, what works and what does not to prevent shootings?

If researchers say they "lost a generation" of knowledge about gun violence, then American families lost even more, with millions of lives cut short and a legacy of trauma passed down through generations.

Rebecca Cunningham, the vice president of research at the University of Michigan and an emergency medical doctor, organized a national conference last fall on the prevention of firearm harm that drew more than 750 academics and public health, law, and criminal justice experts. "You can feel momentum" for change, she says. Oona Tempest/KFF Health News hide caption

Imagine if cancer research had been halted in 1996 — many tumors that are now eminently treatable might still be lethal. "It's like cancer," said Rebecca Cunningham, vice president for research at the University of Michigan, an academic who has kept the thread of gun research going all these years. "There may be 50 kinds of cancer, and there are preventions for all of them. Firearm violence has many different routes, and it will require different kinds of science and approaches."

Cunningham is one of a small group of like-minded researchers from universities across the United States, who refused to let go of investigating a growing public health risk, and they pushed ahead without government funds.

Garen Wintemute has spent about $2.45 million of his money to support seminal research at the University of California-Davis. With state and private funding, he created a violence prevention program in California, a leader in firearm studies. He has documented an unprecedented increase in gun sales since 2020 — about 15 million transactions more than expected based on previous sales data.

Daniel Webster, a Johns Hopkins University researcher, has focused on teenagers and guns. Oona Tempest/KFF Health News hide caption

Daniel Webster at Johns Hopkins University focused on teenagers and guns — particularly access and suicides — and found that local police who coped with gun risks daily were willing to collaborate. He secured grants, even from the CDC, with carefully phrased proposals that avoided the word "guns," to study community violence.

At Duke University, Philip J. Cook explored the underground gun market, interviewing people incarcerated in Chicago jails and compiling pivotal social science research on how guns are bought, sold, and traded.

David Hemenway , an economist and public policy professor at Harvard, worked on the national pilot to document violent deaths — knowing most gun deaths would be recorded that way — because, he said, "if you don't have good data, you don't have nothin'."

Hemenway, writing in the journal Nature in 2017, found a 30% rise in gun suicides over the preceding decade and nearly a 20% rise in gun murders from 2014 to 2015. The data was alarming and so was the lack of preventive know-how, he wrote. "The US government, at the behest of the gun lobby, limits the collection of data, prevents researchers from obtaining much of the data that are collected and severely restricts the funds available for research on guns," he wrote. "Policymakers are essentially flying blind."

David Hemenway, a Harvard economist and public policy professor, anchored the work that led to the most ambitious database of U.S. gun deaths today. Oona Tempest/KFF Health News hide caption

His work helped create the most ambitious database of U.S. gun deaths today — the National Violent Death Reporting System . Funded in 1999 by private foundations, researchers were able to start understanding gun deaths by compiling data on all violent deaths from health department, police, and crime records in several states. The CDC took over the system and eventually rolled in data from all 50 states.

Still, no federal database of nonfatal gun injuries exists. So the government would record one death from the Super Bowl parade shooting, and the 22 people with gunshot injuries remain uncounted — along with many thousands of others over decades.

Philanthropy has supported research that Congress would not. The Joyce Foundation in Chicago funded the bulk of the grants, with more than $33 million since the 1990s. Arnold Ventures ' philanthropy and the Robert Wood Johnson Foundation have added millions more, as has Michael Bloomberg, the politician and media company owner. The Rand Corp. , which keeps a tab of ongoing research, finds states increasingly are stepping up.

Timothy Daly, a Joyce Foundation program director, said he remembers when the field of gun harm was described by some as a "desert." "There was no federal funding. There was slim private funding," he said. "Young people would ask themselves: 'Why would I go into that?'"

Research published in JAMA in 2017 found gun violence "was the least-researched" among leading causes of death. Looking at mortality rates over a decade, gun violence killed about as many people as sepsis, the data showed. If funded at the same rate, gun violence would have been expected to receive $1.4 billion in research funds. Instead, it received $22 million from across all U.S. government agencies.

There is no way to know what the firearm mortality or injury rate would be today had there been more federal support for strategies to contain it.

A reckoning and new push for research

As gun violence escalated to once unthinkable levels, Congressman Dickey came to regret his role in stanching research and became friends with Rosenberg. They wrote a pivotal Washington Post op-ed about the need for gun injury prevention studies. In 2016, they delivered a letter supporting the creation of the California Firearm Violence Research Center.

Both men, they emphasized, were NRA members and agreed on two principles: "One goal must be to protect the Second-Amendment rights of law-abiding gun owners; the other goal, to reduce gun violence."

Dickey died in 2017, and Rosenberg has only kind words for him. "I did not blame Jay at all for what happened," he said. The CDC was "under pressure from Congress to get rid of our gun research."

As alarm over gun fatality statistics from diverse sectors of the nation — scientists, politicians, and law enforcement — has grown, research in the field is finally gaining a foothold.

Even Congress, noting the Dickey Amendment was not an all-out ban, appropriated $25 million for gun research in late 2019, split between the CDC — whose imperative is to research public health issues — and the National Institutes of Health. It's a drop in the bucket compared with what was spent on car crashes, and it's not assured. House Republicans this winter have pushed an amendment to once again cut federal funding for CDC gun research.

Still it's a start. And with growing interest in the field, the torch has passed to the next generation of researchers.

In November, Cunningham helped organize a national conference on the prevention of firearm-related harm. More than 750 academics and professionals in public health, law, and criminal justice met in Chicago for hundreds of presentations. A similar event in 2019, the first in 20 years, drew just a few dozen presentations.

"You can feel momentum," Cunningham said at the conference, reflecting on the research underway. "There's a momentum to propel a whole series of evidence-based change — in the same way we have addressed other health problems."

During a congressional hearing weeks later , Yale University School of Public Health Dean Megan L. Ranney bluntly described the rising number of gun deaths — noting the overwhelming number of suicides — as a warning for lawmakers. "We are turning into a nation of traumatized survivors," she said, urging their support for better data and research on risk factors.

Cassandra Crifasi, co-director of the Johns Hopkins Center for Gun Violence Solutions, was in high school when the Columbine massacre shook the country. Oona Tempest/KFF Health News hide caption

Cassandra Crifasi, 41, was a high school sophomore when the Columbine massacre outside Littleton, Colorado, shook the country. She recently succeeded Webster, her mentor and research partner , as co-director of the Johns Hopkins Center for Gun Violence Solutions.

Crifasi has spent much of her career evaluating risk factors in gun use, including collaborative studies with Baltimore police and the city to reduce violence.

Raised in Washington state, Crifasi said she never considered required training in firearms an affront to the Second Amendment. She owns guns. In her family, which hunted, it was a matter of responsibility.

"We all learned to hunt. There are rules to follow. Maybe we should have everybody who wants to have a gun to do that," she said.

Crifasi pointed to the 2018 shooting at Marjory Stoneman Douglas High in Parkland, Florida — which left 17 dead and 17 injured — as a turning point. Students and their parents took "a page out of Mothers Against Drunk Driving — showing up, testifying, being in the gallery where laws are made," she said.

"People started to shift and started to think: This is not a third rail in politics. This is not a third rail in research," Crifasi said.

Shani Buggs, a lead investigator at the California Firearm Violence Research Center, has studied anxiety and depression among young people who live in neighborhoods with gun violence. Oona Tempest/KFF Health News hide caption

Shani Buggs worked in corporate management before she arrived at Johns Hopkins to pursue a master's in public health. It was summer 2012, and a gunman killed 12 moviegoers at a midnight showing of "The Dark Knight Rises" in Aurora, Colorado. The town's pain led the national news, and "rightfully so," Buggs said. "But I was in Baltimore, in East Baltimore, where there were shootings happening that weren't even consistently making the local news."

Now violence "that once was considered out of bounds, out of balance — it is more and more common," said Buggs who recently joined the California Firearm Violence Research Center as a lead investigator.

Buggs' research has examined anxiety and depression among youths who live in neighborhoods with gun violence — and notes that firearm suicide rates too have drastically increased among Black children and adolescents.

There is a trauma from hearing gunshots and seeing gun injuries, and daily life can be a thrum of risk in vulnerable communities, notably those largely populated by Black and Hispanic people, Buggs said. Last year, Buggs organized the Black and Brown Collective with a core group of about two dozen scientists committed to contextualizing studies on gun violence.

"The people most impacted by the gun violence we usually hear about in America look like our families," she said of the collective.

"They are not resilient. People are just surviving," Buggs said. "We need way more money to research and to understand and address the complexity of the problem."

KFF Health News , formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

• gun violence
• gun violence prevention
• gun violence research

Gun Violence, Prevention of (Position Paper)

Introduction.

Gun violence is a national public health epidemic that exacts a substantial toll on the U.S. society. Gun violence includes homicide, violent crime, attempted suicide, suicide, and unintentional death and injury. According to the Centers for Disease Control and Prevention (CDC), more than 38,000 deaths from firearms (including suicides) occurred in the United States in 2016, 1  and nearly 85,000 injuries from firearms occurred in 2015. 2  That’s an average of 105 deaths and more than 230 injuries from firearms each day. 1,2

In addition to the thousands killed or injured, myriad families must also cope with the consequences of this violence. In terms of the financial toll, although the estimates vary, it’s generally held that gun violence expenses—medical charges, loss of income, daily care/support, and criminal justice expenditures—cost the U.S. economy approximately $229 billion annually. 3

Gun violence should be considered a public health issue, not a political one—an epidemic that needs to be addressed with research and evidence-based strategies that can reduce morbidity and mortality. Gun violence affects people of all ages and races. Family physicians care for victims of gun violence and their families every day. These physicians, who witness the substantial impact firearm-related violence has on the health of their patients, families, and communities, have the power to help improve the safety and wellbeing of those groups.

The complexity and frequency of firearm violence, combined with its impact on the health and safety of Americans, suggest that a public health approach should be a key strategy used to prevent future harm and injuries. This approach focuses on three elements: scientific methodology to identify risk and patterns, preventive measures, and multidisciplinary collaboration. 4  The AAFP encourages this public health approach and supports research that identifies which policies and interventions effectively reduce morbidity and mortality, while also respects the Constitutional right to bear arms.

Call to Action The American Academy of Family Physicians joined the American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, and the American Psychiatric Association urging the president and Congress to take the following three concrete steps to address gun violence:

• Label violence caused by the use of guns as a national public health epidemic.
• Fund appropriate research as part of the federal budget.
• Establish constitutionally appropriate restrictions on the manufacturing and sale, for civilian use, of large-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity. 5

This call to action from physician groups emphasizes the need to treat gun violence as a public health epidemic.

Family physicians can further address gun violence in their practices and communities by following these office- and community-based steps.

Office-based:

• Know the rates of gun violence in your area to help understand the impact on your patient population ( http://www.gunviolencearchive.org/charts-and-maps ). 6
• Ask patients and their families if there are guns in the home. If “yes,” discuss safe storage of firearms and ammunition. Encourage participation in gun safety classes.
• The AAFP  recommends  screening for depression in the general adult population, including pregnant and postpartum women ( https://www.aafp.org/patient-care/clinical-recommendations/all/depression.html ). 7

o   Patients who screen positive should undergo additional assessment that considers severity of depression and comorbid psychological problems, alternate diagnoses, and medical conditions. Patients with depression should be treated with antidepressant medication and/or psychotherapy.

• The AAFP  recommends  that clinicians screen women of childbearing age for intimate partner violence (IPV), such as domestic violence, and provide or refer women who screen positive to intervention services ( https://www.aafp.org/patient-care/clinical-recommendations/all/domestic-violence.html ). 8

o   The presence of guns in the home increases the risk that a woman will die due to an IPV-related homicide eight-fold. 9

Community-based:

• Know the rates of gun violence in your area to better understand the impact on your community ( http://www.gunviolencearchive.org/charts-and-maps ) 6
• Participate in programs that address violence in your community.
• Communicate with your local, state, and federal officials about gun violence as a public health concern. These conversations should specifically address:

o   Funding research to identify effective measures to increase the safety of firearms; o   Gun safety legislation; o   Strict enforcement of current gun laws; o   Constitutionally-appropriate restrictions on the manufacture and sale, for civilian use, of large-capacity magazines and firearms; and o   Appropriate funding for mental health services.

