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The biggest questions about gun violence that researchers would still like to see answered

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There are a few big things we know about gun violence in America: The US has way more guns per capita than any other country. It has far more gun homicides per capita than other wealthy countries. States with more guns have more gun deaths. And people with guns in their homes are more likely to be killed or to kill themselves with guns.

But just as importantly, there’s a lot that researchers still don't know. There’s frustratingly little evidence on what policies work best to reduce gun violence. (Australia saw a drop in homicides and suicides after confiscating everyone’s guns in the 1990s , but that would likely never happen here.) Experts still don’t have a great sense of what impact stricter background checks have, or how the "informal" gun trade operates, or even how people use guns in crimes.

"We have superficial knowledge of most gun violence topics," says Michael Nance, director of the Pediatric Trauma Center at the Children’s Hospital of Philadelphia. And this ignorance has serious consequences. It’s awfully hard to stop gun violence if we can't even agree on basic facts about how and why it happens.

This ignorance is partly by design. Since the 1990s, Congress has prevented various federal agencies from gathering more detailed data on gun violence. The Centers for Disease Control and Prevention (CDC), which has elaborate data gathering and monitoring programs for other public health crises like Ebola or heart disease, has been dissuaded from researching gun violence. The Bureau of Alcohol, Tobacco, Firearms, and Explosives can't distribute much of its trace data for research purposes. Obamacare limits doctors' ability to gather data on patients' gun use.

To get a sense of what we’re missing, I surveyed a number of researchers in the field and asked them about the most pressing questions about gun violence that they’d like to see answered. Here's what they said.

We still don’t know some very basic facts about gun violence in America

1) How are guns actually used? Tom Smith of NORC at the University of Chicago pointed out that "studying how guns are actually used in general" was a top research priority — including the question of how many people use guns for defensive purposes.

Other researchers pointed to related questions like: What percentage of gun owners even commit gun crimes? Why do gun accidents occur? Who's involved? Are criminals deterred by guns? These questions are a basic starting point.

2) Can we get better data on the victims of gun violence? Nance also pointed out that our data on the victims of gun violence leaves a lot to be desired. Researchers typically rely on death data ("one of the few known and reliable data points — you can’t hide the bodies," he says). But without more detailed data on who actually owns guns and who is exposed to guns, it can be hard to put these deaths in context.

And it would be good to have more detailed data on gun injuries that don't result in death. Daniel Webster, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, says, "We still don’t know nearly enough about nonfatal gunshot wounds, including how often they occur." That makes it much harder to get a full picture of gun violence.

3) What state laws, if any, work best to reduce gun violence? Michael Siegel, a professor of public health at Boston University, pointed to these three (broad) topics as the most pressing unanswered questions:

1. What state laws, if any, are effective in reducing rates of firearm violence? 2. Is there a differential impact of state firearm-related laws on homicide rates among white vs. African-American persons? 3. Are higher gun ownership levels related to higher firearm homicide rates because of a causal relationship or because people respond to high homicide rates by purchasing firearms?

There has already been some research on state-level gun control policies. For example, after Connecticut passed a law requiring gun purchasers to first obtain a license, one study found that gun homicides fell by 40 percent . When Missouri repealed a similar law, gun homicides increased by 23 percent . But, in part because they are retrospective and it’s impossible to run controlled experiments, studies like these remain hotly debated.

And there are all sorts of related questions here that (other) researchers would love to know the answers to. Do limits on high-capacity magazines reduce deaths? Do restrictions on alcohol sales make any difference? What about policies that make concealed carry licenses easier to obtain?

To really dig in, researchers would have to study state policies in far more detail. But, says Siegel, that will require need much better data than is currently on offer. He’d like to see more detailed state-level data on household gun ownership, on firearm policies, and on how well (or not) those policies are actually enforced.

4) How do people who commit gun crimes actually get access to their guns? Cathy Barber, who directs the Means Matter Campaign at the Harvard School of Public Health's Injury Control Research Center, listed these as big unanswered questions:

Pretty much every gun starts out as a legal gun. Among the guns that are actually used in crimes, how did they get there? That is, how many are used by their initial legal purchaser and did that person pass a background check? If the gun was not used by the initial purchaser, how did it get to the person who used it in a crime? Straw purchase? Gun trafficking (buying in a state with lax laws and transporting for street sales in state with stricter laws)? Theft? (and what type of theft? Theft from individual homes or from gun shops or what? And if from people’s homes, do these tend to be unsecured guns kept for self-defense purchases – the gun in the bedside table?), etc., etc. I think that both gun rights people and gun control people would be interested in the very specific answers to these questions and figuring out ways that we all could prevent the sort of cross-overs from legal to illegal possession and use.

A couple of other researchers agreed with this line of inquiry. Here’s Nance: "We need to know how weapons move in society to know how to best limit movement in the wrong direction (to those unfit to own)." And here’s Smith: "Understanding the ‘informal' gun market, that is guns that are acquired from others than licenses firearms dealers and therefore without background checks."

5) Is there any way to predict gun suicides? Nearly 21,000 people in the United States use guns to kill themselves each year, accounting for about two-thirds of all gun deaths. "We need to know more about how to predict who will commit suicide using a firearm," says Webster, "and ways to prevent [it]."

Back in 2013, a report from the Institutes of Medicine added some related questions around this topic that needed answering: Does gun ownership affect whether people kill themselves? And what's the best way to restrict firearm access to those with severe mental illnesses?

6) Does media violence have any impact on actual violence? This question came from Brad Bushman, a professor of communication and psychology at Ohio State University:

My research focuses on media violence. We know that youth who see movie characters drink alcohol are more likely to drink alcohol themselves. Similarly, we know that youth who see movie characters smoke cigarettes are more likely to smoke themselves. What about the impact of youth seeing movie characters with guns? Does exposure to movie characters with guns influence youth attitudes and behaviors about guns (e.g., do they think guns are cooler? are they more willing to own or use a gun? do they think guns make males more masculine?)?

7) What do we know about stopping mass shootings? I’ll add one more question to the list, which was considered a pressing research topic in the 2013 Institutes of Medicine report: "What characteristics differentiate mass shootings that were prevented from those that were carried out?"

One big reason current research into US gun violence is so dismal

It’s fair to call gun violence a public health crisis: Some 32,383 Americans were killed by guns in 2013. And for other health crises, like Ebola or heart disease, the CDC usually springs into action, by funding studies and research that look into the best policies to deal with the problem.

But that’s not really the case here. Back in 1996, Congress worked with the National Rifle Association to enact a law banning the CDC from funding any research that would "advocate or promote gun control." Technically, this wasn’t a ban on all gun research (and the CDC wasn’t doing advocacy anyway). But the law seemed vague and menacing enough that the agency shied away from most gun violence research, period.

Funding for gun violence research by the CDC dropped 96 percent between 1996 and 2012. Today, federal agencies spend just $2 million annually on gun violence prevention — compared with, say, $21 million for the study of headaches . And the broader field has withered over that period: Gun studies as a percentage of peer-reviewed research dropped 60 percent since 1996. Today there are only about a dozen researchers in the country whose primary focus is on preventing gun violence.

Private foundations and universities, such as the Johns Hopkins Bloomberg School of Public Health, have been partly able to pick up the slack , but private funders can rarely sustain the big, complicated data gathering and monitoring programs that the federal government can conduct. And that’s a problem because, as the researchers above noted, one of the biggest lacunae in gun research is data.

"If you look at other major public health issues, like Zika or Ebola or heart disease, the CDC is really a very authoritative source," says Andrew Rosenberg of the Union of Concerned Scientists. "Privately funded research can be helpful, but there’s no substitute for the CDC. They can do monitoring programs, long-term tracking, the stuff that’s hard to fund with a one-off grant from this or that foundation."

Siegel agrees: "The CDC has a critical role to play, so the first matter that needs to be resolved is restoring the CDC’s ability to conduct firearm-related research."

So will this situation ever change? After the Sandy Hook massacre in 2013, President Obama signed an executive order directing the CDC to start studying "the causes of gun violence." But very little has happened in the years since. The CDC didn’t actually budget. The problem, Rosenberg says, is that so long as that congressional amendment is in place, the CDC is unlikely to move forward.

Lately, there have been some calls to restore research. Republican Rep. Jay Dickey, who spearheaded the original CDC amendment, expressed remorse about the whole thing last year: "I wish we had started the proper research and kept it going all this time. I have regrets. … If we had somehow gotten the research going, we could have somehow found a solution to the gun violence without there being any restrictions on the Second Amendment."

Read more: What no politician wants to admit about gun control

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An Examination of US School Mass Shootings, 2017–2022: Findings and Implications

Antonis katsiyannis.

1 Department of Education and Human Development, College of Education, Clemson University, 101 Gantt Circle, Room 407 C, Clemson, SC 29634 USA

Luke J. Rapa

2 Department of Education and Human Development, College of Education, Clemson University, 101 Gantt Circle, Room 409 F, Clemson, SC 29634 USA

Denise K. Whitford

3 Steven C. Beering Hall of Liberal Arts and Education, Purdue University, 100 N. University Street, BRNG 5154, West Lafayette, IN 47907-2098 USA

Samantha N. Scott

4 Department of Education and Human Development, College of Education, Clemson University, 101 Gantt Circle, Room G01A, Clemson, SC 29634 USA

Gun violence in the USA is a pressing social and public health issue. As rates of gun violence continue to rise, deaths resulting from such violence rise as well. School shootings, in particular, are at their highest recorded levels. In this study, we examined rates of intentional firearm deaths, mass shootings, and school mass shootings in the USA using data from the past 5 years, 2017–2022, to assess trends and reappraise prior examination of this issue.

Extant data regarding shooting deaths from 2017 through 2020 were obtained from the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, the web-based injury statistics query and reporting system (WISQARS), and, for school shootings in particular (2017–2022), from Everytown Research & Policy.

The number of intentional firearm deaths and the crude death rates increased from 2017 to 2020 in all age categories; crude death rates rose from 4.47 in 2017 to 5.88 in 2020. School shootings made a sharp decline in 2020—understandably so, given the onset of the COVID-19 pandemic and subsequent government or locally mandated school shutdowns—but rose again sharply in 2021.

Conclusions

Recent data suggest continued upward trends in school shootings, school mass shootings, and related deaths over the past 5 years. Notably, gun violence disproportionately affects boys, especially Black boys, with much higher gun deaths per capita for this group than for any other group of youth. Implications for policy and practice are provided.

On May 24, 2022, an 18-year-old man killed 19 students and two teachers and wounded 17 individuals at Robb Elementary School in Uvalde, TX, using an AR-15-style rifle. Outside the school, he fired shots for about 5 min before entering the school through an unlocked side door and locked himself inside two adjoining classrooms killing 19 students and two teachers. He was in the school for over an hour (78 min) before being shot dead by the US Border Patrol Tactical Unit, though police officers were on the school premises (Sandoval, 2022 ).

The Robb Elementary School mass shooting, the second deadliest school mass shooting in American history, is the latest calamity in a long list of tragedies occurring on public school campuses in the USA. Regrettably, these tragedies are both a reflection and an outgrowth of the broader reality of gun violence in this country. In 2021, gun violence claimed 45,027 lives (including 20,937 suicides), with 313 children aged 0–11 killed and 750 injured, along with 1247 youth aged 12–17 killed and 3385 injured (Gun Violence Archive, 2022a ). Mass shootings in the USA have steadily increased in recent years, rising from 269 in 2013 to 611 in 2020. Mass shootings are typically defined as incidents in which four or more people are killed (Katsiyannis et al., 2018a ). However, the Gun Violence Archive considers mass shootings to be incidents in which four or more people are injured (Gun Violence Archive, 2022b ). Regardless of these distinctions in definition, in 2020, there were 19,384 gun murders, representing a 34% increase from the year before, a 49% increase over a 5-year period, and a 75% increase over a 10-year period (Pew Research Center, 2022 ). Regarding school-based shootings, to date in 2022, there have been at least 95 incidents of gunfire on school premises, resulting in 40 deaths and 76 injuries (Everytown Research & Policy, 2022b ). Over the past few decades, school shootings in the USA have become relatively commonplace: there were more in 2021 than in any year since 1999, with the median age of perpetrators being 16 (Washington Post, 2022 ; see also, Katsiyannis et al., 2018a ). Additionally, analysis of Everytown’s Gunfire on School Grounds dataset and related studies point to several key observations to be considered in addressing this challenge. For example, 58% of perpetrators had a connection to the school, 70% were White males, 73 to 80% obtained guns from home or relatives or friends, and 100% exhibited warning signs or showed behavior that was of cause for concern; also, in 77% of school shootings, at least one person knew about the shooter’s plan before the shooting events occurred (Everytown Research & Policy, 2021a ).