Gun Violence: A Public Health Epidemic Gun violence is a public health epidemic and should be treated accordingly. While mass shootings are horrific and capture the attention of the media, they are only part of the gun-violence picture—more than half of all suicides are firearm-related, 10  and firearms are used in more than 50% of female homicides. 3,11

Similarly to females, firearm-related deaths are a particular threat to children in the U.S. They are the third-leading cause of death in children overall, 1  and the U.S. accounts for more than 90% of all firearm deaths among children in developed, high-income nations. 12

Public health professionals are trained to create and test interventions to reduce death and injury. However, limited federal funding is available to research this leading cause of death. Introduced in 1996, the Dickey Amendment prohibits federal funding allocated to the Centers for Disease Control and Prevention (CDC) be used to advocate for or promote gun control, which essentially ended all CDC funding research on gun violence or gun control measures. 13

Appropriate research funding is the first step to understand gun violence and is essential to develop programs to prevent premature death from guns. An inconsistent collection of epidemiologic data is another impediment to this research. Currently, not all U.S. states report surveillance data to the National Violent Death Reporting System. 14 International Classification of Disease (ICD) codes are often used to collect data on a national scale, but do not provide the same level of detail. Creating a comprehensive data collection surveillance system will provide public health researchers with comprehensive and consistent information to study gun violence.

An example of such a system in place with data to study a public health issue is research on motor vehicle accidents. The number of deaths caused by motor vehicle accidents is comparable to gun violence, but motor vehicle deaths have declined significantly over the past decade despite more motorists on the road. Extensive research has improved motor vehicle safety with multiple evidence-based interventions contributing to decreased mortality. Implementation of vehicle safety features, stricter enforcement of traffic laws, and public awareness campaigns effectively addressed high morbidity and mortality associated with motor vehicles.

The National Highway Traffic Safety Administration (NHTSA) operates with a budget of more than $1 billion annually, and is committed to the continued improvement of the safety of motor vehicles and motorists. 15  Research and development for the agency alone had a budget of nearly $146 million in 2017. 15

Similarly, almost all other leading causes of death, whether accident or disease, receive substantially more funding for research than gun violence. 16  One study found that, “in relation to mortality, gun violence research was the least-researched cause of death and the second-least funded cause of death after falls.” 16  When a similar approach to research on motor vehicle accidents is suggested for gun violence, it is often considered political, instead of an evidence-based, data-driven approach to prevent morbidity and mortality.

As whole-person health care providers, family physicians see the effect of gun violence on their patients and in their communities. Using a public health perspective, family physicians can incorporate evidence-based strategies to treat their patients and guide their communities on this important issue. With that in mind, the AAFP:

• Continues to oppose legislation that would prohibit the CDC and other agencies from conducting and distributing research on gun violence as a public health problem;
• Advocates for systems to allow accurate reporting of surveillance data; and
• Encourages the evaluation and implementation of evidence-based research and approaches that addresses gun violence to improve the health and lives of all patients.

Suicide In 2016, almost 45,000 individuals committed suicide in the U.S. 1  Suicide accounts for nearly 60% of all firearm-related deaths in the U.S., with men overwhelmingly choosing firearms as their primary method to commit suicide. 1 Alarmingly, suicide was the second-leading cause of death for adolescents ages 15-19, with firearms as the leading method of suicide (50.7%) in this age group. 1

Firearms are the most lethal method of attempting suicide. Between 85 to 91% of firearm suicide attempts result in death, compared to 3% or less for other common ways of attempting suicide. 17  Suicide is often an impulsive decision. The majority of those who survived a suicide attempt reported that less than one hour had passed between the time they decided to commit suicide and when they took action. 18  The use of a firearm to commit suicide rarely allows for intervention or reconsideration, so increased access to firearms is associated with increased rates of completed suicide. 19  Evidence suggests unsafe gun storage may also pose a higher risk for committing suicide using a firearm. 19  The impulsive nature of suicide, in combination with often times easy access to guns, can result in a completed suicide—one that might have been preventable if another method had been attempted.

Opportunities for Prevention Reducing the availability of firearms is one of the most effective mechanisms for suicide prevention. Waiting periods for purchasing handguns, mandatory background checks, gun locks, and restrictions on open-carry policies are also associated with a reduction in suicide by firearm. 20

Waiting periods may allow for a “cooling off” time for individuals to reconsider suicide. 17  Background checks limit access by creating a second barrier at the point of purchase. 20  Safely securing guns places a barrier on immediate access and open-carry regulations decreases exposure to firearms. 20  These mechanisms have been shown not only to decrease suicide by firearm, but also to decrease overall rates of suicide (by any method). 20

In addition to decreasing access to firearms, increased access to mental health services is associated with a decrease in overall rates of suicide. 19  The majority of patients with mental health issues access the health care system through primary care physicians. 21  Appropriate access to primary care and payment for mental health services are critical to care for individuals with depression, substance abuse, and other mental illnesses, and can ultimately prevent attempted suicide through firearms and other means.

Domestic Violence Among developed nations, the U.S. has the most gun violence against women. Women are nearly 16 times more likely to die by firearm when compared to other developed nations. 12  The majority of these deaths are the result of intimate partner violence (IPV). For example, in 2015, more than 3,500 women and girls were victims of homicide. More than half of those deaths were related to IPV. 11  These rates are even greater in subgroups defined by race. Non-Hispanic black and American Indian/Alaskan Native women have the highest rates of IPV-related homicide. 11

Compared to homes without guns, households with guns are associated with a nearly three-fold increase for the risk of homicide occurring in the home. 22  There is a nearly eight-fold increased risk associated with gun ownership and homicide when the perpetrator is the intimate partner or a relative of the victim. 22  If the gun owner has a history of domestic violence, the risk of homicide is 20 times higher. 22  Women who are physically abused by current or former partners are seven times more likely to be murdered if the partner owned a handgun compared to women whose partner does not own a handgun. 9

Opportunities for Prevention A proven strategy to protect women from IPV-related homicides includes reducing the availability of firearms. The AAFP recommends screening all women of childbearing age for IPV, and referring women who screen positive for IPV to intervention services. 8  A step that family physicians can take after a positive assessment for IPV is to refer female patients to organizations which have resources for crisis intervention and counseling, and finding safe housing, medical care, and legal advocacy. 11

Intimate partner violence is higher in communities experiencing severe disadvantage, such as poverty and low-social cohesion. 23  System-level changes to reinvest in communities of poverty can reduce violence of many forms, including IPV-related homicide. Legislative policy change is an essential component to the reduction of IPV-related homicide.

Restricting firearm purchases for individuals convicted of domestic violence-related crimes or under a domestic violence-related restraining order is an effective way to prevent IPV-related homicide. 24  States with systems to screen for restraining orders prior to firearm purchases have an 8-19% reduction in all IPV homicides and a 9-25% reduction in the rate of IPV homicide with a firearm. 25  However, these safeguards must apply to all purchases to be effective. Currently, federal law only requires background checks for firearm purchases with licensed dealers. 19 Firearms purchased through unlicensed sellers and at gun shows, commonly referred to as the “gun-show loophole,” do not require a background check, allowing for individuals with a history of domestic violence unfettered access to guns. States requiring universal background checks on handgun sales from all sources experienced a 47% reduction in victims of IPV-related firearm homicide. 26

Homicide and Violent Crime with a Firearm In 2016, there were more than 14,400 homicides with a firearm, accounting for nearly three-quarters of all homicides. 1  In contrast to IPV, the majority (80%) of homicide victims are men. 1

In the U.S., individuals are 25 times more likely to be killed by a firearm than in other high-income nations. 12 Disparities exist across racial and ethnic lines, as well. Non-white individuals are more likely to die by homicide than whites. For individuals 10-29 years, homicide is the leading cause of death in non-Hispanic blacks and Hispanics. 27 This is substantially higher than non-Hispanic whites, where homicide is the fifth-leading cause of death. 27

Opportunities for Prevention Not surprising, a lack of research has resulted in a scarcity of evidence regarding prevention of homicide and violent crime. Limited evidence suggests that reducing access to illegal guns through programs that have demonstrated success can reduce homicide and violent crime rates. One program implemented in Baltimore used a system of “hot-spotting,” where detectives were placed in areas at high risk for gun violence. Between 2007 and 2012, areas of “hot spotting” experienced a 12-13% reduction in homicides and an 18-20% reduction in shootings. 28

Background checks may also contribute to decreased rates of both homicide and overall violent crime. 19  Moderate evidence suggests a decrease in violent crime with mental health background checks. 19  However, much of this data is reported voluntarily by states and may vary depending on which conditions prohibit gun ownership. 19  It is important to note that there is evidence that certain policies may actually increase violent crime. There is moderate evidence that stand your ground laws increase rates of homicide, and some evidence that states with concealed carry laws see increased rates of violent crime. 19

Mass Shootings Given no standard definition of “mass shooting,” data on the subject, as well as mass murder is inconsistent. After the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, the U.S. Congress defined “mass killing” as “3 or more killings in a single incident.” 29  This definition does not include information about the weapon(s) used, the number of perpetrator(s), or the location of the shooting. Mass murder is defined by the Federal Bureau of Investigation (FBI) as a “multiple homicide in which four or more victims are murdered, within one event, and in one or more locations in close geographical proximity.” 29  This does not include injuries, nor is this a formal definition used for data collection purposes. Developing standard definitions through consensus among researchers will be crucial for quality, consistent research regarding gun violence.

Mass shootings account for only a small portion of gun violence deaths, but generally garner media attention due to the public and horrific nature of the incidents. In recent years, mass shootings have, by and large, been perpetrated by men using assault-style, semi-automatic weapons, often modified to mimic fully-automatic versions via high-capacity magazines and “bump stock” technology. These shootings have occurred in public places, such as schools, nightclubs, churches, and music venues.

Opportunities for Prevention While a lack of research hinders the development of evidence-based strategies to prevent mass shootings, even small changes—banning modification devices, such as bump stocks and high-capacity magazines—could potentially reduce the number of injuries and deaths that occur.

Congress’s 1994 assault weapons ban, which included 18 types of assault weapons, weapons with military-style features, and weapons with high-capacity magazines (10 or more bullets), lapsed in 2004. In that 10-year period, “gun massacres” (six or more gun deaths) declined compared to the decade prior.

From 2004-2014, after the assault weapons ban lapsed, the number of gun massacre deaths during the ban (89) increased more than three times (302). Also, the number of gun massacre incidents during the ban (12) nearly tripled (34) during the same 10-year period. 30

Unintentional Death and Injury by Firearm Unintentional deaths and injuries by firearms are largely preventable. In 2016, 495 people died from unintentional firearm incidents. 1  Of those, 127 (25.7%) were children and adolescents (0-19 years). 1  Most of those deaths were among two age groups: 15-19 years (53 deaths) followed by 0-4 years (23 deaths). 1  Young adults (20-24 years) had the most deaths by age group, with 68 unintentional firearm deaths. 1

Unintentional injury by firearm also disproportionately affects adolescents and young adults. Of the 17,311 unintentional injuries by firearm in 2015, nearly 8,000 (50%) occurred in individuals between 15-29 years. 2  The rate of unintentional injury by firearm was the highest among individuals between 20-24 years (21.9). 2

Opportunities for Prevention Research suggests clinical interventions and public health campaigns focused on safe storage are effective at preventing unintentional injuries and deaths by firearms. 19  One study found that family physicians and pediatricians who ask patients (mostly those with children) about access to firearms, and are counseled on safe storage and provided a free safe storage device, it results in increased safe storage behaviors. 19  Another study, following the same protocol without a providing a free safe storage device, also found improvements in safe storage of firearms. Safe storage of firearms decreases immediate access to guns, especially for children. 19  Child access prevention (CAP) laws are designed to protect children by legally prosecuting adults who intentionally or carelessly create situations in which children have unsafe and negligent access to guns. 19

These laws often mandate safe storage of firearms, and some states stipulate that firearms must be unloaded when stored. 19  CAP laws also prohibit providing children with unsupervised, reckless access to firearms. 19  Strong evidence suggests CAP laws decrease firearm-related self-injuries (intentional and unintentional) among all ages, and decrease unintentional firearm injuries and death among children. 19,31  Evidence also suggests that classifying violations of CAP law as felonies may further reduce unintentional death and injuries by firearms among children. 19

Policy Strategies to Address Gun Violence Other potential avenues to address gun violence are consistent with common prevention strategies employed in other public health interventions. Two of the most effective public health strategies employed to reduce tobacco use—price increases and taxation—have proven effective deterrents to initiating tobacco use and encouraging the decline and cessation of tobacco use. 32  Applying this economic strategy to the purchase of firearms could potentially reduce gun ownership, and as a result, decrease gun violence.