The USA has had 57 times as many school shootings as all other major industrialized nations combined (Rowhani-Rahbar & Moe, 2019 ). Guns are the leading cause of death for children and teens in the USA, with children ages 5–14 being 21 times and adolescents and young adults ages 15–24 being 23 times more likely to be killed with guns compared to other high-income countries. Furthermore, Black children and teens are 14 times and Latinx children and teens are three times more likely than White children to die by guns (Everytown Research & Policy, 2021b ). Children exposed to violence, crime, and abuse face a host of adverse challenges, including abuse of drugs and alcohol, depression, anxiety, post-traumatic stress disorder, school failure, and involvement in criminal activity (Cabral et al., 2021 ; Everytown Research and Policy, 2022b ; Finkelhor et al., 2013 ).

Yet, despite gun violence being considered a pressing social and public health issue, federal legislation passed in 1996 has resulted in restricting funding for the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). The law stated that no funding earmarked for injury prevention and control may be used to advocate or promote firearm control (Kellermann & Rivara, 2013 ). More recently, in June 2022, the US Supreme Court struck down legislation restricting gun possession and open carry rights (New York State Rifle & Pistol Assn., Inc. v. Bruen, 2021 ), broadening gun rights and increasing the risk of gun violence in public spaces. Nonetheless, according to Everytown Research & Policy ( 2022a ), states with strong gun laws experience fewer deaths per capita. In the aggregate, states with weaker gun laws (i.e., laws that are more permissive) experience 20.0 gun deaths per 100,000 residents versus 7.4 per 100,000 in states with stronger laws. The association between gun law strength and per capita death is stark (see Table ​ Table1 1 ).

Gun law strength and gun law deaths per 100,000 residents

Accounting for the top eight and the bottom eight states in gun law strength, gun law strength and gun deaths per 100,000 are correlated at r  =  − 0.85. Stronger gun laws are thus meaningfully linked with fewer deaths per capita. Data obtained from Everytown Research & Policy ( 2022a )

Notwithstanding the publicity involving gun shootings in schools, particularly mass shootings, violence in schools has been steadily declining. For example, in 2020, students aged 12–18 experienced 285,400 victimizations at school and 380,900 victimizations away from school; an annual decrease of 60% for school victimizations (from 2019 to 2020) (Irwin et al., 2022 ). Similarly, youth arrests in general in 2019 were at their lowest level since at least 1980; between 2010 and 2019, the number of juvenile arrests fell by 58%. Yet, arrests for murder increased by 10% (Puzzanchera, 2021 ).

In response to school violence in general, and school shootings in particular, schools have increasingly relied on increased security measures, school resource officers (SROs), and zero tolerance policies (including exclusionary and aversive measures) in their attempts to curb violence and enhance school safety. In 2019–2020, public schools reported controlled access (97%), the use of security cameras (91%), and badges or picture IDs (77%) to promote safety. In addition, high schools (84%), middle schools (81%), and elementary schools (55%) reported the presence of SROs (Irwin et al., 2022 ). Research, however, has indicated that the presence of SROs has not resulted in a reduction of school shooting severity, despite their increased prevalence. Rather, the type of firearm utilized in school shootings has been closely associated with the number of deaths and injuries (Lemieux, 2014 ; Livingston et al., 2019 ), suggesting implications for reconsideration of the kinds of firearms to which individuals have access.

Zero tolerance policies, though originally intended to curtail gun violence in schools, have expanded to cover a host of incidents (e.g., threats, bullying). Notwithstanding these intentions, these policies are generally ineffective in preventing school violence, including school shootings (American Psychological Association Zero Tolerance Task Force, 2008 ; Losinski et al., 2014 ), and have exacerbated the prevalence of youths’ interactions with law enforcement in schools. From the 2015–2016 to the 2017–2018 school years, there was a 5% increase in school-related arrests and a 12% increase in referrals to law enforcement (U.S. Department of Education, 2021 ); in 2017–18, about 230,000 students were referred to law enforcement and over 50,000 were arrested (The Center for Public Integrity, 2021 ). Law enforcement referrals have been a persistent concern aiding the school-to-prison pipeline, often involving non-criminal offenses and disproportionally affecting students from non-White backgrounds as well as students with disabilities (Chan et al., 2021 ; The Center for Public Integrity, 2021 ).

The consequences of these policies are thus far-reaching, with not only legal ramifications, but social-emotional and academic ones as well. For example, in 2017–2018, students missed 11,205,797 school days due to out-of-school suspensions during that school year (U.S. Department of Education, 2021 ), there were 96,492 corporal punishment incidents, and 101,990 students were physically restrained, mechanically restrained, or secluded (U.S. Department of Education, Office of Civil Rights, 2020 ). Such exclusionary and punitive measures have long-lasting consequences for the involved students, including academic underachievement, dropout, delinquency, and post-traumatic stress (e.g., Cholewa et al., 2018 ). Moreover, these consequences disproportionally affect culturally and linguistically diverse students and students with disabilities (Skiba et al., 2014 ; U.S. General Accountability Office, 2018 ), often resulting in great societal costs (Rumberger & Losen, 2017 ).

In the USA, mass killings involving guns occur approximately every 2 weeks, while school shootings occur every 4 weeks (Towers et al., 2015 ). Given the apparent and continued rise in gun violence, mass shootings, and school mass shootings, we aimed in this paper to reexamine rates of intentional firearm deaths, mass shootings, and school mass shootings in the USA using data from the past 5 years, 2017–2022, reappraising our analyses given the time that had passed since our earlier examination of the issue (Katsiyannis et al., 2018a , b ).

As noted in Katsiyannis et al., ( 2018a , b ), gun violence, mass shootings, and school shootings have been a part of the American way of life for generations. Such shootings have grown exponentially in both frequency and mortality rate since the 1980s. Using the same criteria applied in our previous work (Katsiyannis et al., 2018a , b ), we evaluated the frequency of shootings, mass shootings, and school mass school shootings from January 2017 through mid-July 2022. Extant data regarding shooting deaths from 2017 through 2020 were obtained from the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, utilizing the web-based injury statistics query and reporting system (WISQARS), and for school shootings from 2017 to 2022 from Everytown Research & Policy ( https://everytownresearch.org ), an independent non-profit organization that researches and communicates with policymakers and the public about gun violence in the USA. Intentional firearm death data were classified by age, as outlined in Katsiyannis et al., ( 2018a , b ), and the crude rate was calculated by dividing the number of deaths times 100,000, by the total population for each individual category.

The number of intentional firearm deaths and the crude death rates increased from 2017 to 2020 in all age categories. In absolute terms, the number of deaths rose from 14,496 in 2017 to 19,308 in 2020. In accord with this rise in the absolute number of deaths, crude death rates rose from 4.47 in 2017 to 5.88 in 2020. Table ​ Table2 2 provides the crude death rate in 2017, 2018, 2019, and 2020, the most current years with data available. Figure  1 provides the raw number of deaths across the same time period.

Intentional firearm deaths across the USA (2017–2020)

Data obtained from WISQARS (2022)

Intentional firearm deaths across the USA (2017–2020). Note. Data obtained from WISQARS (2022)

As expected, in 2020, the number of fatal firearm injuries increased sharply from age 0–11 years, roughly elementary school age, to age 12–18 years, roughly middle school and high school age. Table ​ Table3 3 provides the crude death rates of children in 2020 who die from firearms. Males outnumbered females in every category of firearm deaths, including homicide, police violence, suicide, and accidental shootings, as well as for undetermined reasons for firearm discharge. Black males drastically surpassed all other children in the number of firearm deaths (2.91 per 100,000 0–11-year-olds; 57.10 per 100,000 12–18-year-olds). Also, notable is the high number of Black children 12–18 years killed by guns (32.37 per 100,000), followed by American Indian and Alaska Native children (18.87 per 100,000), in comparison to White children (12.40 per 100,000 children), Hispanic/Latinx children (8.16 per 100,000), and Asian and Pacific Islander children (2.95 per 100,000). A disproportionate number of gun deaths were also seen for Black girls relative to other girls (1.52 per 100,000 0–11-year-olds; 7.01 per 100,000 12–18-year-olds).

Fatal firearm injuries for children age 0–18 across the USA in 2020

  AN Alaska Native; – indicates 20 or fewer cases

Mass shootings and mass shooting deaths increased from 2017 to 2019, decreased in 2020, and then increased again in 2021. School shootings made a sharp decline in 2020—understandably so, given the onset of the COVID-19 pandemic and subsequent government or locally mandated school shutdowns—but rose again sharply in 2021. Current rates reveal a continued increase, with numbers at the beginning of 2022 already exceeding those of 2017. School mass shooting counts were relatively low between 2017 through 2022, with four total during that time frame. Figure  2 provides raw numbers for mass shootings, school shootings, and school mass shootings from 2017 through 2022. Importantly, figures from the recent Uvalde, TX, school mass shooting at Robb Elementary School had not yet been recorded in the relevant databases at the time of this writing. With those deaths accounted for, 2022 is already the deadliest year for school mass shootings in the past 5 years.

Mass shootings, school shootings, and mass school shootings across the USA (2017–2022). Note. Data obtained from Everytown Research and Policy. Overlap present between all three categories

Gun violence in the USA, particularly mass shootings on the grounds of public schools, continues to be a pressing social and public health issue. Recent data suggest continued upward trends in school shootings, school mass shootings, and related deaths over the past 5 years—patterns that disturbingly mirror general gun violence and intentional shooting deaths in the USA across the same time period. The impacts on our nation’s youth are profound. Notably, gun violence disproportionately affects boys, especially Black boys, with much higher gun deaths per capita for this group than for any other group of youth. Likewise, Black girls are disproportionately affected compared to girls from other ethnic/racial groups. Moreover, while the COVID-19 pandemic and school shutdowns tempered gun violence in schools at least somewhat during the 2020 school year—including school shootings and school mass shootings—trend data show that gun violence rates are still continuing to rise. Indeed, gun violence deaths resulting from school shootings are at their highest recorded levels ever (Irwin et al., 2022 ).

Implications for Schools: Curbing School Violence

In recent years, the implementation of Multi-Tier Systems and Supports (MTSS), including Positive Behavioral Interventions and Supports (PBIS) and Response to Intervention (RTI), has resulted in improved school climate and student engagement as well as improved academic and behavioral outcomes (Elrod et al., 2022 ; Santiago-Rosario et al., 2022 ; National Center for Learning Disabilities, n.d.). Such approaches have implications for reducing school violence as well. PBIS uses a tiered framework intended to improve student behavioral and academic outcomes; it creates positive learning environments through the implementation of evidence-based instructional and behavioral interventions, guided by data-based decision-making and allocation of students across three tiers. In Tier 1, schools provide universal supports to all students in a proactive manner; in Tier 2, supports are aimed to students who need additional academic, behavioral, or social-emotional intervention; and in Tier 3, supports are provided in an intensive and individualized manner (Lewis et al., 2010 ). The implementation of PBIS has resulted in an improved school climate, fewer office referrals, and reductions in out-of-school suspensions (Bradshaw et al., 2010 ; Elrod et al.,  2010 , 2022 ; Gage et al., 2018a , 2018b ; Horner et al., 2010 ; Noltemeyer et al., 2019 ). Likewise, RTI aims to improve instructional outcomes through high-quality instruction and universal screening for students to identify learning challenges and similarly allocates students across three tiers. In Tier 1, schools implement high-quality classroom instruction, screening, and group interventions; in Tier 2, schools implement targeted interventions; and in Tier 3, schools implement intensive interventions and comprehensive evaluation (National Center for Learning Disabilities, n.d ). RTI implementation has resulted in improved academic outcomes (e.g., reading, writing) (Arrimada et al., 2022 ; Balu et al., 2015 ; Siegel, 2020 ) and enhanced school climate and student behavior.

In order to support students’ well-being, enhance school climate, and support reductions in behavioral issues and school violence, schools should consider the implementation of MTSS, reducing reliance on exclusionary and aversive measures such as zero tolerance policies, seclusion and restraints, corporal punishment, or school-based law enforcement referrals and arrests (see Gage et al., in press ). Such approaches and policies are less effective than the use of MTSS, exacerbate inequities and enhance disproportionality (particularly for youth of color and students with disabilities), and have not been shown to reduce violence in schools.

Implications for Students: Ensuring Physical Safety and Supporting Mental Health

Students should not have to attend school and fear becoming victims of violence in general, no less gun violence in particular. Schools must ensure the physical safety of their students. Yet, as the substantial number of school shootings continues to rise in the USA, so too does concern about the adverse impacts of violence and gun violence on students’ mental health and well-being. Students are frequently exposed to unavoidable and frightening images and stories of school violence (Child Development Institute, n.d. ) and are subject to active shooter drills that may not actually be effective and, in some cases, may actually induce trauma (Jetelina, 2022 ; National Association of School Psychologists & National Association of School Resources Officers, 2021 ; Wang et al., 2020 ). In turn, students struggle to process and understand why these events happen and, more importantly, how they can be prevented (National Association of School Psychologists, 2015 ). School personnel should be prepared to support the mental health needs of students, both in light of the prevalence of school gun violence and in the aftermath of school mass shootings.

Research provides evidence that traumatic events, such as school mass shootings, can and do have mental health consequences for victims and members of affected communities, leading to an increase in post-traumatic stress syndrome, depression, and other psychological systems (Lowe & Galea, 2017 ). At the same time, high media attention to such events indirectly exposes and heightens feelings of fear, anxiety, and vulnerability in students—even if they did not attend the school where the shooting occurred (Schonfeld & Demaria, 2020 ). Students of all ages may experience adjustment difficulties and engage in avoidance behaviors (Schonfeld & Demaria, 2020 ). As a result, school personnel may underestimate a student’s distress after a shooting and overestimate their resilience. In addition, an adult’s difficulty adjusting in the wake of trauma may also threaten a student’s sense of well-being because they may believe their teachers cannot provide them with the protection they need to remain safe in school (Schonfeld & Demaria, 2020 ).

These traumatic events have resounding consequences for youth development and well-being. However, schools continue to struggle to meet the demands of student mental health needs as they lack adequate funding for resources, student support services, and staff to provide the level of support needed for many students (Katsiyannis et al., 2018a ). Despite these limiting factors, children and youth continue to look to adults for information and guidance on how to react to adverse events. An effective response can significantly decrease the likelihood of further trauma; therefore, all school personnel must be prepared to talk with students about their fears, to help them feel safe and establish a sense of normalcy and security in the wake of tragedy (National Association of School Psychologists, 2016 ). Research suggests a number of strategies can be utilized by educators, school leaders, counselors, and other mental health professionals to support the students and staff they serve.

Recommendations for Educators

The National Association of School Psychologists ( 2016 ) recommends the following practices for educators to follow in response to school mass shootings. Although a complex topic to address, the issue needs to be acknowledged. In particular, educators should designate time to talk with their students about the event, and should reassure students that they are safe while validating their fears, feelings, and concerns. Recognizing and stressing to students that all feelings are okay when a tragedy occurs is essential. It is important to note that some students do not wish to express their emotions verbally. Other developmentally appropriate outlets, such as drawing, writing, reading books, and imaginative play, can be utilized. Educators should also provide developmentally appropriate explanations of the issue and events throughout their conversations. At the elementary level, students need brief, simple answers that are balanced with reassurances that schools are safe and that adults are there to protect them. In the secondary grades, students may be more vocal in asking questions about whether they are truly safe and what protocols are in place to protect them at school. To address these questions, educators can provide information related to the efforts of school and community leaders to ensure school safety. Educators should also review safety procedures and help students to identify at least one adult in the building to whom they can go if they feel threatened or at risk. Limiting exposure to media and social media is also important, as developmentally inappropriate information can cause anxiety or confusion. Educators should also maintain a normal routine by keeping a regular school schedule.

Recommendations for School Leaders

Superintendents, principals, and other school administrative personnel are looked upon to provide leadership and comfort to staff, students, and parents during a tragedy. Reassurance can be provided by reiterating safety measures and student supports that are in place in their district and school (The National Association of School Psychologists, 2015 ). The NASP recommends the following practices for school leaders regarding addressing student mental health needs directly. First, school leaders should be a visible, welcoming presence by greeting students and visiting classrooms. School leaders should also communicate with the school community, including parents and students, about their efforts to maintain safe and caring schools through clear behavioral expectations, positive behavior interventions and supports, and crisis planning preparedness. This can include the development of press releases for broad dissemination within the school community. School leaders should also provide crisis training and professional development for staff, based upon assessments of needs and targeted toward identified knowledge or skill gaps. They should also ensure the implementation of violence prevention programs and curricula in school and review school safety policies and procedures to ensure that all safety issues are adequately covered in current school crisis plans and emergency response procedures.

Recommendations for Counselors and Mental Health Professionals

School counselors offer critical assistance to their buildings’ populations as they experience crises or respond to emergencies (American School Counselor Association, 2019 ; Brown, 2020 ). Two models that stand out in the literature utilized by counselors in the wake of violent events are the Preparation, Action, Recovery (PAR) model and the Prevent and prepare; Reaffirm; Evaluate; provide interventions and Respond (PREPaRE) model. PREPaRE is the only comprehensive, nationally available training curriculum created by educators for educators (The National Association of School Psychologists, n.d. ). Although beneficial, neither the PAR nor PREPaRE model directly addresses school counselors’ responses to school shootings when their school is directly affected (Brown, 2020 ). This led to the development of the School Counselor’s Response to School Shootings-Framework of Recommendations (SCRSS-FR) model, which includes six stages, each of which has corresponding components for school counselors who have lived through a school mass shooting. Each of these models provides the necessary training to school-employed mental health professionals on how to best fill the roles and responsibilities generated by their membership on school crisis response teams (The National Association of School Psychologists, n.d. ).

Other Implications: Federal and State Policy

Recent events at Robb Elementary School in Uvalde, TX, prompted the US Congress to pass landmark legislation intended to curb gun violence, enhancing background checks for prospective gun buyers who are under 21 years of age as well as allowing examination of juvenile records beginning at age 16, including health records related to prospective gun buyers’ mental health. Additionally, this legislation provides funding that will allow states to implement “red flag laws” and other intervention programs while also strengthening laws related to the purchase and trafficking of guns (Cochrane, 2022 ). Yet, additional legislation reducing or eliminating access to assault rifles and other guns with large capacity magazines, weapons that might easily be deemed “weapons of mass destruction,” is still needed (Interdisciplinary Group on Preventing School & Community Violence, 2022 ; see also Flannery et al., 2021 ). In 2019, the US Congress started to appropriate research funding to support research on gun violence, with $25 million in equal shares provided on an annual basis from both the Centers for Disease Control and Prevention and the National Institutes of Health (Roubein, 2022 ; Wan, 2019 ). Additional research is, of course, still needed.

Despite legislative progress, and while advancements in gun legislation are meaningful and have the potential to aid in the reduction of gun violence in the USA, school shootings and school mass shootings are something schools and students will contend with in the months and years ahead. This reality has serious implications for schools and for students, points that need serious consideration. Therefore, it is imperative that gun violence is framed as a pressing national public health issue deserving attention, with drastic steps needed to curb access to assault rifles and guns with high-capacity magazines, based on extensive and targeted research. As noted, Congress, after many years of inaction, has started to appropriate funds to address this issue. However, the level of funding is still minimal in light of the pressing challenge that gun violence presents. Furthermore, the messaging of conservative media, the National Rifle Association (NRA) and republican legislators framing access to all and any weapons—including assault rifles—as a constitutional right under the second amendment bears scrutiny. Indeed, the second amendment denotes that “A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” Security of the nation is arguably the intent of the amendment, an intent that is clearly violated as evidenced in the ever-increasing death toll associated with gun violence in the USA.

Whereas federal legislation would be preferable, the possibility of banning assault weapons is remote (in light of recent Congressional action). Similarly, state action has been severely curtailed in light of the US Supreme Court’s decision regarding New York state law. However, data on gun fatalities and injuries, the correspondence of gun violence to laws regulating access across the world and states, and failed security measures such as armed guards posted in schools (e.g., Robb Elementary School) must be consistently emphasized. Additionally, the widespread sense of immunity for gun manufacturers should be tested in the same manner that tobacco manufacturers and opioid pharmaceuticals have been. The success against such tobacco and opioid manufacturers, once unthinkable, is a powerful precedent to consider for how the threat of gun violence against public health might be addressed.

Author Contribution

AK conceived of and designed the study and led the writing of the manuscript. LJR collaborated on the study design, contributed to the writing of the study, and contributed to the editing of the final manuscript. DKW analyzed the data and wrote up the results. SNS contributed to the writing of the study.

Declarations

The authors declare no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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ERPO.org is a first-of-its-kind resource and represents a significant step forward in the national effort to prevent gun violence and promote public safety. 

Study of Fatal and Nonfatal Shootings by Police Reveals Racial Disparities, Dispatch Risks

The analysis, thought to be one of the first published studies that captures both fatal and nonfatal injurious shootings by police nationally, also highlights risks of well-being checks.

A Year of Achievements and Our Vision for a Safer 2024

As we step into a new year at the Johns Hopkins Center for Gun Violence Solutions, it's crucial to reflect on the milestones achieved in 2023 and the work that lies ahead for a safer 2024. 

Questions and Answers on Firearm Purchaser Licensing

Frequently asked questions about firearm purchaser licensing as new laws are considered in several states across the country.

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New report highlights recommendations and policies to help prevent political violence 

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Study comes as last year’s Bruen Supreme Court decision forces several states to loosen concealed carry permitting laws.

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The Geography of Gun Violence

Gun death rates vary widely across the United States due to differences in socio-economic factors, demographics, and, importantly, gun policies. In general, the states with the highest gun death rates tend to be states in the South or Mountain West, with weaker gun laws and higher levels of gun ownership, while gun death rates are lower in the Northeast, where gun violence prevention laws are stronger.

* The total number of gun homicide deaths in New Hampshire and Vermont were less than 10 and thus repressed by CDC. Gun homicide deaths are thus listed as “other gun death rate” for these two states. Additionally, “other intents” include legal intervention, unintentional, and unclassified.

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Defending Democracy: Addressing the Dangers of Armed Insurrection

The report,  Defending Democracy: Addressing the Dangers of Armed Insurrection , recounts that the January 6 insurrection in 2021 at the U.S. Capitol was part of a long line of events in which individuals have sought to justify political violence or threats of violence by invoking false claims that the U.S. Constitution protects citizens’ rights to insurrection and the unchecked carrying of firearms in public. The report argues that armed insurrection can be prevented with effective policies and practices at the local, state, and national levels focused on protecting the integrity of the nation’s democratic processes.

Defending Democracy: How Policy Makers Can Protect Free and Fair Elections

Recent U.S. elections have been marked by threats, armed intimidation and political violence. As the 2024 U.S. general election approaches the Center hosted a webinar to discuss solutions against political violence and the threat of armed insurrection. Expert panelists discussed the implications of these threats to our country, public perception, and steps our leaders must take to protect our democratic institutions laid out in the Center's report "Defending Democracy".

Center for Gun Violence Solutions

We address gun violence as a public health emergency and utilize objective, non-partisan research to develop solutions which inform, fuel and propel advocacy to measurably lower gun violence.  The Center applies our unique blend of research and advocacy to advance five priority evidence-based gun violence prevention policies . Our research shows that, when enacted in combination, these policies have the potential to save thousands of lives. 

The Public Health Approach to Prevent Gun Violence

A public health approach to prevent gun violence addresses both firearm access and the factors that contribute to and protect from gun violence. This multidisciplinary approach brings together a range of experts across sectors—including researchers, advocates, legislators, impacted communities, community-based organizations, and others—in a common effort to develop and implement equitable, evidence-based solutions. 

A Successful Example of the Public Health Approach

The public health approach to tackling public health crises in America has been used over the last century to eradicate diseases like polio, reduce smoking deaths, and make cars safer. This public health approach has saved millions of lives. We can learn from the public health successes — like car safety — and apply these lessons to preventing gun violence.

Sources: National Traffic Highway Safety Administration (NTHSA). Motor Vehicle Traffic Fatalities and Fatality Rates, 1899-2017; Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 1968-2017 on CDC WONDER Online Database.

One of the greatest American public health successes is our nation's work to make cars safer. To reduce gun violence, we should apply this same time-tested public health approach.

Quick Facts From 2022 CDC Provisional Data

In 2022, 48,117 people died by guns, an average of one person every 11 minutes. 26,993 people died by gun suicide in 2022. Provisional data shows gun deaths are up 21% since 2019. Overall, the gun death rate decreases, and the number of gun suicides reaches an all-time high. 

In the past decade (2013-2022), the gun death rate among children & teens has increased 87%. Guns were the leading cause of death for children and teens (ages 1-19) in the U.S. for the fifth straight year. Both gun homicides and suicides fueled the increase. 

Black children & teens were 20x as likely to die by firearm homicide compared to their white counterparts, in 2022. The gun suicide rate among Black children & teens (age 10-19) surpassed the rate among white children & teens (age 10-19) for the first time on record. 

The Center recommends 5 evidence-based solutions to prevent gun death and injury: Firearm purchaser licensing, Extreme Risk Protection Orders and Domestic Violence Protection Orders, safe and secure firearm storage practices, strong laws limiting public carry, and community violence intervention programs. 