For example, background checks for ammunition purchases, limits on ammunition purchases, and identification requirements for firearms, have been shown to reduce firearm deaths. 33  Reinstating the 1994 federal assault weapons ban could decrease access to dangerous semi-automatic weapons. Requiring microstamping—microscopic, laser-generated engravings on guns and ballistic materials—contribute to a higher solve rate for homicides and other violent crimes. 34

Call for Research The AAFP calls for increased research funding on gun violence, and identifying key areas that must be addressed. These areas could begin to be addressed by answering the following questions:

• What specific counseling (regarding gun safety and given by physicians) reduces the likelihood of gun violence?
• Does gun safety training reduce gun violence?
• What policies and interventions (including legal remedies and prevention strategies) reduce gun violence?
• What are the most effective interventions for securing public venues to minimize the risk of mass shootings and minimize resulting casualties?

AAFP Efforts to Address Firearm Safety and Violence Family physicians frequently find themselves on the frontlines on public health issues and discussions. This role provides them an opportunity to address and guide conversations about public health issues, such as gun violence, in both the exam room and their communities. By advancing policies that promote safety and discourage violence, family physicians are instrumental in the gun violence debate.

To assist family physicians in this effort, the AAFP has policies and advocacy efforts relating to violence to help equip family physicians as they serve the needs of their patients. The AAFP recognizes violence as a public health concern, and the impact of violence has on immediate and long-term health outcomes. The AAFP acknowledges that violence occurs in the context of a broad range of human relationships and complex interactions. These encompass social, cultural, and economic risk factors, including but not limited to, the influence of the media, substance abuse, interpersonal violence, fragmentation of family life, and the increased availability of weapons.

Moreover, the AAFP recognizes that violence disproportionately affects vulnerable populations, such as women, children, lesbian, gay, bisexual, transgender, questioning, and intersex individuals, as well as those living in poverty, among other populations. The AAFP has outlined multi-faceted issues surrounding violence in position papers, and describes both the challenges and opportunities for family physicians to address the health consequences, as well as to help prevent a continued cycle of violence.

• Violence Position Paper : This paper discusses the incidence and prevalence of violence, the impact it has on health, causes of violence, and the family physician’s role in preventing violence and serving patients who have been impacted by violence (www.aafp.org/about/policies/all/violence.html).
• Violence as a Public Health Concern : This policy discusses the AAFP’s stance on violence as a public health concern (www.aafp.org/about/policies/all/violence-public-health.html).
• Firearms and Safety Issues: This policy covers the AAFP’s stance on firearms, guns, and violence as a public health issue (www.aafp.org/about/policies/all/weapons-laws.html).
• Prevention of Gun Violence : This policy discusses the AAFP’s stance on background checks as a mechanism to prevent gun violence (www.aafp.org/about/policies/all/prevention-gun-violence.html).

As clinicians, family physicians can help prevent gun violence in their practice and within their communities by proper screening and treatment of depression, screening for IPV, referring patients to appropriate services, and talking with patients about the safe storage and handling of guns.

Outside of the exam room, family physicians can help prevent suicide and intentional injuries and deaths by advocating for gun violence research funding and gun control legislation at the community, state, and federal levels. To gain a better understanding of gun violence and potential solutions, it is essential that the U.S. Congress implements research funding to create evidence-based strategies to combat and prevent gun violence.

Gun violence in the U.S. is a public health epidemic. Using comprehensive, interdisciplinary approaches, and working in collaboration with other public health professionals, family physicians can play an imperative role in the reduction of gun violence.

• Web-based Injury Statistics Query and Reporting System. Fatal injury reports, national, regional and state (RESTRICTED) , 1999 – 2016. Centers for Disease Control and Prevention. Accessed April 2, 2018.
• Web-based Injury Statistics Query and Reporting System. Nonfatal injury reports, 2000 – 2015 . Centers for Disease Control and Prevention. Accessed April 2, 2018.
• Follman M, Lurie J, Lee J, West J. The true cost of gun violence in America . The data the NRA doesn’t want you to see. Mother Jones. Accessed April 2, 2018.
• Institute of Medicine. National Research Council. Priorities for research to reduce the threat of firearm-related violence. Washington, DC. The National Academies Press. Accessed April 2, 2018.
• American Academy of Family Physicians. Physician groups demand action now on gun violence . AAFP joins call for president, Congress to start with three steps. Accessed April 2, 2018.
• Gun Violence Archive. Charts and maps.  Accessed April 2, 2018.
• American Academy of Family Physicians. Clinical preventive service recommendation. Depression . Accessed April 2, 2018.
• American Academy of Family Physicians. Clinical preventive service recommendation. Intimate partner violence and abuse of vulnerable adults . Accessed April 2, 2018.
• Campbell JC, Webster D, Koziol-McLain J, et al. Risk factors for femicide in abusive relationships: results from a multistate case control study. Am J Public Health. 2003;93(7):1089-1097.
• National Center for Health Statistics. Suicide and self-inflicted injury. Centers for Disease Control and Prevention. Accessed April 2, 2018.
• Petrosky E, Blair JM, Betz CJ, et al. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence – United States, 2003-2014. MMWR. 2017;66(28):741-746.
• Grinshteyn E, Hemenway D. Violent death rates: the US compared with other high-income OECD countries, 2010. Am J Med. 2016;129(3):266-273.
• Jamieson C. Gun violence research: history of the federal funding freeze. Newtown tragedy may lead to lifting of freeze in place since 1996. American Psycholigal Association. Accessed April 2, 2018.
• National Violent Death Reporting System. Violence prevention. Centers for Disease Control and Prevention . Accessed April 2, 2018.
• National Highway Traffic Safety Administration. Budget estimates. Fiscal year 2017. U.S. Department of Transportation . Accessed April 3, 2018.
• Stark DE, Shah NH. Funding and publication of research on gun violence and other leading causes of death. JAMA. 2017;317(1):84-85.
• Brady Center to Prevent Gun Violence. The truth about suicide & guns.  Accessed April 3, 2018.
• Drexler M. Guns & suicide. The hidden toll. Harvard Public Health . Accessed April 3, 2018.
• RAND Corporation. The science of gun policy. A critical synthesis of research evidence on the effects of gun policies in the United States . Accessed April 3, 2018.
• Anestis MD, Anestis JC. Suicide rates and state laws regulating access and exposure to handguns. Am J Public Health. 2015;105(10):2049-2058.
• American Academy of Family Physicians. Mental health care services by family physicians (position paper). Accessed April 3, 2018.
• Kellermann AL, Rivara FP, Rushforth NB, et al. Gun ownership as a risk factor for homicide in the home. N Engl J Med. 1993;329:1084-1091.
• Beyer K, Wallis AB, Hamberger LK. Neighborhood environment and intimate partner violence: a systematic review. Trauma Violence Abuse. 2015;16(1):16-47.
• Center for Gun Policy and Research. Intimate partner violence and firearms. Johns Hopkins Bloomberg School of Public Health . Accessed April 3, 2018.
• Zeoli AP, Malinski R, Turchan B. Risks and targeted interventions: firearms in intimate partner violence. Epidemiol Rev. 2016;38(1):125-139.
• Everytown for Gun Safety. Guns and domestic violence. Accessed April 3, 2018.
• Web-based Injury Statistics Query and Reporting System. Leading causes of death reports, national and regional , 1999 – 2015. Centers for Disease Control and Prevention. Accessed April 3, 2018.
• Samuels A. Hot spot policing focusing on guns is most effective strategy for reducing gun violence in Baltimore, stud finds . Accessed April 3, 2018.
• Congressional Research Service. Mass murder with firearms: incidents and victims, 1999-2013 . Accessed April 3, 2018.
• Ingraham C. It’s time to bring back the assault weapons ban, gun violence experts say. The Washington Post. Accessed April 3, 2018.
• Dowd MD, Sege RD. Firearm-related injuries affecting the pediatric population. Council on Injury, Violence, and Poison Prevention Executive Committee. Pediatrics. 2012;130(5):e1416-e1423.
• Public Health Law Center at Mitchell Hamline School of Law. Taxation and product pricing. Accessed April 3, 2018.
• Kalesan B, Mobily ME, Keiser O, Fagan JA, Galea S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. The Lancet. 2016; 387(10030):1847-1855.
• Giffords Law Center to Prevent Gun Violence. Microstamping & ballistics . Accessed April 3, 2018.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

Gun Violence in America: The 13 Key Questions (With 13 Concise Answers)

It's not like no one has ever asked them before. There's data everywhere and decades of research. We tracked down the best of it so you don't have to. 

Jump to a question:

How much gun violence is there in the U.S.?

How many guns are there in the U.S.?

How do mass shootings differ from other types of gun violence?

What gun control laws currently exist?

What could be done to reduce gun violence?

Would fewer guns result in less gun violence?

• Would gun control result in fewer guns?

How often are guns used in self-defense?

Won't criminals kill with other weapons if they don't have guns?

What has worked to reduce gun violence?

Are the White House proposals likely to be effective?

How does the U.S. compare to other countries?

What don't we know yet?

There were 8,583 homicides by firearms in 2011, out of 12,664 homicides total, according to the FBI . This means that more than two-thirds of homicides involve a firearm. 6,220 of those homicides by firearm (72%) are known to have involved a handgun.

It's worth noting that violent crime rates of all types have been steadily decreasing since the early 1990s. No one is quite sure what is causing this decrease, though there are many theories , ranging from tighter gun control laws to more innovative policing and changes in the drug market. Whatever the cause of this decline, America still has a homicide rate of 4.7 murders per 100,000 people, which is one of the highest of all developed countries (see: international comparison).

Gun violence also affects more than its victims. In areas where it is prevalent, just the threat of violence makes neighborhoods poorer. It's very difficult to quantify the total harm caused by gun violence, but by asking many people how much they would pay to avoid this threat -- a technique called contingent valuation -- researchers have estimated a cost to American society of $100 billion dollars .

Guns are also involved in suicides and accidents. 19,392 of 38,264 suicides in 2010 involved a gun (50%), according to the CDC . There were 606 firearm-related accidents in the same year -- about 5% of the number of intentional gun deaths.

There are about 310 million guns in the country . About 40% of households have them, a fraction that has been slowly declining over the last few decades, down from about 50% in the 1960s. Meanwhile, the overall number of guns has increased to about one gun per person, up from one gun for every two persons in the 1960s. This means that gun ownership has gotten much more concentrated among fewer households: if you own one gun, you probably own several. America has the highest rate of gun ownership of any country in the world, by a wide margin (see: international comparison).

( More : A long running poll by Gallup ; the wide-ranging General Social Survey ; a New York Times demographic breakdown by Nate Silver)

The FBI defines a "mass murder" as four or more murders during the same incident. This is an arbitrary number, but a dividing line is useful when asking whether there are differences between mass shootings and other kinds of gun violence. The most comprehensive public list of U.S. mass shootings is the spreadsheet of 62 incidents from 1982-2012, compiled by Mother Jones . Their list shows:

• Mass shootings happen all over the country .
• Killers used a semi-automatic handgun in 75% of incidents, which is about the same percentage as the 72% in overall gun violence.
• Killers used an assault weapon in 40% of incidents. This is much higher than overall assault weapon use in crimes, estimated at less than 2%.
• The guns were obtained legally in 79% of mass shootings.
• Many of the shooters showed signs of mental illness, but in only two cases was there a prior diagnosis.
• There were no cases where an armed civilian fired back.