Firearm Violence

For each firearm death, many more people are shot and survive their injuries, are shot at but not physically injured, or witness firearm violence. Many experience firearm violence in other ways, by living in impacted communities with high levels of violence, losing loved ones to firearm violence, or being threatened with a firearm. Others are fearful to walk in their neighborhoods, attend events, or send their child to school. In short, firearm violence is public health epidemic that has lasting impacts on the health and well-being of everyone on this country. 

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Do Gun Regulations Equal Fewer Shootings? Lessons From New England

Gun rights advocates often point to low rates of shootings in Maine, New Hampshire, and Vermont to argue that you don’t need strong gun laws to keep violence in check. Here’s what the data actually reveals.

Why Are Gun Ads So Uncommon?

How often are ar-style rifles used for self-defense, do armed guards prevent school shootings.

July 5, 2022

What Researchers Know about Gun Policies’ Effectiveness

Studies are “decades behind,” owing to a lack of funding, but research is picking up

By Lynne Peeples & Nature magazine

Gun sales in the United States have been on the rise.

Jon Cherry/Bloomberg via Getty Images

About 40% of the world’s civilian-owned firearms are in the United States, a country that has had some 1.4 million gun deaths in the past four decades. And yet, until recently, there has been almost no federal funding for research that could inform gun policy.

US gun violence is back in the spotlight after mass shootings this May in Buffalo, New York, and Uvalde, Texas. And after a decades-long stalemate on gun controls in the US Congress, lawmakers passed a bipartisan bill that places some restrictions on guns. President Joe Biden signed it into law on 25 June.

The law, which includes measures to enhance background checks and allows review of mental-health records for young people wanting to buy guns, represents the most significant federal action on the issue in decades. Gun-control activists argue that the rules are too weak, whereas advocates of gun rights say there is no evidence that most gun policies will be effective in curbing the rate of firearm-related deaths.

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The latter position is disingenuous, says Cassandra Crifasi, deputy director of the Center for Gun Violence Prevention and Policy at Johns Hopkins University in Baltimore, Maryland. Although some evidence, both from the United States and overseas, supports the effectiveness of gun policies, many more studies are needed. “The fact that we have a lot of unanswered questions is intentional,” she says.

The reason, Crifasi says, is mid-1990s legislation that restricted federal funding for gun-violence research and was backed by the US gun lobby — organizations led by the National Rifle Association (NRA) that aim to influence policy on firearms. Lars Dalseide, a spokesperson for the NRA, responds that the association “did support the Dickey Amendment, which prohibited the CDC [US Centers for Disease Prevention and Control] from using taxpayer dollars to conduct research with an exclusive goal to further a political agenda — gun control.” But he adds that the association has “never opposed legitimate research for studies into the dynamics of violent crime”.

Only in the past few years — after other major mass shootings, including those at schools in Newtown, Connecticut, and Parkland, Florida — has the research field begun to rebuild , owing to an infusion of dollars and the loosening of limitations. “So, our field is much, much smaller than it should be compared to the magnitude of the problem,” Crifasi says. “And we are decades behind where we would be otherwise in terms of being able to answer questions.”

Now, scientists are working to take stock of the data they have and what data they’ll need to evaluate the success of the new legislation and potentially guide stronger future policies.

Among the reforms missing from the new US law, according to gun-safety researchers, is raising the purchasing age for an assault rifle to 21 years. Both the Buffalo and Uvalde gunmen bought their rifles legally at age 18. But making the case for minimum-age policies has been difficult because there are few data to back it up, Crifasi says. “With the limited research dollars available, people were not focusing on them as a research question.”

Gun-violence research is also stymied by gaps in basic data. For example, information on firearm ownership hasn’t been collected by the US government since the mid-2000s, a result of the Tiahrt Amendments. These provisions to a 2003 appropriations bill prohibit the US Bureau of Alcohol, Tobacco, Firearms and Explosives from releasing firearm-tracing data. For researchers, this means not knowing the total number of guns in any scenario they might be studying. “If we want to understand the rate at which guns become crime guns, or the rate at which guns are used in suicide, and which kind of guns and where, then we have to have that denominator,” says John Roman, a senior fellow at NORC, an independent research institution at the University of Chicago, Illinois.

Accurate counts of gun-violence events — the numerators needed to calculate those rates — are hard to come by, too. The CDC provides solid estimates of gun deaths, researchers note, but the agency hasn’t historically provided important context, such as the kind of weapon used or the relationship between the shooter and victim. Now fully funded, the state-based National Violent Death Reporting System (NVDRS) is beginning to fill in those details. Still, it remains difficult for researchers to study changes over time.

What’s more, most shootings do not result in death, but still have negative impacts on the people involved and should be tracked. Yet CDC data on non-fatal firearm injuries are limited to imperfect summary statistics and are not included in the NVDRS. If researchers were better able to examine shootings beyond firearm deaths, they could have much greater statistical power to evaluate the effects of state and federal laws, Crifasi says. Without enough data, a study might conclude that a gun policy is ineffective even if it actually does have an impact on violence.

“The CDC strives to provide the most timely, accurate data available — including data related to firearm injuries,” says Catherine Strawn, a spokesperson for the agency.

Another complicating factor is that primary sources of gun-violence data — hospitals and police departments — issue statistics that are incomplete and incompatible. Hospitals frequently report intentional gunshot injuries as accidents. “Folks in the ER are not criminal investigators, and they default to saying things are accidents unless they absolutely know for certain that it was an intentional shooting,” Roman says.

Data on gun-related hospital care — which are collected under an agreement between the US Agency for Healthcare Research and Quality, states and industry — can also be difficult for researchers to access. Some states charge for access to their data. “To get the complete set is incredibly expensive for researchers, so no one uses it,” says Andrew Morral, director of the National Collaborative on Gun Violence Research at the RAND Corporation in Washington DC. “The federal government could do better at aggregating data and making it available for research.”

In addition to hospitals, police departments are crucial to the collection of accurate gun-violence data. In 2021, the FBI began requiring all local law-enforcement agencies to report crimes to the National Incident-Based Reporting System. Although users are required to input more-comprehensive data to the system than before, compliance among departments has been low. “You have very, very active data collection at every scene of every traffic accident that involves an injury,” says Philip Alpers, a gun-violence researcher at the University of Sydney in Australia, referring to standard reporting protocols for US paramedics and police. So it’s certainly possible for law-enforcement agencies also to collect information about guns, Alpers adds. But he and others suggest that a culture of gun rights among agency personnel could be disincentivizing them from complying, as well as a lack of financial support for adapting to the new system.

The FBI did not respond to Nature ’s queries about the reporting system.

Looking for lessons from abroad

Researchers emphasize that the call for more data and research is no reason to delay implementing gun controls. After all, some data do exist, from international studies on gun safety and from state- and privately funded US investigations, that could guide policymakers.

For instance, in Israel, policy changes that restrict military personnel from bringing their weapons home resulted in reductions in gun suicides. And after a mass shooting in Port Arthur, Australia, in 1996, officials imposed a suite of gun regulations centred around a massive buyback programme. The country approximately halved its rates of gun homicides and suicides over the following seven years. It also had no mass shootings in the subsequent 2 decades, compared with 13 such incidents in the 18 years leading up to the massacre.

Still, these successes might not translate to the United States. “Could America do what Australia did? The answer is no, not a chance. You’ve got too many guns [in the US],” Alpers says. “You have to separate America from the rest of the world.” And, with the prospect of tightened regulation on the horizon, US firearm ownership seems to be rising: gun stores around the country are seeing increased sales.

“We can learn from [other countries’ experiences],” Roman says. “But that seems so far outside of any reasonable expectation of where US policy is headed.” In other words, the United States needs more research.

Slow, belated progress

The good news is that data collection in the United States has been on the rise since the influx of federal funding. Researchers and others will meet at the first National Research Conference on Firearms Injury Prevention, planned for later this year.

This revived interest in gun-safety research will bolster the sparse efforts across the country that relied mainly on state and private funds. For instance, California initiated a restriction on assault weapons in 1989, and has since layered on other regulations, such as universal background checks and red-flag laws that allow police, family members, employers, co-workers and school employees to petition the court to temporarily separate a person from their firearms.

For the past 22 years, California’s gun-death rate has been trending downwards , explains Garen Wintemute, an emergency-medicine physician at the University of California, Davis. In 2020, the overall rate across the other 49 states was around 64% higher than the rate in California. Although it is difficult to tease apart the impacts of individual laws, the sum total seems to be working. “I suspect that they acted synergistically: where one law wasn’t effective, the other one stepped in,” Wintemute says.

A similarly layered approach successfully targeted US car crashes. For decades, motor-vehicle accidents were the most common cause of death among young people. But investments in research and the resulting evidence-based regulations put a major dent in those numbers. “It wasn’t one thing: we did seat belts, we did airbags, we did improvements to the roads,” says Rebecca Cunningham, a gun-violence researcher at the University of Michigan, Ann Arbor. “We got less drunk driving. It was all these layers of public-health protection on top of each other.”

Raising the legal age to drink from 18 to 21 helped to reduce the number of young drunk drivers. Cunningham sees a similar potential precedent for raising the legal age to buy a rifle.

But funding for gun-violence research has been a fraction of that invested in traffic safety — nearly fourfold fewer dollars per life lost. In 2020, gun violence surpassed car accidents as the leading cause of death among US children and young adults.

“For 20 years, we turned our back on the health problem and declined to do research on it,” Wintemute says. “How many thousands of people are dead today who would be alive if that research had been allowed to continue?”

This article is reproduced with permission and was first published on July 1 2022.

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Funded Research

• RFA-CE-23-005
• RFA-CE-23-006
• RFA-CE-22-004
• RFA-CE-20-006
• RFA-CE-20-002

Research Priorities

In 2013, the Institute of Medicine (IOM), in collaboration with the National Academies of Science, Engineering and Medicine (NASEM), released the report Priorities for Research to Reduce the Threat of Firearm-Related Violence . CDC and the CDC Foundation asked the IOM/NASEM to convene a committee to engage diverse stakeholders and identify the most pressing research questions on gun violence, including those with the greatest potential for public health impact.

The National Center for Injury Prevention and Control (NCIPC) funding opportunities are intended to support research that aligns with several of the priorities identified in the IOM/NASEM report, including:

• understanding the characteristics of firearm violence
• the risk and protective factors for interpersonal and self-directed firearm violence
• the effectiveness of interventions to prevent firearm violence

Current Awardees

It is important to note that descriptions of CDC’s other violence prevention research awards are also available online . Some of these projects also focus on firearm-related injuries, deaths, and crime. This page reflects the projects funded under the specific funding opportunities listed below. Each funded project description includes a link to the Research Portfolio Online Reporting Tools page under “Learn More” which provides the most up-to-date information on the project, including publications.

RFA-CE-23-005: Research Grants to Inform Firearm-Related Violence and Injury Prevention Strategies (R01)

CDC is committing $2,138,459 to fund four research awards under RFA-CE-23-005 : Research Grants to Inform Firearm-Related Violence and Injury Prevention Strategies. This initiative supports research to inform the development or improvement of prevention programs, policies, or practices that have the potential to substantially reduce firearm-related violence, injuries, death, or crime within populations or settings experiencing elevated risk.

Two-year Project Project Period: September 30, 2023 – September 29, 2025

Principal Investigator: Lynette Renner, University of Minnesota First-Year Award: $349,601 This project is a longitudinal study of youth trajectories to firearm violence perpetration, with the overall objective to conduct research to inform opportunities to enhance safety and prevent firearm-related injuries, death, and crime.

Firearm violence impacts some populations more than others, and youth who are at increased risk for violence are overrepresented in school discipline and justice systems. This study will retrospectively follow 1.4 million children enrolled in Minnesota K-12 public schools for over 15 critical years of their development. Researchers will link school data with other data from Minnesota Department of Human Services and the State Court Administrator’s Office. They plan to measure how early forms of school violence escalate to future firearm violence and identify how involvement with the social welfare system impacts firearm violence. The findings will help inform how the formative school years, adolescence, and emerging adulthood affect firearm violence. See updates.

Three-year Projects Project Period: September 30, 2023 – September 29, 2026

Principal Investigator: Allison Miller, University of Michigan at Ann Arbor First-Year Award: $649,828 This study will engage parents of young children (ages 0-5 years) with a mixed-methods, community-based approach to develop and pilot an intervention among firearm-owning parents with young children to inform prevention of unintentional firearm injury and death in early childhood.

Firearm-related injuries recently became the leading cause of death among children in the U.S., and children under five years old are among the largest age groups impacted by unintentional firearm injury. Unsafe firearm storage is a leading cause of firearm-related injury and death among young children, so more can be learned about improving safety practices. This study will help improve understanding about the scope and motivations for gun ownership, storage, and use among parents with young children. Using behavioral and decision science with community partners as messengers, this study will assess what parents know about firearm safety and injury prevention during early childhood. Findings from this project will inform a parent-driven firearm injury prevention program for parents of young children. See updates .

Principal Investigator: Jeff Temple, The University of Texas Medical Branch at Galveston First-Year Award: $649,465 This study will expand and extend an ongoing 15-year longitudinal study of adolescent health among ethnically and socioeconomically diverse participants to examine experiences with firearms and risk and protective factors.

Since firearm injury and violence are costly and risk for all forms of violence begins early in life, prevention efforts are needed that start early and are specific to audience, gender, race/ethnicity, life stage, and developmental phases. This research will do several things. It will expand a long-term survey and will conduct in-depth interviews with those who carry firearms to better understand their ideas, practices, contexts, and experiences of acquiring, carrying, using, sharing, and storing firearms. Additionally, the research will identify key individual, behavioral, situational, trauma-related, and community risk factors for firearm injury and violence and compile findings into easily understandable language and summaries. Findings will directly benefit communities by informing schools and communities with more tailored violence prevention approaches for adolescents and young adults. See updates .

Principal Investigator: Briana Woods-Jaeger, Emory University First-Year Award: $489,565 This study will evaluate economic security policies such as minimum wages, the Earned Income Tax Credit, Temporary Assistance for Needy Families, and Supplemental Nutrition Assistance Program as primary prevention strategies for firearm violence among Black youth and young adults.

This study will evaluate the effectiveness of economic security policies (minimum wages, the Earned Income Tax Credit, Temporary Assistance for Needy Families, and Supplemental Nutrition Assistance Program) as primary prevention strategies for firearm violence among Black youth and young adults 10-34 years old. The study will also involve conducting interviews with Black youth and young adults 10-34 years old who have been injured by firearms and their primary caregivers who live in environments that have fewer of these economic policies. The study will evaluate economic security policies, focusing on whether existing policies are effective for primary prevention among those most impacted by firearm violence. See updates.

RFA-CE-23-006: Research Grants to Rigorously Evaluate Innovative and Promising Strategies to Prevent Firearm-Related Violence and Injuries (R01)

CDC is committing $3,799,696 to fund eight research awards under RFA-CE-23-006 : Research Grants to Rigorously Evaluate Innovative and Promising Strategies to Prevent Firearm-Related Violence and Injuries. This initiative supports research to evaluate the effectiveness of strategies to keep individuals, families, schools, and communities safe from firearm-related violence, injuries, deaths, or crime.

Two-year Projects Project Period: September 30, 2023 – September 29, 2025

Principal Investigator: Justin Heinze, University of Michigan at Ann Arbor First-Year Award: $350,000 This study will analyze school-based anonymous and confidential reporting system submissions to characterize the types of tips reported, what factors influence student tip submissions and content, and whether exposure to training influences tip behavior and content.

Anonymous and confidential reporting systems (ARS) and school-based tip lines are designed to help students share concerning or suspicious behaviors. These systems eliminate barriers to reporting, such as the social cost of “tattling,” helping students identify and report threats correctly, and creating school safety. Despite their widespread adoption and availability, there is limited data measuring how well these systems function and if they prevent firearm and other violent injuries in school. To define the type of tips reported, what influences student tip submissions, and whether training influences tip behavior, the study will use a large data set of more than 17,000 tips submitted to a statewide ARS over five years. Schools and reporting systems can use the findings to identify strategies and best practices for improving anonymous and confidential reporting systems. See updates .

Principal Investigator: James Macinko, University of California, Los Angeles First-Year Award: $349,898 This study will identify public policies that target the intersection of alcohol and firearms and provide a rigorous evaluation of their potential impacts on firearm-related homicide, suicide, and unintentional deaths over 2010 to 2022.

This study will evaluate the potential impact of state alcohol-related firearm laws on firearm-related homicide, suicide and unintentional deaths by analyzing state statutes using machine learning techniques and causal inference methods. Additional analyses will study whether these laws impact the incidence of intimate partner homicide. In addition to publishing findings from the analyses, the study team will produce an interactive web-based tool for public use that allows users to understand alcohol and firearm policies in their states, as well as firearm-related deaths in their states over time. Results from this study will be used to assess the effectiveness of these approaches in reducing U.S. firearm-related deaths. See updates .

Principal Investigator: Sonja Swanson, University of Pittsburgh at Pittsburgh First-Year Award: $333,217 This study will rigorously quantify the effects of extreme risk protection order (ERPO) and waiting period laws on mortality risk among handgun owners and the people they live with.

Many firearm deaths, including suicides and homicides related to household violence, occur during periods of heightened stress. As such, some suicide and violence prevention strategies focus on reducing firearm access during those periods of stress, including applying ERPO laws to proactively and temporarily remove firearms and using mandatory waiting-period laws to delay firearm access. Using the Longitudinal Study of Handgun Ownership and Transfers (LongSHOT), an established cohort of over 25 million adults in California, research from this study will help estimate the effect of California’s ERPO law on the risk of suicide among handgun owners and homicide among people who live with handgun owners. This study will help build the evidence base for understanding the effects of ERPO and waiting period policies. See updates.

Principal Investigator: Ziming Xuan, Boston University Medical Campus First-Year Award: $348,515 This study will assess the confluence of state-level bullying policies and firearm policies on reducing youth gun carrying and firearm-related fatality from 1999 to 2021.

Little is known about how youth-focused health policies impact youth gun violence, including state bullying or firearm policies. The goal of this study is to improve the evidence base for youth firearm prevention by conducting a comprehensive evaluation to assess state-level bullying policies and firearm policies on youth gun carrying and firearm-related deaths. This research will provide evidence on the effectiveness of policy strategies in reducing youth firearm violence and how these youth-specific policies may impact certain youth populations who are at higher risk for gun violence. See updates .

Principal Investigator: Alice Ellyson, Seattle Children’s Hospital First-Year Award: $650,000 This study will rigorously evaluate the effectiveness of implementing domestic violence protection order (DVPO) firearm prohibitions in reducing subsequent firearm-related crime, injury, and death of victim-survivors / petitioners, protected minors, and respondents.

Domestic violence is a substantial public health and safety problem with lasting consequences for individuals, families, and communities. Firearms play a major role in domestic violence harm, and American Indian/Alaska Native, Black, and multiracial women disproportionately experience this harm. According to federal law, individuals who are under domestic violence protection orders (DVPOs) are prohibited from purchasing and possessing firearms. These restrictions are not consistently implemented or enforced across the United States. This study will collect new data on around 12,500 DVPOs and firearm-related harm in Washington state to assess if DVPOs reduce firearm-related injury, crime, and death. Findings from this study will provide actionable information for local and state policymakers and professionals. See updates .

Principal Investigator: Cynthia Ewell Foster, University of Michigan at Ann Arbor First-Year Award: $470,325 This study will evaluate Store Safely , a multicomponent online primary prevention strategy designed via a university-community partnership for rural families who own firearms.

Firearm injuries are the leading cause of death among youth in the United States, and rates of firearm-related suicides among rural youth are increasing at an alarming rate. Reducing access to firearms is a key component of suicide prevention because most suicide attempts with a firearm are fatal. Although safe firearm storage reduces the risk of firearm injury and death, few interventions are tailored to rural communities where firearms are prevalent and are part of community and family culture. Disparities in access to health care also limit opportunities for safe storage education. This study will use a community-based participatory research approach and other methods to test the Store Safely, an innovative and highly scalable online intervention. If found to be effective, Store Safely can potentially reduce suicide mortality in rural areas by focusing on the strengths of rural communities to enhance safety. See updates .

Principal Investigator: Katherine Hoops, Johns Hopkins University First-Year Award: $647,776 This study will implement a universal firearm injury prevention initiative in three pediatric trauma centers to demonstrate best practices for pediatric trauma center-based firearm injury prevention strategies that promote safe storage practices and reduce firearm-related injury and death. The study will use the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) methodology for evaluation.

For more than a decade, multiple national organizations have recommended universal firearm injury and violence prevention counseling for parents and patients, yet clinicians rarely deliver this counseling. This study will test the effectiveness of comprehensive training for improving the implementation of universal firearm injury prevention. Findings will help establish best practices for delivering firearm injury prevention screening and counseling within pediatric trauma centers. This research has the potential to impact clinical care, prevent firearm-related injury and death, and significantly improve implementation science. See updates .

Principal Investigator: Nicholas Thomson, Virginia Commonwealth University First-Year Award: $649,965 This study will conduct a randomized control trial to assess the effectiveness of brief violence intervention virtual reality (BVI-VR) for preventing firearm-related violence, injury, and death.

With rising gun violence rates, developing innovative interventions is critical to effectively engage adults at high-risk and prevent future firearm-related violence, injury, and death. Once discharged from a hospital, violently injured adults are at an increased risk of additional firearm-related violence and are more likely to engage in retaliatory violence. Because of this, the hospital has become a critical location for violence prevention. Patients who are most at risk of retaliatory violence are often difficult to engage in intervention; however, new strategies can help meet their interests and needs. This project will develop an innovative, brief hospital-based violence intervention using virtual reality and conduct a randomized controlled trial to evaluate its effectiveness for preventing retaliatory firearm-related violence, injury, and death among violently injured adults. See updates .

RFA-CE-22-004: Research Grants to Prevent Firearm-Related Violence and Injuries (R01)

The National Center for Injury Prevention and Control, Division for Violence Prevention (DVP) is committing $2,539,786 to fund four research awards under RFA-CE-22-004 : Research Grants to Prevent Firearm-Related Violence and Injuries.

The intent of this initiative is to support research to improve understanding of firearm injury, inform the development of innovative and promising prevention strategies, and rigorously evaluate the effectiveness of strategies to keep individuals, families, schools, and communities safe from firearm-related injuries, deaths, and crime. RFA-CE-22-004 is intended to directly support activities under one or both of the following research objectives:

• Objective One: Research to improve understanding of firearm injury and inform the development of innovative and promising prevention strategies.
• Objective Two: Research to rigorously evaluate the effectiveness of innovative and promising strategies to keep individuals, families, schools, and communities safe from firearm-related injuries, deaths, and crime.

Three-year Projects Project Period: September 30, 2022 – September 29, 2025

Principal Investigator: Shannon Frattaroli, Johns Hopkins University First-Year Award: $643,055 This study will develop and pilot test implementation guidance for law enforcement agencies using Extreme Risk Protection Order (ERPO) laws.

Preventing firearm access by those at significant risk of violence is a strategy used to help prevent firearm homicide, firearm suicide, and nonfatal firearm violence. Extreme Risk Protection Order (ERPO) laws provide a civil court option for temporarily removing firearms from, and preventing purchase by, high-risk individuals. A key question is how law enforcement agencies can best implement existing ERPO laws. This project will develop and pilot test ERPO implementation guidelines using community-based participatory research with a focus on communities that experience high rates of firearm violence.  See updates.

Principal Investigator: Hsun-ta Hsu, University of Missouri – Columbia First-Year Award: $597,148 This study will investigate how individual, social network, and neighborhood environmental characteristics are associated with firearm risks for youth experiencing homelessness and examine the role their social network may play in moderating these risks.

Youth experiencing homelessness are especially vulnerable to firearm violence and often have access to firearms. This project will use data from face-to-face structured interviews with youth experiencing homelessness in Los Angeles County, California, and the greater St. Louis, Missouri area. The study   investigates how individuals, social networks, and neighborhood environmental characteristics are associated with firearm risks for youth experiencing homelessness and examines the role their social network may play in moderating these risks. Understanding firearm risks among youth experiencing homelessness will provide critical information to inform innovative interventions to help keep youth experiencing homelessness safe from firearm-related injuries, death, and crime. See updates.

Principal Investigator: Julie Richards, Kaiser Foundation Hospitals (KFH) First-Year Award: $649,586 This study will examine patient-centered strategies in healthcare settings to identify and engage patients at high risk of firearm suicide and pilot test intervention strategies.

Firearms are the most common method of suicide in the United States. Most people who die by suicide see a health care provider sometime in the year prior to death, giving clinical providers important opportunities to intervene with patients at risk for firearm suicide. There is little evidence available to guide implementation of promising clinical practices for firearm suicide prevention. This study will elicit patient, clinician, and leader perspectives on clinical practices for identifying and engaging individuals at risk of firearm suicide, identify opportunities for practice improvement, and pilot test intervention strategies in three healthcare systems. The results will fill the critical need for patient-centered strategies to identify and engage patients at high risk of firearm suicide. See updates.

Principal Investigator: Bruce Taylor, National Opinion Research Center First-Year Award: $649,979 This study will survey youth and young adults to identify risk and protective factors associated with firearm violence.