2012 was the worst year in American history, in terms of total victims. A graph of yearly victims shows a slight upward trend. But the pattern is a lot less clear without the 2012 peak, and because yearly numbers vary so widely, it's likely that there will be many fewer victims next year.

Several criminologists deny that mass shootings are increasing. Although these incidents dominate headlines and conversation, it's important to remember that they account for only a small fraction of gun violence in the United States. For example, the spike of 72 deaths in 2012 includes only 0.8% of all firearm-related homicides in 2011 (the last year for which statistics are available.) Many gun deaths, especially in large cities, never make the news . This means that the most effective gun violence reduction strategies -- in terms of lives saved -- might not target mass shootings at all.

There are two major federal laws that regulate firearm ownership and sales. The National Firearms Act of 1934 restricts civilians from owning automatic weapons, short-barreled shotguns, hand grenades, and other powerful arms. The Gun Control Act of 1968 focuses on commerce. It prohibits mail-order sales of weapons, and requires anyone in the business of selling guns to be federally licensed and keep permanent sales records. It also prohibits knowingly selling a gun to those with prior criminal records, minors, individuals with mental health problems, and a few other categories of people.

The Brady Handgun Violence Prevention Act of 1993 requires licensed gun dealers to perform background checks. Background checks are not required for private gun sales (though, as mentioned above, it's still a crime to knowingly sell a gun to someone with a criminal record). To ensure privacy, Section 103(i) of the Act prevents the Federal government from keeping the names submitted for background checks, or using this information to create any sort of registry of gun owners.

From 1994 to 2004, the Federal Assault Weapons Ban prohibited the sale and manufacture of semi-automatic weapons (in which each pull of the trigger fires one shot) with various military features such as large-capacity magazines and pistol grips. It was still legal to keep previously owned weapons. The law expired in 2004 due to a built-in "sunset" clause.

These federal laws set minimum standards, but many states have also passed various types of gun laws. These laws determine which weapons are legal to own, and also set requirements on sales, background checks, storage, open and concealed carrying permits, and sentencing of gun-related crimes.

( More: Gun Laws in the US, State by State , The Guardian , and Gun Control Legislation , Congressional Research Service)

The firearms debate usually revolves around "gun control" -- that is, laws that would make guns harder to buy, carry, or own. But this is not the only way of reducing gun violence. It is possible to address gun use instead of availability. For example, Project Exile moved all gun possession offenses in Richmond, Virginia, to federal courts instead of state courts, where minimum sentences are longer. Policies like these, which concern gun use, are sometimes said to operate on gun "demand," as opposed to gun control laws, which affect "supply."

Similarly, while the idea of new laws gets most of the attention, some projects have focused on enforcing existing laws more effectively, or changing policing strategies the way Boston's Operation Ceasefire did in the 1990s. In fact, launching community-based programs has proven to be one of the most effective strategies for reducing gun violence. (See: What has worked , below.)

There have also been programs based on other principles, such as public safety education and gun buy-back campaigns. The White House proposals (see below ) address both gun access and gun use, and include both new laws and enhanced enforcement of existing laws.

( More: Aiming for Evidence-based Gun Policy , Phillip Cook and Jens Ludwig)

Suppose it were possible to reduce the number of guns in circulation, or make it harder for people to get a gun. Would gun violence go down?

Although countries that offer easier access to guns also have more gun violence , at least among developed nations, this doesn't necessarily mean that more guns cause more deaths . People may own more guns in dangerous places because they want to protect themselves. It's also possible that gun ownership is a deterrent to crime, because criminals must consider the possibility that their intended victim is armed.

Economist John Lott did extensive work on this question in the late 1990s, culminating in his 1998 book More Guns, Less Crime . He studied the effect of right-to-carry laws by examining violent crime rates before and after they were implemented in various states, up until 1992, and concluded that such laws decreased homicides by an average of 8%. Lott's data and methods have been extensively reviewed since then. A massive 2004 report by a 16-member panel of the National Research Council found that there was not enough evidence to say either way whether right-to-carry laws affected violence. In 2010, different researchers re-examined Lott's work, the NRC report, and additional data up through 2006, and reaffirmed that there is no evidence that right-to-carry laws reduce crime.

Meanwhile, other studies have suggested that reduced access to guns would result in less crime. These studies compared homicide rates with gun availability in various states and cities. The most comprehensive estimate is that a 10% reduction in U.S. households with guns would result in a 3% reduction in homicides. Internationally , the effect of reductions in gun ownership might be much larger. This might have to do with the large number of guns already available in the U.S.: Any reduction in gun violence hinges on whether gun control laws would actually make it prohibitively difficult to get a gun.

( More: Gun Rhetoric vs. Gun Facts , Factcheck.org; The Impact of Right to Carry Laws and the NRC Report: Lessons for the Empirical Evaluation of Law and Policy , John J. Donohue III, Abhay Aneja, and Alexandria Zhang)

Does gun control result in fewer guns?

In principle, it's not necessary to keep guns away from everyone , just those who would misuse them. Background checks are promising because a high fraction of future killers already have a criminal record. In one study in Illinois, 71% of those convicted of homicide had a previous arrest, and 42% had a prior felony conviction.

Yet current federal gun regulation (see above) contains an enormous loophole: While businesses that deal in guns are required to keep records and run background checks, guns can be transferred between private citizens without any record. This makes straw purchases easy. In other words, these laws may generally make guns harder to come by, but those who really want them can still obtain them through private sales.

Also, although it's generally illegal to sell guns across state lines, in practice this is very common. There's abundant evidence that under the current system, guns flow easily between legal and illegal markets. Washington, D.C,. banned all handguns in 1976, and Chicago did the same in 1982. In neither case did the percentage of suicides using firearms -- considered a very good proxy for general gun availability -- fall significantly.

Similarly, Illinois had a background check requirement before 1994, so the local gun market was not affected by the passage of the Brady Act, but gun trace data shows that criminals simply switched from smuggling guns from out of state to buying them illegally in state.

( More : Where 50,000 Guns Recovered in Chicago Came From , New York Times )

There are no comprehensive records kept of incidents where guns are used in self-defense, so the only way to know is to ask people. Data from the National Crime Victimization Survey suggest that a gun is used in self-defense about 60,000 to 120,000 times each year . Several other surveys confirm this estimate. By comparison, each year about a million violent crimes involve guns. This means guns are used to commit a crime about 10 times as often as they are used for self-defense.

A few surveys in the early 1990s suggested that there are millions gun self-defense incidents each year, but there are very good reasons to believe that these estimates were improperly calculated and these numbers are way off , more than 10 times too high. If the numbers really were this high, this would imply that pretty much every gunshot wound in America is the result of somebody protecting him or herself.

Even among the more accurate surveys, according to a panel of criminal court judges who reviewed survey respondents' stories, about half the time the gun use was "probably illegal," even assuming the gun itself had been purchased legally.

( More : Gun threats and self-defense gun use , Harvard Injury Control Research Center)

The crux of this question is whether most homicides are planned, or whether killers more often confront their victims with no clear intention. In the second case, adding a gun could result in a fatal shooting that would otherwise have been avoided.

The evidence that weapon does matter goes back decades. In 1968, Franklin Zimring examined cases of knife assaults versus gun assaults in Chicago. The gun attacks were five times more deadly. Moreover, the two sets of attacks were similar in all other dimensions: age, sex, race, whether the victim knew the assailant beforehand, and so forth. A few years later, he repeated his analysis, this time comparing small and large caliber guns. As expected, the victim was much more likely to die from larger caliber guns.

Although it is surely true that a determined killer cannot be stopped by the absence of a gun, this type of evidence indicates that many homicides are unplanned. The outcome depends, at least partially, on the weapon at hand. In that restricted sense, guns do kill people.

( More: Crime is Not the Problem: Lethal Violence in America , by Franklin E. Zimring and Gordon Hawkins)

This is not an easy question to answer, because crime rates can decline for a wide range of reasons . For example, violent crime rates declined sharply all across the country in the mid-1990s, regardless of whether a given area had tightened its gun laws. So based on a naive interpretation of the numbers, any attempt at reducing gun violence in 1995 would have appeared successful by 1998. Then there is the problem of comparing different states or cities: Circumstances differ, and what works in Memphis may fail in Detroit.

Nonetheless, there are some plausible methods for isolating the different factors, using comparison groups or other controls . The most thorough summary is a 2008 meta-analysis where the authors reviewed every prior American gun violence reduction study, examining both the reported effectiveness and the strength of the statistical evidence. Here are some approaches that don't seem to work, at least not by themselves, or in the ways they've been tried so far:

• Stiffer prison sentences for gun crimes.
• Gun buy-backs: In a country with one gun per person, getting a few thousand guns off the street in each city may not mean very much.
• Safe storage laws and public safety campaigns.

We don't really have good enough evidence to evaluate these strategies:

• Background checks, such as the Brady Act requires.
• Bans on specific weapons types, such as the expired 1994 assault weapons ban or the handgun bans in various cities.

These policies do actually seem to reduce gun violence, at least somewhat or in some cases:

• More intensive probation strategies: increased contact with police, probation officers and social workers.
• Changes in policing strategies, such increased patrols in hot spots .
• Programs featuring cooperation between law enforcement, community leaders, and researchers, such as Project Safe Neighborhoods .

There is no obvious solution here, and there's a huge amount we still don't know . But it's possible that combinations of these policies, or variations in a different context, might work better. For example, background checks would probably be more effective if they were also applied to private sales. Also, of course, this list does not include policies that have not yet been tried.

As one group of researchers put it ,

There are no feasible policies that would reduce the rate of gun violence in the United States to that of Western Europe. But we believe there are ways to make a substantial dent in the problem.

( More: The Effectiveness of Policies and Programs That Attempt to Reduce Firearm Violence: A Meta-Analysis , Journalist's Resource. Project Safe Neighborhoods and Violent Crime Trends in US Cities: Assessing Violent Crime Impact , Edmund F. McGarrell, Nicholas Corsaro, Natalie Kroovand Hipple, Timothy S. Bynum)

There is no way to know whether the recent White House proposals will be effective in reducing gun violence. How can there be, when it's so difficult to assess the actual policies that have already been tried, let alone vague plans? But the White House proposals do at least plausibly target several components of the gun violence problem.

Probably the most significant proposal is the idea of requiring background checks for gun sales between private individuals, not just from licensed dealers (with some exceptions, such as transfers within a family). Private sales are currently the main way guns move between legal and illegal owners. However, the White House has yet to specify how a private seller would perform such a check.

There is less evidence for the effectiveness of banning assault weapons and large-capacity magazines. During the 1994-2004 assault weapons ban, the use of assault weapons in crimes fell, but use of large-capacity magazines increased . This is thought to be largely due to the huge number of already-owned LCMs, which were exempt from the ban on manufacturing and sales. If the new law does not address the LCMs already in private hands, it may be decades before it has any real effect.

Removing legal restrictions that prevent the Centers for Disease Control and other agencies from tracking and researching gun violence is also a sensible idea, and follows a long history of calls from scientists (see: what don't we know ).

The U.S. has one of the highest rates of violent crime and homicide, per capita, of any developed country. According to 2008 figures compiled by the United Nations Office on Drugs and Crime, the U.S. homicide rate for 2010 is 5.1 per 100,000 people. Only Estonia's is higher, at 6.3. The next most violent country is Finland, which has a homicide rate of 2.5, half that of the U.S. The remaining 28 developed countries are even lower, with an average of 1.1 homicides per 100,000 people.

But many less developed countries have much higher homicide rates -- for example Columbia (35.9), South Africa (36.8) and Sudan (24.2). This analysis uses the 2012 IMF list of developed countries.

The U.S. also has the highest rate of civilian gun ownership in the world, by far. The best data is from the 2007 Small Arms Survey , which notes:

With less than 5% of the world's population, the United States is home to roughly 35-50 per cent of the world's civilian-owned guns, heavily skewing the global geography of firearms and any relative comparison.

U.S. gun violence has had several decades-long cycles over the past three centuries, but shows a long-term downward trend. Overall homicide rates were similar to Western Europe until the 1850s , but since then violence has declined more slowly in the U.S.

It's tempting to plot the relationship between gun ownership and gun violence across countries, but recent research suggests that gun violence is shaped by "socio-historical and cultural context," which varies regionally, meaning that it's not always possible to make direct comparisons. However, it's still reasonable to compare places with similar histories, and more guns still correlate with more homicides in Western nations. Meanwhile, in developing countries, cities with more guns have more homicides .

( More: Chart: The U.S. has far more gun-related killings than any other developed country , The Washington Post; Facebook post says the U.S. is No. 1 in gun violence. Is it? , Politifact' Gun homicides and gun ownership listed by country , Guardian Data Blog)

A lot! We lack some of the most basic information we need to have a sensible gun policy debate, partially because researchers have been prevented by law from collecting it. The 2004 National Research Council report discussed above identified several key types of missing data : systematic reporting of individual gun incidents and injuries, gun ownership at the local level, and detailed information on the operation of firearms markets. We don't even have reliable data on the number of homicides in each county.

For such sensitive data sets, it would be important to preserve privacy both legally and technically. There have been recent advances in this area, such as anonymous registries . But the Centers for Disease Control, the main U.S. agency that tracks and studies American injuries and death, has been effectively prevented from studying gun violence , due to a law passed by Congress in 1996.

Similarly, anonymized hospital reporting systems are the main ways we know about many other types of injuries, but the Affordable Care Act prevents doctors from gathering information about their patients' gun use . A 2011 law restricts gun violence research at the National Institutes of Health . The legal language prevents these agencies from using any money "to advocate or promote gun control."

This may not technically rule out basic research, but scientists say it has made the issue so sensitive that key funding agencies will not support their work. They point to grant data as evidence of an effective ban. The White House has recently proposed lifting these research restrictions (see above )

( More: NRA Stymies Firearms Research, Scientists Say , The New York Times )

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Gun Violence in the United States

Gun violence is a preventable public health tragedy affecting communities all over the United States. Every day, more than 100 Americans die by gun violence, including 64 who die by firearm suicide, 39 Americans who die by firearm homicide, and 3 who are killed by other forms of gun violence. In addition, every day nearly 200 Americans visit the emergency department for nonfatal firearm injuries. Over half of these cases are a result of a firearm assault and an additional 37% are unintentional injuries. Overwhelming evidence shows that firearm ownership and access is associated with increased suicide, homicide, unintentional firearm deaths, and injuries. These injuries and deaths are preventable, and we must advocate for evidence-based solutions to make gun violence in the U.S. rare and abnormal.

Gun Ownership

How does gun ownership and access to firearms affect gun deaths, an in-depth look at gun violence in the united states, gun death rates by state, gun deaths by demographics, recommendations.

Gun violence is a public health epidemic in the United States. Every year nearly 40,000 Americans are killed by guns, including more than 23,000 who die by firearm suicide, 14,000 who die by firearm homicide, more than 500 who die by legal intervention, 12 nearly 500 who die by unintentional firearm injuries, and more than 300 who die by undetermined intent. 12 This equates to more than 100 gun deaths every single day. In addition, every day nearly 200 Americans visit the emergency department for nonfatal firearm injuries. 13

In 2019, the most recent year of data available, there were 39,707 gun deaths – 109 every single day. 14 Three in every five gun deaths are suicides and more than one-third are homicides, while the remainder are unintentional, of unknown intent, or law enforcement intervention.

Among high-income countries, the United States is an outlier in terms of gun violence. It has been well-documented that firearm ownership rates ? are associated with increased firearm-related death rates. The U.S. has the highest firearm ownership and highest firearm death rates of 27 high-income countries. 15 The firearm homicide rate in the U.S. is nearly 25 times higher than other high-income countries and the firearm suicide rate is nearly 10 times that of other high-income countries. 16

It is a common misconception that individuals living with mental illness are responsible for gun violence. When compared to other countries, the United States has similar rates of mental illness, yet we have much higher rates of gun violence. 17, 18 To be clear, mental illness does not cause gun violence – the problem is access to firearms.

While gun death data are the most reliable type of gun violence data currently available, it is important to recognize that gun deaths are only the tip of the iceberg of the gun violence epidemic. In addition to gun deaths, many more people are shot and survive their injuries, are shot at but not hit, or witness gun violence. Many experience gun violence in other ways, for example by living in impacted communities, losing loved ones to gun violence, or being threatened with a gun.

The CDC Plays a Vital Role in Providing Public Health Data to Researchers

Researchers need robust and reliable data to study and develop solutions to address the epidemic of gun violence in the United States. The Centers for Disease Control and Prevention (CDC) is the federal agency responsible for protecting the health of Americans by ensuring that data is properly collected to develop solutions to our nation’s public health crises, including gun violence. The CDC’s National Violent Death Reporting System (NVDRS) plays an instrumental role for gun violence prevention advocates and researchers. The NVDRS uses death certificates, police reports, and hospital records to report information about the victim, the cause of death, and the circumstances surrounding their death. 19 The CDC makes this data publicly available and easily accessible through their Web-based Injury Statistics Query and Reporting System (WISQARS).

To learn more, visit our page on nonfatal firearm injuries.

The following data presented on this page focuses on the impact to those who were killed by gun violence.

Many Americans celebrate guns in our culture and disregard the inherent public safety issues that a gun-friendly culture creates. U.S. firearm ownership rates exceed those of other high-income countries 20 and Americans own 46% of the world’s civilian-owned firearms. 21 Thirty percent of Americans report owning a gun, 22 with estimates of the total number of privately-owned guns in the U.S. ranging from 265 million to nearly 400 million. 23, 24, 25 The majority of gun owners (66%) report owning multiple guns, 26 and it is estimated that half of all guns are in the hands of just 3% of the U.S. population. 27

Gun Ownership by State

Gun ownership varies significantly by state. For example, one study found that gun ownership varies from 61.7% in Alaska to 5.2% in Delaware. 28 Higher levels of gun ownership are correlated with higher rates of suicide, 29, 30, 31, 32, 33 homicide, 34, 35, 36, 37 unintentional firearm deaths, 38, 39 law enforcement killings, 40 and violent crime. 41

Reasons for Gun Ownership – “Protection”

More than 6 in 10 Americans believe that a gun in the home makes the family safer – a figure that has nearly doubled since 2000. 42 This increase in perceived safety is reflected in shifting reasons for gun ownership. In a 2017 Pew Research survey, two-thirds (67%) of gun owners cited protection as a major reason for gun ownership. 43 This represents a notable increase from the mid-1990s, when the majority of American gun owners cited recreation as their primary reason for gun ownership and fewer than half owned guns primarily for protection. 44

However, the evidence is clear: guns don’t make you safer. Contrary to the gun lobby’s talking points, overwhelming research shows that gun ownership and easy access to guns inherently puts individuals and their families at higher risk of death and injury. 22, 23 With a recent study estimating that there are more guns than people in the United States 45 and with a rate of gun violence continually increasing, it is imperative to know the facts about guns and gun violence.

“We must remember that stopping gun violence isn’t only about preventing high-profile mass shootings. It is about stopping gun violence in all its forms. We must acknowledge that gun violence comes in many different forms — from gun suicide to police brutality to domestic violence to unintentional shootings to daily gun violence in neighborhoods across the country.”

- Bryan Barks, Director of Strategic Communications

Every year, nearly 40,000 Americans are killed by guns, including: 46

• More than 23,000 who die by firearm suicide
• 14,000 who die by firearm homicide
• More than 500 who die by legal intervention ?
• Nearly 500 who die by unintentional firearm injuries
• More than 300 who die by undetermined intent

This equates to more than 100 gun deaths every single day.

More than 60% of all gun deaths are suicides. 58 Evidence consistently shows that access to firearms increases the risk of suicide. 48, 49, 50, 51, 52, 53, 54 Access to a gun in the home increases the odds of suicide more than three-fold. 55 Firearms are so dangerous when someone is at risk for suicide because they are the most lethal suicide attempt method.

Though research shows that few individuals substitute means for suicide if their preferred method is not available, if firearms are not available, the person at risk for suicide is much more likely to survive even if they attempt using another method. 56 Delaying a suicide attempt can also allow suicidal crises to pass and lead to fewer suicides. Ninety percent of individuals who attempt suicide do not go on to die by suicide. 57 The use of a firearm in a suicide attempt often means there is no second chance.

To learn more, visit PreventFirearmSuicide.com or visit our page on firearm suicide .

Over 35% of all gun deaths are homicides. 58 Access to firearms – such as the presence of a gun in the home – is correlated with an increased risk for homicide victimization. 58, 59 States with high rates of gun ownership consistently have higher firearm homicide rates. 60, 61, 62 Studies show that access to firearms doubles the risk of homicide. 63 Nearly 75% of all U.S. homicides are by firearm. 64 Firearm homicide is a complex issue that includes different types of gun violence – domestic violence, interpersonal community violence, and mass shootings – and requires an array of different policies, programs, and practices if we want to see meaningful change.

Gun ownership also has implications for the number of mass shootings in a state. A 2019 study found that the permissiveness of state gun laws and an increase in a state’s gun ownership were associated with higher rates of mass shootings. Specifically, every 10 unit increase in the permissiveness of a state’s gun laws is associated with a 9% higher rate of mass shootings. For every 10% increase in gun ownership, states have a 35.1% higher rate of mass shootings. 65 The authors wrote, “This means that a state like California, which has approximately two mass shootings per year, will have an extra mass shooting for every 10 unit increase in permissiveness over five years. It will also have three to five more mass shootings per five years for every 10 unit increase in gun ownership.” 66

To learn more, visit our pages on firearm homicide or mass shootings .

Unintentional Shootings

About 1% of all gun deaths are unintentional. 67 “Unintentional” is the description used for a death that was not caused purposely. In gun violence, examples include fatal injuries that occur when a weapon misfires or is mishandled by a child and results in the victim being shot (in contrast with homicide and suicide, both of which involve an intent to pull the trigger and cause harm). Easy access to firearms, particularly unsecured firearms and the presence of firearms in risky situations, increases risk of unintentional injury and death by firearm. Mitigating access with safer storage practices and through evidence-based policy prevents unintentional gun violence.

To learn more, visit our page on unintentional shootings .

Legal Intervention / Police-Involved Shootings

“Legal intervention” is the description used by the CDC for injuries inflicted by the police or other law enforcement agents, including military on duty, in the course of arresting or attempting to arrest lawbreakers, suppressing disturbances, maintaining order, and other legal actions. In gun violence, these are also known as police-involved shootings. According to the CDC, more than 500 Americans die by legal intervention every year.

However, the government’s data (including the CDC data) provide a substantial under-count of police-involved injuries and deaths. To address this gap, a number of media sources have tracked police-involved shootings in recent years, most notably the Washington Post’s Fatal Force database. This database found that 1,000 Americans are shot and killed by police every year – more than double the number of police-involved fatal shootings than are reported in FBI and CDC databases. 68 Black Americans are disproportionately impacted by police-involved shootings and are killed at more than twice the rate as White Americans. 69

Ultimately, better data on police-involved injuries and deaths are sorely needed. Compulsory and comprehensive data collection at the local level, reporting to the federal government, and transparency in public dissemination of data will be critical for understanding this unique kind of gun violence and developing evidence-based solutions to minimize police-involved shootings.

Gun Violence in America - A Public Health Crisis Decades in the Making

A report from the Educational Fund to Stop Gun Violence and Coalition to Stop Gun Violence, A Public Health Crisis Decades in the Making: A Review of 2019 CDC Gun Mortality Data , draws on the most recent gun death data from the Centers for Disease Control and Prevention (CDC) to illustrate the fatal toll of the gun violence epidemic in the U.S. The report outlines gun death data from 2019, including demographic details, state-by-state breakdowns, and reviews trends over the last two decades.