In this project, researchers will conduct a nationally representative 3-wave longitudinal survey of 2,750 youth and young adults ages 10-34 to identify risk and protective factors associated with firearm violence in the US, including witnessing violence, gun carrying, perpetration, and victimization. By enhancing understanding of the individual, family, peer, school/work, community contexts, and bystander behaviors associated with firearm violence, the results will inform the development of prevention and intervention efforts that are applicable to a broad range of youth and young adults as well as those at high risk for firearm violence exposure. See updates.

RFA-CE-20-006: Research Grants to Prevent Firearm-Related Violence and Injuries (R01)

The National Center for Injury Prevention and Control, Division for Violence Prevention (DVP) is committing $7,836,869 to fund sixteen research awards under RFA-CE-20-006: Research Grants to Prevent Firearm-Related Violence and Injuries.

The purpose of this initiative is to solicit investigator-initiated research to understand and prevent firearm-related injuries, deaths, and crime. For the purposes of this NOFO, firearm-related injuries, deaths, and crime include mass shooting incidents, other firearm homicides/assaults, firearm suicides/self-harm, unintentional firearm deaths and injuries, and firearm-related crime. RFA-CE-20-006 is intended to directly improve understanding of firearm-related violence and promising prevention approaches by supporting activities under one or both of the following two research objectives:

• Objective One: Research to help inform the development of innovative and promising opportunities to enhance safety and prevent firearm-related injuries, deaths, and crime.

Two-year Projects Project Period: September 30, 2020 – September 29, 2022

Principal Investigator: Dr. Catherine Dempsey; Henry M. Jackson Foundation Year Two Award: $350,000

This study will analyze longitudinal data to improve understanding of the motivations and opportunities for prevention among service members and Veterans owning firearms, storing them in unsafe conditions and using them to hurt others or themselves.

Veterans bear a disproportionate share of the burden of firearm suicide. This study will analyze existing data from the longitudinal Study to Assess Risk and Resilience in Servicemembers Study (STARRS-LS), which includes more than 14,000 soldiers. The study will identify firearm behavioral practices that may predict suicidal behaviors; establish if there is a relationship between geographic location and suicide; identify the principal reasons for keeping a gun and the degree to which identified reasons mediate suicide risk; and establish if there is a relationship between storage practices and personality characteristics or other mental health issues. The broader impact of this study is anticipated to be the development of a comprehensive understanding of risks contributing to firearm mediated suicide, thus improving risk identification capabilities in both the military and civilian populations. See updates.

Principal Investigator: Dr. Rowell Huesmann, University of Michigan at Ann Arbor Year Two Award: $346,354

This study will use integrative analyses of two longitudinal datasets to examine how individual, family, and neighborhood risk factors for gun violence affect the development of violence- and weapons-related social cognitions and behaviors into early adulthood.

Firearm violence in the United States is a serious public health concern, and the rates are much higher among African American and Hispanic youth compared to White youth. This study will conduct integrative data analyses using data from two longitudinal studies on youth exposure to violence and subsequent weapons use in urban areas at high risk for gun violence. The analysis will examine how risk factors for gun violence at multiple levels of the social ecology (including self-report and geospatial crime coding of gun violence and other characteristics at the neighborhood level) affect the development of violence-related and weapons-related social cognitions that shape use of guns and other weapons into early adulthood. The findings are expected to have implications for enhancing the impact of community- and school-based prevention programs targeting firearm violence specifically and youth violence more generally. See updates.

Principal Investigator: Dr. Nicole Kravitz-Wirtz, University of California at Davis Year Two Award: $301,478

This study will estimate the population prevalence and consequences of youths’ direct and indirect exposure to community gun violence to inform prevention efforts.

Community violence is a recognized form of trauma that disproportionately impacts youth of color. There is growing consensus that community gun violence exposure and its consequences may extend to youth even if they do not report experiencing gun violence and even if they do not hear or see it in person. Existing studies have largely relied on self-reported survey items that prohibit examination of this broader conceptualization of exposure. The proposed project will use a unique combination of longitudinal data on a national, probability-based sample of youth and their families, schools, and neighborhoods geospatially linked with temporal and spatial information on deadly gun violence incidents. It will examine the population prevalence and health-related consequences of youths’ exposure to community gun violence, regardless of whether the violence was experienced firsthand. Results from this study are intended to help enhance the process of identifying individual, familial, school, and neighborhood-level factors associated with increased vulnerability or resilience to the adverse impacts of community gun violence exposure to guide efforts to disrupt the cycle of violence. See updates.

Principal Investigator: Dr. Andrew Morral, Rand Corporation Year Two Award: $349,758

This study is designed to use small-area estimation techniques to generate informative estimates of household firearm ownership and then use these new estimates to test the effects of firearm safety policies.

Gaps in available data measuring firearm ownership across population strata over time limit the ability to evaluate firearm safety policies and interventions. This study uses small-area estimation techniques to generate informative estimates of household firearm ownership within strata defined by gender, race, marital status, urbanicity, and state, over the period 1980-2020. The study will then use the new measures of firearm ownership to understand disparities in firearm mortality and to conduct innovative and more sensitive and precise evaluations of the effects of policies designed to improve firearm safety. Findings will be used to inform how firearm ownership varies across populations, communities, and time and how this variation relates to differential firearm homicide and suicide risk among subgroups. See updates.

Principal Investigator: Dr. Aimee Moulin, University of California at Davis Year Two Award: $316,127

This study examines the synergistic impacts of firearm access and opioid-related harm on firearm suicide risk at the individual and population levels in the state of California.

Research on risky opioid use among firearm owners is limited, though evidence suggests the link between substance use and suicide extends to firearm owners. This study will incorporate multiple population-based sources of existing data, including but not limited to mortality and emergency department/hospital records. The study will use an individual-level case-control design and a population-level time series analysis to examine whether personal firearm ownership moderates the impact of individual and community opioid-related harm on individual firearm suicide risk. Similarly, the study will examine whether firearm availability moderates the impact of community opioid-related harm on firearm suicide rates. Results are intended to inform innovative and promising opportunities to enhance safety and prevent self-directed firearm-related injuries and deaths. See updates.

Principal Investigator: Dr. Bindi Naik-Mathuria, Baylor College of Medicine Year Two Award: $330,672

This study will integrate data from trauma centers, the medical examiner’s office, and law enforcement to examine individual-level and neighborhood-level risk factors for firearm-related violence.

Firearm violence is a major public health issue; however, efforts to curb firearm injuries and deaths are hampered by incomplete and out-of-date data. This study will conduct a 3-year retrospective review of data on children and adults who were injured or killed by firearms and integrate data from trauma centers, the medical examiner’s office, and law enforcement. The analyses will identify and categorize individual-level and neighborhood-level geographic, demographic, temporal, social, and socioeconomic risk factors for firearm-related violence. The integration of firearm violence data from multiple data sources in a large and diverse population center is intended to provide a unique platform to analyze injury clusters and provide evidence-based prioritization of risk factors to help communities design targeted interventions. See updates.

Principal Investigator: Dr. Anna Yaros, Research Triangle Institute Year Two Award: $349,545

This study will analyze Crisis Text Line data related to multiple types of firearm violence to help inform firearm violence prevention activities.

There is a critical need for more information on the moment of crisis immediately before an act of firearm violence. This study will analyze data from the Crisis Text Line (CTL), a nonprofit organization that provides free around-the-clock text message support to anyone experiencing any crisis, to examine text conversations related to multiple types of firearm violence (e.g., impending acts of suicide, domestic violence, mass shootings). The study will conduct content analysis to examine how texters initiate and continue conversations related to firearm violence, compare texts related to firearm crises with those related to non-firearm crises, identify risk and protective factors for different types of firearm crises relative to those of non-firearm crises, and track the types of firearm texts before and after the coronavirus pandemic and consider how pandemic-specific anxieties are affecting the texts. The study is designed to provide insight about the best ways to stop firearm violence before it occurs. See updates.

Three-year Projects Project Period: September 30, 2020 – September 29, 2023

Principal Investigator: Dr. Patrick Carter, University of Michigan at Ann Arbor Year Three Award: $649,997

This study will determine the effectiveness of IntERact, a technology-enhanced behavioral intervention, in reducing risky firearm behaviors, firearm carriage and violence, and co-occurring mental health and behavioral risks among youth seeking treatment in an emergency department.

Intervening early with youth who are engaged in risky firearm behaviors when they are seen in urban emergency departments has the potential to decrease subsequent firearm violence, but additional evidence of effectiveness is needed. This study will conduct a randomized controlled trial of IntERact, a technology-enhanced behavioral intervention program, in reducing risky firearm behavior and violence in youth ages 16-24 who are seen in the emergency department and have reported recent firearm carriage and smartphone ownership. IntERact uses remotely delivered behavioral therapy and care management combined with a supportive smartphone app to facilitate therapist contact, just-in-time GPS-triggered notifications upon entry into high-risk areas, and enhanced care management access. This study will determine the effectiveness, including cost benefits, of the IntERact intervention and the potential for broader public health impact. See updates.

Principal Investigator: Dr. Jason Goldstick, University of Michigan at Ann Arbor Year Three Award: $649,899

This study will use cutting-edge machine learning methods to optimize the ability to assess youth risk for firearm violence so that prevention resources and emergency department interventions can be used efficiently.

Interventions in clinical settings, such as the emergency department (ED), are an opportunity for interpersonal firearm violence prevention, particularly among youth. A crucial prerequisite to successful clinical interventions is an accurate gauge of risk. This prospective longitudinal study will validate the SAFETY clinical screening tool by determining its ability to predict youth firearm violence involvement within the next year and improve the SAFETY score by conducting a comparative analysis of four powerful machine learning methods. The results from this work will lay the groundwork for future research involving the development and testing of interventions for interpersonal firearm violence both by identifying potential high-leverage modifiable predictive factors and by identifying youth most in need of intervention. See updates.

Principal Investigator: Dr. Sabrina Mattson, University of Colorado Year Three Award: $649,988

This study is looking at Gun Shop Projects (GSPs), community-driven suicide prevention partnerships, to better understand how they impact firearm safety behaviors and suicides involving firearms.

This study examines the implementation and impact of Gun Shop Projects (GSPs). GSPs are community-driven suicide prevention partnerships between the firearms community (retailers, ranges, and other businesses) and local public or community health agencies aimed at temporarily reducing access to firearms during times of crisis. The research team will identify the implementation core components of GSPs, examine the mechanisms for firearm safety behavior change, and examine the impact GSPs may have on suicide outcomes. Study results will advance scientific knowledge on involving the firearms community in suicide prevention efforts as a way to optimize implementation of community-level means reduction and safe storage strategies. See updates.

Principal Investigator: Dr. Phillip Smith, University of South Alabama Year Three Award: $642,872

This study is looking at risky gun-related behaviors and the acceptability of specific approaches to prevention for populations at greatest risk for homicide (African American boys and young men) and suicide (older White men).

Current approaches to prevent gun injury are limited in their ability to reach those at highest risk, which may be due to the cultural disconnect between gun injury prevention strategies and the populations at greatest risk for violence and suicide. This study uses a mixed-methods participatory action research approach to improve understanding of the factors underlying risky gun-related attitudes, behaviors, and practices and to identify the acceptability of specific approaches to prevention for two distinct groups at risk for homicide (African American boys and young men) and suicide (older White men). Through the use of interviews and surveys, the research team will identify methods of gun access or acquisition, storage, and carrying; motivations for gun access, ownership, storage practices, use, and carrying; attitudes about ownership, storage safety, use, and carrying; acceptability of gun-focused prevention strategies; and ideas for novel prevention strategies. The results of this work will advance prevention science by creating a culturally grounded social-ecological model that can guide research on risk and protective factors for intentional gun-related injuries and inform the development of public health interventions. See updates.

Principal Investigator: Dr. Nicole Nugent, Brown University Year Three Award: $649,986

This study will evaluate the effectiveness of a bystander intervention in changing firearm injury prevention norms, attitudes, intentions, and behaviors among a sample of 50 4-H Shooting Sports Club communities.

Modifiable risk factors for youth firearm injury and death include unsafe storage of a firearm in the home, prior victimization/aggression, substance use, and depressive symptoms, yet there are few partnerships with firearm owners and firearm safety training programs to implement effective, non-policy-based preventive interventions for youth firearm injury. This study will conduct a hybrid effectiveness-implementation trial to evaluate the effectiveness of The Reframe, a bystander intervention designed to promote changes in firearm injury prevention norms , attitudes, intentions, and behaviors among a sample of 50 4-H Shooting Sports Club communities comprising both adults and youth. This project is designed to build the evidence base for interventions that promote safe behaviors related to youth firearm use and injury prevention and advance firearm injury prevention science by supporting a synergistic partnership between well-established firearm injury, suicide, and violence prevention researchers and the national 4-H Shooting Sports community. See updates.