Gun Death Trends Over Time

39,707 Americans died by gun violence in 2019, a small decrease of 33 gun deaths from 2018. 70

• An average of 109 people died of gun violence each day in 2019, bringing the most recent five-year average (2015-2019) to 106 gun deaths per day.
• 23,941 Americans died by firearm suicide in 2019, 66 people every day.
• 14,414 Americans died by firearm homicide in 2019, more than 39 people every day.

Gun Deaths in the United States, 2010-2019

Number of deaths

Source: CDC WONDER.

Gun Death Rate Trends Over Time

The overall gun death rate increased 17% over the last decade – the gun suicide rate increased 12.5% and the gun homicide rate increased nearly 26%. 71

• While the firearm suicide rate decreased slightly from 2018 to 2019, the rate has trended upward  over the last decade.
• The firearm homicide rate increased over the last decade spiking 31% from 2014 to 2016 and remaining at at this elevated level.

Gun Death Rates in the United States, 2010-2019

Age-adjusted rate per 100,000

All rates listed are age-adjusted in order to allow for accurate comparisons between populations with differing age distributions.

Gun violence is an epidemic that reaches communities large and small, but it is more common in some places than others. Among the states in 2019, Alaska had the highest gun death rate (24.40 per 100,000 people), followed by Mississippi, Wyoming, and New Mexico (24.23, 22.33, and 22.27 per 100,000, respectively). Conversely, Massachusetts had the lowest gun death rate (3.40 per 100,000 people), followed by New York, New Jersey, and Hawaii (3.94, 4.13, and 4.42 per 100,000, respectively). 72

Age-adjusted gun death rate, 2019

• 3.40 to 8.70
• 8.71 to 14.01
• 14.02 to 19.32
• 19.33 to 24.40

For all forms of gun violence, males die at much higher rates than females. 72 In 2019:

• 87% of firearm suicide decedents were male
• 84% of firearm homicide decedents were male
• 90% of unintentional firearm decedents were male
• 96% of police-involved shooting decedents were male

Firearm Suicide Deaths by Sex, 2019

Firearm homicide deaths by sex, 2019, unintentional firearm deaths by sex, 2019, police-involved shooting firearm deaths by sex, 2015-2020.

Source: Washington Post.

By Race, Ethnicity, and Age

Overall: 73

• Firearm suicide rates are highest among White people, followed by American Indian/Alaska Native people. Firearm suicide risk is highest among people age 75 and older across the population as a whole, but that is primarily due to the very high rate of suicide among White males in that age group. Firearm suicide rates peak at younger ages (ages 20-34) for American Indian/Alaska Native, Asian, and Black males and females.
• Firearm homicide rates are highest among Black people as compared to people of other racial and ethnic identities and firearm homicide risk is highest among people ages 20-34 across the entire population.
• Unintentional firearm death rates are highest among American Indian/Alaska Native and Black Americans, followed by White Americans. Nearly one-quarter of all unintentional firearm decedents are 0-19 years old.
• Police-involved shootings disproportionately affect Black Americans and Hispanic/Latino Americans. Black Americans are killed in police-involved shootings at more than twice the rate of White Americans. Hispanic/Latino Americans are killed by police-involved shootings at nearly twice the rate of White Americans. 74

Stop gun violence in all its forms through a multifaceted public health approach.

Gun violence is a complex issue requiring many approaches to its prevention. We are committed to evidence-based policies, programs, and practices and ensuring that all of these preventative measures are designed and implemented equitably. To stop gun violence in all its forms:

• Apply the public health approach for effective gun violence prevention. See Public Health Approach for more information.
• Fund and conduct gun violence research, which is fundamental for effective gun violence prevention. See Gun Violence Research for more information.
• Enact and implement policies, programs, and practices that create time and space between individuals who may be at risk of suicide and firearms. See Firearm Suicide for more information.
• Enact and implement policies, programs, and practices that reduce easy access to firearms by people at risk of interpersonal violence and invest in interventions that address the root causes of gun violence in structurally disadvantaged communities. See Firearm Homicide , Community Violence , and Nonfatal Injuries for more information.
• Expand both federal and state domestic violence firearm prohibitions to reduce abusers’ access to firearms and improve collection and reporting of domestic violence related data. See Domestic Violence for more information.
• Enact and implement policies that reduce easy access to firearms by people at elevated risk of interpersonal violence and ban assault weapons and large capacity magazines that increase lethality in mass shootings. See Mass Shootings for more information.
• Implement programs and practices that promote safer firearm storage and handling. See Unintentional Shootings for more information.
• Train healthcare professionals on lethal means safety counseling so they are prepared to ask patients about firearm access and provide effective and respectful counseling when appropriate. See Lethal Means Safety Counseling for more information.
• Enact and implement a true universal background check law that requires background checks on all gun sales and transfers, including private and online sales, and eliminate “default proceed” sales. See Universal Background Checks for more information.
• Enact and implement state extreme risk laws to prevent tragedy before it occurs and support robust implementation through federal funding. See Extreme Risk Laws for more information.
• Reinstate the federal ban on assault weapons and large capacity magazines. In the absence of federal action, states should continue to enact and implement assault weapons and large capacity magazine bans. See Assault Weapons and Large Capacity Magazines for more information.
• Focus gun violence prevention policies on evidence-based risk factors — not mental illness. Use appropriate language and avoid harmful stereotypes. See Mental Illness for more information.

Educational Materials

• A Public Health Crisis Decades in the Making: A Review of 2019 CDC Gun Mortality Data
• Gun Violence in America: An Analysis of 2018 CDC Data
• Gun Violence in America: Data Brief

Fact sheets

• Overview of U.S. Gun Deaths: 2020
• United States Gun Deaths: 2019
• Guns Don’t Make You Safer    
• Staying Safe At Home    
• December 2018 op-ed in The Hill , Five gun violence prevention priorities for the incoming Congress
• June 2018 blog, On Wear Orange Day, we must focus on gun violence in all its forms
• November 2017 op-ed in The Hill ,  The path forward for Democrats starts with gun violence prevention
• Anglemyer A, Horvath T, & Rutherford G. (2014). The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis . Annals of Internal Medicine.
• Bangalore S & Messerli FH. (2013). Gun ownership and firearm-related deaths. American Journal of Medicine.
• Choron R, Spitzer S, & Sakran JV. (2019). Firearm violence in America: Is there a solution? Advances in Surgery.
• Dahlberg LL, Ikeda RM, & Kresnow MJ. (2004). Guns in the home and risk of a violent death in the home: findings from a national study. American Journal of Epidemiology.
• Grinshteyn E & Hemenway D. (2019). Violent death rates in the U.S. compared to those of the other high-income countries, 2015. Preventive Medicine.
• Kalesan B, Villarreal MD, Keyes KM, & Galea S. (2016). Gun ownership and social gun culture. Injury Prevention.
• Karp A. (2018). Estimating global civilian-held firearms numbers. Small Arms Survey.
• Knopov A, Sherman RJ, Raifman JR, Larson E, & Siegel MB. (2019). Household gun ownership and youth suicide rates at the state level, 2005–2015. American Journal of Preventive Medicine.
• Miller M, Azrael D, & Hemenway D. (2002). Rates of household firearm ownership and homicide across U.S. regions and states, 1988-1997. American Journal of Public Health.
• Miller M, Hemenway D, & Azrael D. (2007). State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003. Social Science & Medicine.
• Monuteaux MC, Lee LK, Hemenway D, Mannix R, & Fleegler EW. (2015). Firearm ownership and violent crime in the US: an ecologic study. American Journal of Preventive Medicine.
• Parker K, Horowitz JM, Igielnik R, Oliphant JB, & Brown A. (2017). America’s complex relationship with guns. Pew Research Center.
• Reeping PM, Cerdá M, Kalesan B, Wiebe DJ, Galea S, & Branas CC. (2019). State gun laws, gun ownership, and mass shootings in the US: cross sectional time series. British Medical Journal.
• Siegel M, Ross CS, & King C. (2014). Examining the relationship between the prevalence of guns and homicide rates in the USA using a new and improved state-level gun ownership proxy. Injury Prevention.

Additional resources

• Reducing Gun Violence in America: Informing Policy with Evidence and Analysis by Daniel Webster and Jon Vernick.
• Gunfight: The Battle Over the Right to Bear Arms in America by Adam Winkler.

Last updated February 2021

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© 2020 Educational Fund to Stop Gun Violence Information on this website does not constitute legal or medical advice. Every factual situation is unique; if you want advice specific to your particular circumstances, you should consult knowledgeable counsel or medical personnel.

President Biden Speaks at Gun Violence Prevention Conference

President Biden spoke at Everytown for Gun Safety’s “Gun Sense University,” an annual conference bringing together gun violence survivors, v… read more

President Biden spoke at Everytown for Gun Safety’s “Gun Sense University,” an annual conference bringing together gun violence survivors, volunteers, and advocates for training on organizing efforts, in Washington, D.C. He talked about the impact of the Bipartisan Safer Communities Act, which was passed nearly two years previously in the wake of the shooting at Robb Elementary School in Uvalde, Texas. The president also called for additional policies to be enacted, including an assault weapons ban and universal background checks. He was introduced by Julvonnia McDowell, an advocate and mother whose son died by gun violence. A pro-Palestinian protester interrupted President Biden during his remarks, and the audience drowned her out, but the president said, “They care. Innocent children have been lost,” referring to civilian deaths in the Israel-Hamas war. close

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Senator Chuck Grassley (R-IA) spoke on the Senate floor about reducing gun violence.

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Gun violence in the United States - Statistics & Facts

The political culture of guns, the importance of gun laws, key insights.

Detailed statistics

Number of homicides by firearm in the U.S. 2006-2022

Number of firearm deaths in the U.S. 1990-2021

Gun ownership in the U.S. 1972-2023

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U.S. gun laws 2024, by state

Share of U.S. adults with select opinions on what causes gun violence 2022

Gun violence rate U.S. 2024, by state

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Gun-related violence.

• Premium Statistic Number of firearm deaths in the U.S. 1990-2021
• Basic Statistic Homicide by firearm rate in the U.S. 2018-2022
• Basic Statistic Number of homicides by firearm in the U.S. 2006-2022
• Basic Statistic Murder victims by weapon used in the U.S 2022
• Basic Statistic Murders involving firearms in the U.S. 2022, by state
• Premium Statistic Gun violence rate U.S. 2024, by state
• Premium Statistic Number of firearm deaths U.S. 2021, by gender
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Number of firearm deaths in the United States from 1990 to 2021

Homicide by firearm rate in the U.S. 2018-2022

Homicide by firearm rate per 100,000 population in the United States from 2018 to 2022

Number of homicides by firearm in the United States from 2006 to 2022

Murder victims by weapon used in the U.S 2022

Number of murder victims in the United States in 2022, by weapon used

Murders involving firearms in the U.S. 2022, by state

Number of murders involving firearms in the U.S. in 2022, by state

Number of gun deaths per 100,000 residents in the United States in 2024, by state

Number of firearm deaths U.S. 2021, by gender

Number of firearm deaths in the United States in 2021, by gender

Number of firearm deaths U.S. 2021, by ethnicity

Number of firearm deaths in the United States in 2021, by ethnicity

Gun ownership

• Premium Statistic Gun ownership in the U.S. 1972-2023
• Basic Statistic Number of registered weapons U.S. 2021, by state
• Premium Statistic Gun ownership in the U.S. 2022, by ethnicity
• Premium Statistic Gun ownership in the U.S. 2022, by education level
• Premium Statistic Gun ownership U.S. 2022, by party affiliation
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• Basic Statistic U.S. support for protecting or limiting gun ownership rights 2023, by party

Percentage of households in the United States owning one or more firearms from 1972 to 2023

Number of registered weapons U.S. 2021, by state

Number of registered weapons in the United States in 2021, by state

Gun ownership in the U.S. 2022, by ethnicity

Percentage of population in the United States with at least one gun in the household in 2022, by ethnicity

Gun ownership in the U.S. 2022, by education level

Percentage of population in the United States with at least one gun in the household in 2022, by education level

Gun ownership U.S. 2022, by party affiliation

Percentage of population in the United States owning at least one gun in 2022, by political party affiliation

Gun ownership in the U.S. 2022, by age

Percentage of population in the United States with at least one gun in the household in 2022, by age

U.S. support for protecting or limiting gun ownership rights 2023, by party

Do you think it's more important to protect or to limit gun ownership rights?

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• Premium Statistic U.S. states with highest number of trafficked guns in 2021
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• Basic Statistic U.S. public opinion on the strictness of laws covering firearms sale 1990-2023
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Gun laws in the United States in 2024, by state

U.S. states with highest number of trafficked guns in 2021

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Leading states for gun law strength in the United States as of January 2024 (index score)

U.S. public opinion on the strictness of laws covering firearms sale 1990-2023

In general, do you feel that the laws covering the sale of firearms should be made more strict, less strict, or kept as they are now?

U.S. support for stricter gun control laws 2023, by party

Do you support or oppose stricter gun control laws in the United States?

U.S. public opinion on a law that bans private handgun possession 1959-2023

Do you think there should or should not be a law that would ban the possession of handguns, except by the police and other authorized persons?

Share of Americans who were satisfied with gun laws 2012-2024

Share of Americans who were satisfied with the nation's laws or policies on guns in the United States from 2012 to 2024

U.S. support for banning assault-style weapons in the U.S. 2023, by party

Do you support or oppose banning assault-style weapons?

U.S. beliefs on how Democratic and Republican gun policies impact safety 2023

Share of Americans with various beliefs on how gun policy by the Democratic Party and gun policy by the Republican Party impacts people's safety from gun violence in the United States in 2023

Mass shootings

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• Basic Statistic U.S. mass shooting victims, by fatalities and injuries 1982-2023
• Basic Statistic Guns used in mass shootings in the U.S. 1982-2023
• Basic Statistic Worst mass shootings in the U.S., as of December 2023
• Basic Statistic Mass shootings in the U.S.: legality of shooter's weapons, as of December 2023
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Mass shootings in the U.S. 1982-2023

Number of mass shootings in the United States between 1982 and December 2023

Mass shootings in the U.S. 1982-2023, by state

Number of mass shootings in the United States between 1982 and December 2023, by state

U.S. mass shooting victims, by fatalities and injuries 1982-2023

Number of victims of mass shootings in the United States between 1982 and December 2023

Guns used in mass shootings in the U.S. 1982-2023

Weapon types used in mass shootings in the United States between 1982 and December 2023, by number of weapons and incidents

Worst mass shootings in the U.S., as of December 2023

Number of victims of the worst mass shootings in the United States between 1982 and December 2023

Mass shootings in the U.S.: legality of shooter's weapons, as of December 2023

Number of mass shootings in the United States between 1982 and December 2023, by legality of shooter's weapons

Mass shootings in the U.S. by shooter’s by race/ethnicity as of December 2023

Number of mass shootings in the United States between 1982 and December 2023, by shooter's race or ethnicity

Mass shootings in the U.S.: shooters by gender, as of December 2023

Number of mass shootings in the United States between 1982 and December 2023, by shooter's gender

Share of U.S. adults with select opinions on mass shootings U.S. 2023

Do you think that mass shootings are something that can be stopped or are just a fact of life in the United States today?

School shootings

• Basic Statistic Number of K-12 school shootings U.S. 1970-2022, by active shooter status
• Basic Statistic School shootings in the U.S. as of December 2023, by victim count
• Basic Statistic Number of K-12 school shootings by state U.S. 1966-2024
• Premium Statistic School shootings occurring in G7 countries 2009-2018
• Basic Statistic Share of K-12 school shootings U.S. 1966-2024, by shooter affiliation
• Basic Statistic Number of K-12 school shootings by time of day U.S. 1966-2024
• Basic Statistic Number of K-12 school shootings by age of shooter U.S. 1970-2020
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• Basic Statistic Share of teachers afraid of school shootings U.S. 2022, by location and student race

Number of K-12 school shootings U.S. 1970-2022, by active shooter status

Number of K-12 school shootings in the United States from 1970 to June 2022, by active shooter status

School shootings in the U.S. as of December 2023, by victim count

Number of victims of school shootings in the United States between 1982 and December 2023

Number of K-12 school shootings by state U.S. 1966-2024

Number of K-12 school shootings in the United States from 1966 to March 15, 2024, by state

School shootings occurring in G7 countries 2009-2018

Number of school shootings occurring in G7 countries between 2009 and 2018

Share of K-12 school shootings U.S. 1966-2024, by shooter affiliation

Share of K-12 school shootings in the United States from 1966 to April 18, 2024, by relation of shooter to school

Number of K-12 school shootings by time of day U.S. 1966-2024

Number of K-12 school shootings in the United States from 1966 to March 15, 2024, by time of day

Number of K-12 school shootings by age of shooter U.S. 1970-2020

Number of K-12 school shootings in the United States from 1970 to June 16, 2020, by age of shooter

Share of school shootings in high/low minority schools U.S. 2009-2019, by situation

Share of shootings occurring at K-12 schools with 75 percent or more minority students and with less than 25 percent minority students in the United States from school years 2009-10 to 2018-19, by situation

Share of teachers afraid of school shootings U.S. 2022, by location and student race

Share of K-12 teachers who reported feeling afraid that they or their students would be a victim of attack or harm at school in the United States in 2022, by school locale and student racial composition

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Preventing Violence Through Gun Control Laws

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Gun Violence

Oct 13, 2014

260 likes | 760 Views

Gun Violence. Murder by the Numbers. Since 1993 the number of murders with handguns has declined. The media portrays the incidence of gun violence as increasing Assault rifles are a hotly debated issue with recent mass shootings. Sources.

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Presentation Transcript

Gun Violence Murder by the Numbers

Since 1993 the number of murders with handguns has declined • The media portrays the incidence of gun violence as increasing • Assault rifles are a hotly debated issue with recent mass shootings

Sources • http://www.unodc.org/unodc/en/data-and-analysis/homicide.html • CQ Press http://proxy.uscupstate.edu:3812/statestats/document.php?id=series-341 • http://www.outsidethebeltway.com/u-s-murder-rate-on-track-to-be-lowest-in-more-than-100-years/

Murder Rate Decreasing Nationwide • http://www.deathpenaltyinfo.org/murder-rates-nationally-and-state#nat1970

People believe the gun violence rate is increasing • http://www.npr.org/blogs/thetwo-way/2013/05/07/181998015/rate-of-u-s-gun-violence-has-fallen-since-1993-study-says • ”In a survey, the Pew Research Center found that only 12 percent of Americans believe the gun crime rate is lower today than it was in 1993; 56 percent believe it's higher.”

Link to lead? • http://www.wired.com/wiredscience/2011/06/the-crime-of-lead-exposure/

Why it is relevant • ”In a survey, the Pew Research Center found that only 12 percent of Americans believe the gun crime rate is lower today than it was in 1993; 56 percent believe it's higher.” • Misconceptions about gun ownership and violence • Just because there is a trend does not mean there is causality

Guns in the world • http://www.theguardian.com/news/datablog/2012/jul/22/gun-homicides-ownership-world-list • Small Arms Survey from 2007

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Community learns all about gun, water and fire safety at special event in Mallison Park

Aaron Farrar , News4Jax reporter

JACKSONVILLE, Fla. – In an effort to keep people safe this summer, the organization USA Unlimited hosted a safety event at Mallison Park Saturday morning to focus on teaching kids and adults about gun, water and fire safety.

There are countless cases of people accidentally shooting themselves or someone else, and those unfortunate situations are not limited by age either. It could be kids or adults.

That’s why Dr. Camika Jerido and her organization USA Unlimited held its third annual event to teach gun, water, and safety.

“Secure weapons, and even if there is an adult, just make sure that you be careful when you are handling your weapons. Even if you are experienced, you still have to be careful because you never know if it would just go off,” Jerido said.

There have been several cases of accidental shootings, with two examples that stick out from our viewing area.

A little more than a year ago in the Regency neighborhood, a 16-year-old was shot in the leg after The Jacksonville Sheriff’s Office said he and five others between 12 and 16 years were playing with a gun and it went off.

That teenager was treated for his injury.

RELATED | Teen hurt in accidental shooting, another to face charges

Jerido encouraged people to never leave guns out and in the open unattended and to store them in a locked box container or secure them with a trigger lock.

“If you have young kids, please, please, please make sure that you secure your weapons. You secure the guns or anything that is harmful to kids,” Jerido said.

Early January of this year, the Nassau County Sheriff’s Office said Tyler Shepperd was charged with manslaughter after he was accused of accidentally shooting and killing a friend.

Deputies said Shepperd’s friend was mishandling a gun and passed it to Shepperd.

Investigators said Shepperd thought it was unloaded, and he pulled the trigger. The gun fired a shot and hit Shepperd’s friend, who died at a hospital.

“Never hold a gun by the trigger. Never hold it by the trigger. Most of the time they probably don’t even know if there’s a safety or anything. I always advise to keep it pointed down,” Jerido said.

MORE | Crime analyst shares safety tips when out at large gatherings after weekend of gun violence across the nation

Last year was the worst year on record for unintentional shootings by children, people younger than 18.

According to the gun safety group, Everytown, there were more than 400 cases of unintentional shootings.

Jerido said she hosts these events as a way to help stop these things from happening, which can be avoided in the first place.

“We have to stay consistent because when people have guns, they stay consistent in buying guns or whatever. For us, we are going to stay consistent and this is where we are going to be every year,” Jerido said.

Copyright 2024 by WJXT News4JAX - All rights reserved.

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Aaron farrar.

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The Supreme Court upholds a gun control law intended to protect domestic violence victims

Mark Sherman

Associated Press

Copyright 2024 Associated Press. All rights reserved

Supreme Court Police officers stand on duty outside of the Supreme Court building on Thursday, June 13, 2024, in Washington. (AP Photo/Mark Schiefelbein)

WASHINGTON – The Supreme Court on Friday upheld a federal gun control law that is intended to protect victims of domestic violence.

In their first Second Amendment case since they expanded gun rights in 2022, the justices ruled 8-1 in favor of a 1994 ban on firearms for people under restraining orders to stay away from their spouses or partners. The justices reversed a ruling from the federal appeals court in New Orleans that had struck down the law.

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Chief Justice John Roberts, writing for the court, said the law uses “common sense” and applies only "after a judge determines that an individual poses a credible threat” of physical violence.

Justice Clarence Thomas, the author of the major 2022 Bruen ruling in a New York case, dissented.

President Joe Biden, who has been critical of previous high-court rulings on guns, abortion and other hot-button issues, praised the outcome.

“No one who has been abused should have to worry about their abuser getting a gun,” Biden said in a statement. “As a result of today’s ruling, survivors of domestic violence and their families will still be able to count on critical protections, just as they have for the past three decades.”

Last week, the court overturned a Trump-era ban on bump stocks , the rapid-fire gun accessories used in the deadliest mass shooting in modern U.S. history. The court ruled that the Justice Department exceeded its authority in imposing that ban.

Friday's case stemmed directly from the Supreme Court’s Bruen decision in June 2022. A Texas man, Zackey Rahimi, was accused of hitting his girlfriend during an argument in a parking lot and later threatening to shoot her.

At arguments in November, some justices voiced concern that a ruling for Rahimi could also jeopardize the background check system that the Biden administration said has stopped more than 75,000 gun sales in the past 25 years based on domestic violence protective orders.

The case also had been closely watched for its potential to affect cases in which other gun ownership laws have been called into question, including in the high-profile prosecution of Hunter Biden . Biden’s son was convicted of lying on a form to buy a firearm while he was addicted to drugs. His lawyers have signaled they will appeal.

A decision to strike down the domestic violence gun law might have signaled the court's skepticism of the other laws as well. But Friday's decision did not suggest that the court would necessarily uphold those law either.