Principal Investigator: Dr. Ali Rowhani-Rahbar, University of Washington Year Three Award: $453,262

This study will identify the context, antecedents, and consequences of handgun carrying among adolescents who reside in rural communities in order to inform culturally appropriate and community-specific interventions.

Rural communities have high levels of firearm access and mortality, yet they are understudied and underserved. This study will utilize existing data and collect new data from rural adolescents to improve understanding of the cultural and environmental context within which handgun carrying occurs, identify developmental patterns of handgun carrying during adolescence and as youth transition to adulthood, examine the salient antecedents and consequences of this behavior, and test the effects of the Communities That Care prevention system. This project is intended to inform the development, adoption, and refinement of non-punitive prevention approaches to address factors that influence handgun carrying and reduce the burden of firearm-related injury among youth in rural communities.  See updates.

Principal Investigator: Dr. David Schwebel, University of Alabama at Birmingham Year Three Award: $650,000

This project will develop and evaluate ShootSafe, a website designed to teach children how to engage safely with firearms to reduce risk for unintentional pediatric firearm-related injuries and deaths.

Firearm-related injuries present a major pediatric public health challenge in the United States. This project will develop and evaluate ShootSafe, a website accessible by smartphone, tablet, or computer that engages children to learn firearms safety. ShootSafe will use interactive games, activities, and videos to teach children the knowledge and skills they need to hunt, shoot, and use firearms safely. It will also be designed to help children learn and hone the critical cognitive skills of impulse control and hypothetical thinking needed to use firearms safely and alter children’s perceptions about their own vulnerability and susceptibility to firearm-related injuries, the severity of those injuries, and their perceived norms about peer behavior surrounding firearms. Once developed, the website will be evaluated in a randomized controlled trial with children ages 10-12. Results from the study will have implications for strategies to reduce unintentional pediatric firearms-related injuries and deaths. See updates.

Principal Investigator: Dr. Linda Teplin, Northwestern University at Chicago Year Three Award: $649,762

This study will use prospective and intergenerational data to examine differences within and between families in risk and protective factors for youth involvement with firearms.

Many juvenile offenders become parents when young; their children are likely to be at significant risk for firearm involvement and victimization. Yet there are remarkably few data on how parents’ involvement with firearms during their own adolescence and young adulthood influences their children’s risk for firearm involvement. This prospective and intergenerational study will examine patterns of concordance and discordance between siblings; examine the influence of parents’ firearm involvement on their children’s involvement, focusing on differences between siblings; and identify risk and protective factors that explain within- and between-family differences. Findings are intended to help guide the development and adaptation of preventive interventions for the highest risk families. See updates.

Principal Investigator: Dr. Nicholas Thomson, Virginia Commonwealth University Year Three Award: $649,769

This study will determine the effectiveness of a hospital-based violence prevention program for reducing risk of firearm-related violence and injury in adult victims of violence.

Violently injured adults are not only victims in the present, but are also likely to be violently re-injured and at increased risk of committing retaliatory violence. Hospital-based violence intervention programs have become increasingly popular because of their success at engaging individuals who have suffered a violent injury. This study will conduct a randomized controlled trial to evaluate Bridging the Gap (BTG), a strategy that includes a hospital-based violence intervention, a firearm counseling program, and 6 months of community case management for victims of violence. The study will include a cost-benefit analysis to determine the economic benefits of implementing BTG. Results from this study will help determine the effectiveness of BTG as a firearm-related violence intervention for adult victims of violence. See updates.

RFA-CE-20-002: Grants to Support New Investigators in Conducting Research Related to Preventing Interpersonal Violence Impacting Children and Youth (K01 Grants)

The purpose of this initiative is to provide support for an intensive, mentored career development experience in conducting violence prevention research. NCIPC supports K01 grants to help ensure the availability of an adequate number and diverse group of highly trained scientists to address critical public health research questions to prevent violence and injury.

These grants can help new investigators grow their skills by developing and conducting research related to violence prevention. This funding opportunity is specifically focused on addressing the interpersonal forms of violence impacting children or youth, including child abuse and neglect, youth violence, teen dating violence, and sexual violence. Proposed research could examine firearm-related behavior, crime, injuries and deaths among children and youth or include firearm-related behavior, crime, injuries, and deaths among children and youth as outcomes. CDC awarded support to four recipients. Two of the recipients are focused on firearm-related research and their projects are described below.

Project Period: September 30, 2020 – September 29, 2022

Principal Investigator: Dr. Caitlin Elsaesser, University of Connecticut Storrs Year Two Award: $125,000

This study will gather formative and survey data to develop an intervention to reduce threats expressed via social media that have been implicated in firearm-related violence and other forms of youth violence.

Social media dominates the social lives of modern youth, and threats are now being expressed via social media in a phenomenon referred to as “cyberbanging.” While data suggest that cyberbanging is implicated in multiple forms of youth violence, including firearm-related violence, little is known about ways to prevent it. This study will gather formative data to develop a social media-based intervention to reduce cyberbanging implicated in youth violence by conducting focus groups with low-income urban adolescents and violence street outreach staff. It will explore social media behaviors, strategies to avoid cyberbanging, and preferences for social media-based interventions; leverage an existing study to gather survey data to describe social media habits, barriers/facilitators to cyberbanging and intervention preferences of this specific population; and draft messages and strategies for a future social media intervention to address threats implicated in violence. The study is designed to inform the development of a social media-based intervention that enhances street outreach programs to reduce cyberbanging implicated in youth violence. See updates.

Principal Investigator: Dr. Rose Kagawa, University of California at Davis Year Two Award: $124,119

This study will examine neighborhood-level exposures and how they work together to impact firearm violence.

Important gaps remain in understanding the relative importance and joint effects on risk for firearm violence of exposures that make up the neighborhood environment. This study will use data from an ongoing investigation of demolition and rehabilitation of decaying properties in Cleveland, Ohio, and Detroit, Michigan, to describe the range of neighborhood-level exposures in each of these cities and to identify how these exposures work together to impact firearm violence. The study will describe variations in programs and polices across neighborhoods from 2010-2019; identify the neighborhood-level exposures that are most predictive of high levels of neighborhood youth firearm violence; and estimate effects of neighborhood interventions on rates of neighborhood violent crime, firearm-related crime, firearm homicides, and firearm suicides among youth and young adults ages 10 to 29. Describing the range of neighborhood exposures and their importance in predicting youth firearm violence can help improve understanding of how “place” affects violence and inform broad-based interventions with widespread and lasting impacts. See updates.

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Safety in Numbers is our new monthly newsletter highlighting all things Team Research here at Everytown. Get to know our work and get to know us!

Beyond Measure

Gun Violence Trauma

Learn More:

• Background Checks on All Gun Sales
• City Gun Violence
• Impact of Gun Violence on Historically Marginalized Communities
• Lack of Gun Industry Accountability
• Mass Shootings
• Victims of Crime Act (VOCA) Assistance Funding

Executive Summary

“We just learn how to cope. Trauma never goes anywhere, and healing is an ongoing process—it’s just a lifelong process.”

—A gun violence survivor

The trauma of gun violence is immeasurable. Trauma can ripple beyond communities in the same geographic environment and reverberate throughout the nation to people with shared identities like race, ethnicity, gender, sexual orientation, and similar experiences with gun violence.

The impact of gun violence extends far beyond those killed or wounded. People may identify as survivors if they have witnessed acts of gun violence, experienced intimate partner violence with a firearm, been threatened with a gun, or had a loved one who has been shot and wounded, or killed—including by suicide with a gun.

When we think about gun violence as a public health epidemic, we often think about the numbers: Every day in the United States, 120 people are killed with guns and more than 200 are shot and wounded. 1 Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using four years of the most recent available data: 2018 to 2021. Everytown For Gun Safety Support Fund, “EveryStat: United States,” https://everystat.org . Based on analysis of 2019 HCUP nonfatal injury data. But what are the experiences behind these metrics? How do survivors and their communities cope in the aftermath of gun violence? What are the immediate and lasting impacts of trauma from gun violence? An understanding of these questions cannot be gained with numbers alone. Far less attention has been dedicated to understanding the experiences of gun violence on survivors. For this reason, this study fills a critical gap in research by focusing on trauma from gun violence by listening to the voices and experiences of those directly impacted.

This report is divided into six sections. We discuss the aftermath of gun violence, the impacts of trauma on safety and fear, the ripple effects of gun violence and trauma in communities, support services to cope with trauma, post-traumatic growth, and recommendations to better support survivors of gun violence. We hope to honor the power of the voices of gun violence survivors by elevating their experiences, their stories, and their journeys.

Key findings

• All gun violence survivors in this study experienced trauma. To cope with the complexity of trauma, every survivor had a unique experience that was influenced by navigating multiple traumatic events, community and collective trauma, and access to services.
• Communities disproportionately impacted by gun violence experienced an ongoing and consistent struggle to cope within the ripples of trauma. Historical traumas based on racism, transphobia, and homophobia, in particular, were compounded by the added trauma from gun violence.
• After an incident of gun violence, one in three survivors lived in fear and felt unsafe. Gun violence eroded their sense of safety and ultimately influenced how people navigated their environments—leading to changes in communities.
• Nearly one in five survivors in the focus groups were directly impacted by intimate partner violence with a firearm, and all of these survivors experienced trauma as a result of this incident.
• About half of the survivors experienced post-traumatic growth or positive changes in their lives after experiencing gun violence.
• Nearly half of survivors said they needed support, services, or assistance to cope with the impact of gun violence within at least the first six months or longer after the violent incident.

Introduction

America’s gun death rate is 13 times higher than that of other high-income countries. 1 Everytown analysis of the most recent year of gun deaths by country (2015-2019), accessed March 3, 2023, GunPolicy.org. Every year, more than 43,000 Americans are killed with guns and approximately 76,000 more are shot and wounded. 2 Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using four years of the most recent available data: 2018-2021. Everytown For Gun Safety Support Fund, “EveryStat: United States,” https://everystat.org . Based on analysis of 2019 HCUP nonfatal injury data. Everytown’s nationally representative survey shows that 59 percent of adults reported that they or someone they know or care about have experienced gun violence in their lifetime, and 41 percent of these adults say it has caused them trauma. 3 SurveyUSA, “Results of SurveyUSA Market Research Study #26602,” October 24, 2022, https://bit.ly/3JJuwLY . See question 29 and 36. See also Everytown for Gun Safety Support Fund, “Gun Violence Survivors in America,” February 1, 2023, https://everytownresearch.org/report/gun-violence-survivors-america . This public health epidemic disproportionately impacts Black, Latinx, and other communities of color.

To better understand the breadth and depth of trauma experienced by survivors of gun violence, Everytown for Gun Safety Support Fund conducted focus groups 4 This study is approved by the Pearl IRB Institutional Review Board, and the protocol number is #22-AUHG-102. Sixteen focus groups were conducted with 103 gun violence survivors from January to mid-March 2023. Previous studies that used focus groups as a method of data collection agree that three or more focus groups for each population of interest provides a comprehensive understanding of issues. Focus group questions explored experiences with gun violence and trauma, with a focus on understanding the ripple-effects and short-term and long-term impact of trauma. Prior to focus groups, participants also completed a demographic survey. All focus groups were audio-recorded and transcribed. All focus group data was professionally analyzed, and with Nvivo qualitative coding software. A line-by-line analysis was completed to develop theoretical codes, and focus groups were analyzed 3-4 at a time to determine themes, categories, and mapping connections across concepts and themes. with 103 survivors from January to March 2023. Participants had diverse identities, many of which have not been previously researched extensively, including bereaved parents, students over the age of 18, Latinx and Black communities, and LGBTQ+ people. Interview questions focused on survivors’ experiences of gun violence, the short- and long-term impacts of trauma, the ripple effects of trauma that families and communities experience, access to support services, and post-traumatic growth.

Survivors’ Experience with Gun Violence

All of the survivors interviewed experienced trauma from gun violence. Trauma refers to the lasting adverse effects of an event or series of events. Living through this ordeal can change how one sees oneself and the world around them. The everyday emotional and physical responses from trauma include feelings of anxiety, fear, and hypervigilance. Despite this, some survivors experienced post-traumatic growth in their healing and recovery journey by seeing positive changes in their lives, such as personal growth and appreciation of life.

Gun violence survivors may experience multiple events of gun violence and are exposed to other events, such as intimate partner violence, community trauma, and childhood trauma. This study included 40 survivors who experienced multiple incidents of gun violence, and more than half of these survivors identified as Latinx and/or Black. The accumulation and interaction of many forms of violence, including gun violence, disproportionately impacts Black and Latinx communities, which can cause community trauma. This study highlights the urgency of preventing gun violence and interrupting cycles of violence by exploring these layers of harm.