The justices could weigh in soon in one or more of those other cases.

Many of the gun law cases grow out of the Bruen decision. That high court ruling not only expanded Americans’ gun rights under the Constitution but also changed the way courts are supposed to evaluate restrictions on firearms.

Roberts turned to history in his opinion. "Since the founding, our nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms,” he wrote.

Some courts have gone too far, Roberts wrote, in applying Bruen and other gun rights cases. "These precedents were not meant to suggest a law trapped in amber,” he wrote.

In dissent, Thomas wrote, the law “strips an individual of his ability to possess firearms and ammunition without any due process.”

The government “failed to produce any evidence” that the law is consistent with the nation’s historical tradition of firearm regulation, he wrote.

“Not a single historical regulation justifies the statute at issue,” Thomas wrote.

Seven of the nine justices wrote opinions in the guns case spanning 94 pages, mainly focused on the proper use of history in evaluating gun restrictions and other limitations on constitutional rights.

Justice Sonia Sotomayor wrote that Roberts' opinion “permits a historical inquiry calibrated to reveal something useful and transferable to the present day, while the dissent would make the historical inquiry so exacting as to be useless.” She was among the three liberal justices who dissented in the Bruen case.

Justice Brett Kavanaugh, who was part of the Bruen majority, noted that the court probably will have many more cases about the reach of gun rights because “Second Amendment jurisprudence is in its early innings.” It was only in 2008 that the court declared for the first time that the Constitution protects an individual's right to keep and bear arms.

Rahimi’s case reached the Supreme Court after prosecutors appealed a ruling that threw out his conviction for possessing guns while subject to a restraining order.

Rahimi was involved in five shootings over two months in and around Arlington, Texas, U.S. Circuit Judge Cory Wilson noted. When police identified Rahimi as a suspect in the shootings and showed up at his home with a search warrant, he admitted having guns in the house and being subject to a domestic violence restraining order that prohibited gun possession, Wilson wrote.

But even though Rahimi was hardly “a model citizen,” Wilson wrote, the law at issue could not be justified by looking to history. That’s the test Justice Thomas laid out in his opinion for the court in Bruen.

The appeals court initially upheld the conviction under a balancing test that included whether the restriction enhances public safety. But the panel reversed course after Bruen. At least one district court has upheld the law since the Bruen decision.

After the ruling, Attorney General Merrick Garland said the Justice Department “will continue to enforce this important statute, which for nearly 30 years has helped to protect victims and survivors of domestic violence from their abusers.”

“As the Justice Department argued, and as the Court reaffirmed today, that commonsense prohibition is entirely consistent with the Court’s precedent and the text and history of the Second Amendment,” Garland said in a statement.

Advocates for domestic violence victims and gun control groups had called on the court to uphold the law.

Firearms are the most common weapon used in homicides of spouses, intimate partners, children or relatives in recent years, according to data from the federal Centers for Disease Control and Prevention. Guns were used in more than half, 57%, of those killings in 2020, a year that saw an overall increase in domestic violence during the coronavirus pandemic.

Seventy women a month, on average, are shot and killed by intimate partners, according to the gun control group Everytown for Gun Safety.

Gun rights groups backed Rahimi, arguing that the appeals court got it right when it looked at American history and found no restriction close enough to justify the gun ban.

Associated Press writers Fatima Hussein, Alanna Durkin Richer and Lindsay Whitehurst contributed to this report.

Follow the AP's coverage of the U.S. Supreme Court at https://apnews.com/hub/us-supreme-court .

Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

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Letitia James

Statement from attorney general james on supreme court decision upholding federal law blocking domestic abusers from possessing guns, june 21, 2024.

NEW YORK – New York Attorney General Letitia James today issued a statement after the United States Supreme Court announced a decision in  United States v. Rahimi , reversing the U.S. Court of Appeals for the Fifth Circuit’s decision that a federal law prohibiting persons under a domestic violence restraining order from accessing guns violates the Second Amendment. The case involved Zackey Rahimi, who was under a domestic violence restraining order for assaulting his girlfriend, and was therefore barred from possessing guns. Rahimi was subsequently involved in multiple shootings and then indicted for possession of a firearm while under a domestic violence restraining order. The Supreme Court’s decision in this case upholds the federal law and will ensure domestic abusers cannot legally access firearms:

“Gun safety laws save lives. I am pleased with the U.S. Supreme Court’s decision to uphold the federal law that stops domestic abusers from legally possessing firearms. This law, and the similar statutes that have been established in nearly every American state and territory, help protect vulnerable people, and keep guns out of dangerous hands. I am proud of the work my fellow attorneys general and I did to stand up for this federal law and to protect commonsense guardrails when it comes to gun safety. I will continue to use the great tools of my office to get guns off New York streets and protect our state’s residents from the scourge of gun violence.”

Attorney General James as part of a coalition of 25 attorneys general, submitted an amicus brief to the Supreme Court arguing that striking down the existing federal law would make it more difficult to protect survivors of domestic abuse. Attorney General James and the coalition noted that studies have shown an abuser is five times more likely to murder an intimate partner if a firearm is in the home. Attorney General James and the coalition also noted that in addition to the federal law, 46 states, the District of Columbia, and multiple territories have laws limiting the ability of those under a domestic violence restraining order to access firearms, and asserted that the lower court ruling could negatively impact these existing laws and make it harder to protect Americans’ lives and safety. Additionally, the coalition pointed out that 80 percent of these homicide victims are women, and pregnant women and women of color are disproportionately the targets of intimate partner violence.

Attorney General James has been a leader in the fight to protect New Yorkers and communities across the nation from gun violence. In April 2024, Attorney General James  took down gun traffickers for selling ghost guns and other firearms in Central New York . In March 2024, Attorney General James  secured a $7.8 million judgment against gun retailer Indie Guns  for illegally selling ghost gun components in New York. In August 2023, Attorney General James  took action with a coalition of 18 attorneys general  to defend Delaware’s ban on assault weapons and large capacity magazines. In May 2023, Attorney General James  sued a gun accessory manufacturer that aided the Buffalo mass shooter . In March 2023, Attorney General James  secured a court order banning 10 gun distributors from selling and shipping ghost gun parts into New York . 

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Gun Violence Awareness event slated for Sunday

The seeing eye.

MOTHERS PRAYER: The seventh annual Mother’s Prayer Against Violence will be 3 p.m. Sunday at the Lloyd McCoy Health Center, 1977 Niles Road SE, Warren. The event is being held as a part of National Gun Violence Awareness Month. Those attending are asked to wear orange. Guest speaker is Pamela Williams McCoy. The event will include Communities Against Violence, as well as counselors, local leaders and pacers. There will be a peace walk and planting of trees.

FOOD TRUCK FRIDAY: Howland Township will hold Food Truck Friday from 5 to 8 p.m. today at the Richard E. Orwig Park, 8189 E. Market St., across the street from Giant Eagle in Howland Township. The event is held rain or shine. This is the first of four Food Truck Friday events. Event goers are encouraged to bring their lawn chairs and enjoy music while relaxing with family and friends in the park. Steve Vuich and Brian Bonhomme will be performing live acoustic music. Several local food trucks will offer a selection of street food. The Howland Food Truck Friday series takes place the third Friday of the month June through August.

AMATEUR RADIO ASSOCIATION: The Warren Amateur Radio Association will conduct a radio relay league summer field day operations from 2 p.m. Saturday to 2 p.m. Sunday at Mosquito Lake State Park in Bazetta. The public is invited to attend to observe and participate in activities with guidance and supervision of amateur radio operators.

RIVERFEST SHOWCASES RIVER: Riverfest will be held from 11 a.m. to 4 p.m. Sunday at Spring Commons Park / B&O Station in Youngstown. This a free, fun, family-friendly event and will include exhibits, food trucks, music, kids crafts and the Komara Outdoor reptile display. Trumbull Canoe Trails will be there to offer kayak or canoe experiences on the Mahoning River as well. In addition, the Artists of the Rust Belt will be having a show inside the B&O Station.

TALK TO A TRUSTEE: The Brookfield Township trustees will hold a “Talk with a Trustee” from 10 a.m. to noon Saturday at the park gazebo on the center green.

McDONALD ALUMNI: The McDonald High School Alumni Association annual dinner meeting is planned for June 28 at Ciminero’s Banquet Centre. Social hour is at 6 p.m. with dinner at 7 p.m. Contact Gayle Frantz Bowser at [email protected] or Maria McNulty at [email protected] for information. Class reunions are welcomed. The classes of 1964 and 1974 are celebrating 60 and 50 years. Give advance notice for table reservations

NILES 1984 REUNION: The Niles McKinley High School Class of 1984 will hold a class reunion at noon July 20 at Waddell Park. Bring a dish to share if you wish. Please RSVP to Bill Blystone 216-333-2545. On July 21 they will also attend the Mahoning Valley Scrappers game at 2:05 p.m.

NILES ALUMNI SEEKS NOMINATIONS: The Niles McKinley High School Alumni Association is seeking nominations for the 2024 Distinguished Alumni Hall of Fame. The nominee must have graduated at least 10 years ago, achieved success in their career and must have made significant contributions in their field and community. Information is on the Niles city schools website. Deadline is June 30. Send nominations to Joyce Mahan, 1059 Griffin Court, Niles, OH, 44446, of the Niles McKinley Alumni Association.

CLASS REUNION: The Warren G, Harding High School Class of 1984 40th class reunion will be held 5 p.m. July 27 at Holiday Bar, 2124 Elm Road, Warren.

IMMUNIZATION CLINIC: The Warren City Health District will provide a public childhood immunization clinic, 9 to 11 a.m. and 1 to 3 p.m. Monday, at the Warren City Health District, 258 E. Market St., Third Floor, Warren. Bring the child’s updated shot record.

FAMILY RECIPES: Champion Historical Society Presents: Family Recipe: Legacy Leads the Way by Jackie Brown, co-owner of Doughlicious Bakery, at 6 p.m. June 26, at One Room School House No. 3, 149 Center St. E., Warren, adjacent to Champion Township Cemetery. The presentation will focus on a family kalachi recipe shared through generations that has culminated in the formation of a family business. The topic highlights how recipes can be windows into history that can build strong bonds that benefit the community. Samples will be available. Free and open to the public. For information, visit www.champion

historicalsociety.com.

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City of San Antonio set to give away free gun safe boxes this weekend

Community safety fair will be 9-11 a.m. on saturday at southside lions senior center.

Patty Santos , Reporter

SAN ANTONIO – June is National Gun Violence Awareness Month and the City of San Antonio in partnership with District 3 Councilwoman Phyllis Viagran and COPS Metro are giving away free gun safety boxes.

People can get the boxes from 9-11 a.m. on Saturday at Southside Lions Senior Center, 3303 Pecan Valley Drive.

In a news conference on Tuesday, San Antonio Police Chief William McManus said the City secured $200,000 to purchase 4,000 gun safety lock boxes to be distributed in the community.

Viagran said it’s an effort to continue the conversation about gun education.

“This is just making sure that the guns that you have at home don’t end up in somebody else’s hands, that that shouldn’t have them, whether that’s the youth or whether that is, you know, somebody who breaks in and happens to find it and then it gets it’s out there on the streets,” she said.

The free boxes are basic and Viagran said there are others that are more high-tech and cost more, so those who can afford the better gun safe boxes should get them.

“Owning a gun and being a responsible gun owner means an investment,” she said.

The safe boxes given away by the city are meant for those who have guns and don’t want to get rid of them, but can’t afford to buy a box.

“It’s really for the people that didn’t do the buyback program and turn in their gun because they just thought, well, one day I might need it or I’m going to go to that shooting range once again. We’ll make sure it’s in that lockbox when you do,” Viagran said.

Viagran said people who have stickers on their vehicles or signs outside their homes that could advertise that they’re a gun owners should be sure to secure their weapons because those stickers and signs are basically advertising the availability of weapons.

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About the Author

Patty santos.

Patty Santos joined the KSAT 12 News team in July 2017. She has a proven track record of reporting on hard-hitting news that affects the community.

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