This report is divided into six sections:

• The Moment that Changes Everything : We explore trauma in the aftermath of gun violence, grief, retraumatization, and difficulties in coping with trauma.
• Impact of Trauma on Safety and Fear : Survivors discuss the trauma after certain gun violence incidents, such as hate crimes, school shootings, and domestic violence. They also discuss how they navigate their social environments as a result of fear after the incident.
• Community Trauma : We illustrate how trauma extends beyond the victims and survivors to their families, communities, and extended communities with shared identities and experiences.
• Post-Traumatic Growth : Survivors discuss positive changes following their struggles with trauma.
• Support Services : Survivors discuss the availability of support services to cope with trauma.
• Opportunities to Better Support Survivors : We outline eight recommendations to address the needs of gun violence survivors who experience trauma.

“(I was) dancing around the edge of a black hole, trying to avoid sucking me into the black hole where I’d be gone forever.” —Bereaved parent of a daughter who died in a gun homicide

The Moment that Changes Everything

When someone witnesses or experiences a violent event, the initial impact can affect their immediate decisions and how they cope with trauma. Survivors shared that during the initial aftermath of gun violence, they felt numb, in shock, in disbelief. They disassociated and did not have strong memories of the aftermath. Their immediate responses included leaving their homes to be with family and friends, talking to someone about the incident, protecting family and friends around them, seeking therapy right away, and relying on faith and spirituality.

To avoid initial feelings, some participants stated that they “immediately got busy ” by using their energy to redirect behaviors that may lead to this type of gun violence and protecting the memory of their loved ones. Black and Latinx survivors specifically sought to protect loved ones from the negative racial narratives in media reports and from law enforcement officials. A Black bereaved parent whose son died by gun homicide said, “After the incident, I was protecting who my son is, so that people don’t ruin his reputation by saying things about him.” This precarity of being a Black man or child in America reflects the gendering and racialization of gun violence. 5 Shannon Malone Gonzalez, “Making it Home: An Intersectional Analysis of the Police Talk,” Gender & Society 33, no. 3 (2019): 363-386. Focus group participants’ remarks suggest that racial narratives of criminality and self-blame in the media and from law enforcement shape how victims, survivors, and families experience the immediate aftermath and beyond, which may compound the trauma experience.

In the immediate aftermath of gun violence, survivors also experienced grief when a loved one was killed, and often strains in other relationships. In some instances, focus group participants indicated that family members did not know how to approach survivors in their grief, which created isolation, disrupted support systems, and, in some cases, ended relationships. This is discussed by a bereaved parent whose son died in an unintentional shooting:

“My family didn’t really know what to do with me. So, for me, what’s hurtful is they don’t talk about him at all…. I think they think they’re doing me a favor because they don’t want to bring up something so hurtful…. But for me, my biggest fear is that the world is going to forget about my son.“

Survivors found that talking about their loved ones who had been killed or wounded by guns was important in their grieving process. They lived with hopes to again connect with their family members from whom they were estranged following the tragedy.

Some survivors described using alcohol and substances following the incident in an effort to numb or escape from the lasting impact of gun violence. Research shows that frequently, posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are experienced by an individual at the same time. 6 Kathleen T. Brady, Sudie E. Back and Scott F. Coffey, “Substance Abuse and Posttraumatic Stress Disorder,” Current Directions in Psychological Science 13, no. 5 (2004): 206-209. An LGBTQ+ survivor said, “I noticed I started drinking myself to death… it became a big problem. I’m clean and sober now and have been for 13 years.” This reality emphasizes the importance of workers and service providers responding to the variety of needs survivors may be navigating.

Focus group participants also discussed feeling guilt for surviving a shooting or not preventing an incident from occurring. An LGBTQ+ survivor whose cousin died by suicide stated, “I think, ‘Why didn’t I talk to them more about life’ and … all of the whys, all of the what-ifs.” In some instances, these incidents contributed to hypervigilance about the emotions and behaviors of those around them. The survivors found themselves looking “for any signs of any trouble or any issues that they may have, mental, emotional, otherwise.” This hypervigilance stemming from trauma became a likely coping mechanism to avoid retraumatization in the aftermath.

Retraumatization occurs when a person still experiencing the impact from a previous event or incident has heightened vulnerability to another traumatic event or incident and is impacted by that experience. Retraumatization can occur directly by experiencing the repetition of a traumatic event such as another shooting, another wound, and/or another threat. Retraumatization can also occur indirectly through caring about someone who experienced a traumatic event or witnessing an event in the media. This harm is exacerbated when individuals and communities are repeatedly exposed to gun violence. Persistent gun violence in communities and continuous news cycles about incidents of gun violence become daily reminders of their experiences. A bereaved parent whose son died by gun homicide reflected on this:

“Every time there’s a mass shooting, you know, it’s in the news. It brings back the trauma of that day. And then today there was a mass shooting right here in my own city so that… those are tough.”

Reliving this experience can heighten vulnerability and increase paranoia during the grieving process. To avoid this, survivors may practice behaviors to anticipate trauma 7 Madison Armstrong and Jennifer Carlson, “Speaking of Trauma: The Race Talk, the Gun Violence Talk, and the Racialization of Gun Trauma,” Palgrave Communications 5, no. 1 (2019): 1-11. from gun violence. Researchers developed the term “anticipatory trauma” to refer to the practices grounded in fear of sudden violence by those exposed. 8 Brian J. Houston, “Media Coverage of Terrorism: A Meta-analytic Assessment of Media Use and Posttraumatic Stress,” Journalism & Mass Communication Quarterly 86, no. 4 (2009): 844-861, https://doi.org/10.1177/107769900908600408 ; Betty Pfefferbaum et al., “Disaster Media Coverage and Psychological Outcomes: Descriptive Findings in the Extant Research,” Current Psychiatry Reports 16 (2014): 1-7, https://doi.org/10.1007/s11920-014-0464-x ; Madison Armstrong and Jennifer Carlson, “Speaking of Trauma: The Race Talk, the Gun Violence Talk, and the Racialization of Gun Trauma,” Palgrave Communications 5, no. 1 (2019): 1-11. Psychologists use similar terms, such as “anticipatory stress reaction,” to describe the anxiety, stress, depression, and consistent negative thinking in individuals impacted by the fear of future events. 9 Tanya Hopwood, Nicola S. Schutte, and Natasha M. Loi, “Stress Responses to Secondary Trauma: Compassion Fatigue and Anticipatory Traumatic Reaction Among Youth Workers,” The Social Science Journal 56, no. 3 (2019): 337-348. To manage these stressors, people develop practices and behaviors, such as avoiding the media and public locations, both in the aftermath and beyond, as they anticipate harmful events.

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“Isn’t there someplace we can be safe? And it’s getting to be where, nope… you just have to fend for yourself wherever you are and either live in fear or live your life. And I think probably all of us have learned we never know when the last minute is going to be. For myself, I’m trying so hard to live life more fully now because of it.” —Bereaved parent of a son who died by gun homicide

Impact of Trauma on Safety and Fear

In the focus groups, one in three survivors reported that they live in fear after experiencing gun violence, and that they are always anticipating harm or hurt in their daily lives. Gun violence can erode one’s sense of safety and impact how people navigate their environments. Survivors who witnessed gun-related experiences and lived through incidents such as hate crimes, mass shootings, and intimate partner violence saw how guns were used to inflict harm and as a mechanism of control. Each of these types of violence leaves survivors with different patterns of fear and coping.

Hate Crimes

Hate-motivated gun violence influences fears among survivors who hold identities that have been primary targets of hate crimes, such as LGBTQ+ people, communities of color, and religious minorities. Survivors in the focus groups who hold these identities were more likely to live in fear. In fact, one in three LGBTQ+ survivors of gun violence experienced feeling unsafe after their experiences.

One in three survivors reported that they live in fear after experiencing gun violence.

One in three LGBTQ+ survivors of gun violence experienced feeling unsafe after their experiences.

An LGBTQ+ survivor who experienced hate-motivated gun violence discussed this:

“And then just like this constant state of paranoia… just every time you… hear about a shooting or anything like, you know, you can’t go to work, you can’t go to Walmart, you can’t go to Target, you can’t go to a gas station, you can’t go to school, you can’t go to a play… We went and saw [a] comedian last weekend, and I bought tickets next to the exit row at the edge of the aisle just because it’s something that I think about now.”

Hate-motivated violence is a growing problem in the United States, and LGBTQ+ people continue to be targets because of who they are. On an average day, there are 69 hate crimes committed with a firearm. 10 Everytown analysis of the National Crime Victimization Survey (NCVS). A yearly average was developed using 11 years of the most recently available data: 20102021. During this period, there were 6,668,159 hate crimes, 276,308 of which involved a firearm. Feelings of paranoia among LGBTQ+ participants elevate ongoing concerns for safety and fear as survivors experience emotional distress from continuously seeing gun violence in the news and social media. 11 Christopher B. Stults et al., “Perceptions of Safety among LGBTQ People following the 2016 Pulse Nightclub Shooting,” Psychology of Sexual Orientation and Gender Diversity 4, no. 3 (2017): 251–56, https://doi.apa.org/doi/10.1037/sgd0000240 .

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Our research on the intersection of guns and hate crimes.

• Remembering and Honoring Pulse: Anti-LGBTQ+ Bias and Guns are Taking the Lives of Countless LGBTQ+ People Fact Sheet
• Disarm Hate: the Deadly Intersection of Guns and Hate-Motivated Violence Fact Sheet

School Shootings

Due to fears of experiencing another gun-related incident, survivors can become hypervigilant in their environments, such as on school campuses. School shootings can produce fears of being wounded or killed in a place where a child or young adult is supposed to thrive. In 2022, there were at least 177 incidents of gunfire on school grounds, resulting in 57 deaths and 148 injuries nationally, according to a database maintained by Everytown . A student who witnessed a shooting on campus stated:

“I was always on a very high alert of like… it happened here [at school], it can happen again…. It’s not like a one-time thing, like, oh, you experienced this so now you’re clear.”

Fear of school shootings impacts how students navigate their campuses. Students in the focus groups echoed that they remain on high alert when walking outside on campus after dark or in similar neighborhoods or settings. While school shootings account for less than one percent of the more than 40,300 annual US gun deaths, 12 Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using four years of the most recent available data: 2018-2021. experiencing a school shooting has lasting effects on communities, school systems, and individuals in schools and other public spaces.

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• How To Stop Shootings and Gun Violence in Schools: A Plan to Keep Students Safe Report
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Intimate Partner Violence

Survivors of intimate partner gun violence also felt unsafe and fearful after the incident. Every month, an average of 70 women in the United States are shot and killed by an intimate partner, 13 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, National Violent Death Reporting System, 2019. and many more are shot and wounded. Nearly one million American women alive today have been shot or shot at by an intimate partner. 14 Everytown analysis of the National Violence Against Women Survey (Patricia Tjaden and Nancy Thoennes, “Full Report of the Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the National Violence Against Women Survey,” November 2000, https://www.ojp.gov/pdffiles1/nij/183781.pdf ) and US Census 2020.

For those who survive intimate partner violence, immediate steps to gain a sense of safety include uprooting their lives, relocating their homes, and leaving their careers behind.

A Latinx domestic violence survivor discussed that they were in a constant state of “flight or fight.” In the aftermath of the incident, they decided that flight was the best option:

“We ended up having to sell the house because I could never live inside of it again…. I could never step back into my bedroom. I was too traumatized…. I was living in fear, thinking that around the corner, he would show up and find me somehow. I had night terrors up until—actually, for decades.”

Nearly one in five survivors in the focus groups were impacted by intimate partner violence with a firearm, and all experienced trauma due to these incidents.

This focus group participant relocated after the incident; however, decades later, they continued to feel unsafe. Nearly one in five survivors in the focus groups were impacted by intimate partner violence with a firearm, and all experienced trauma due to these incidents. One study on domestic violence found that women who were threatened or feared that their partner would use a gun against them had more psychological symptoms than women who experienced other types of abuse, such as physical or psychological abuse. 15 Tami P. Sullivan and Nicole H. Weiss, “Is Firearm Threat in Intimate Relationships Associated with Posttraumatic Stress Disorder Symptoms among Women?” Violence and Gender 4, no. 2 (June 1, 2017): 31–36, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467129/ . The fear of firearm threat is significantly associated with PTSD—an even stronger association, compared to the link between physical and sexual abuse and PTSD. 16 Jennifer Mascia, “No Shots Fired,” The Trace , September 12, 2018, https://bit.ly/2QAOSg7 .

The impact of domestic violence extends beyond intimate-partner relationships , impacting others, including children. Children who survive or witness the death of a parent struggle with lasting consequences, such as suicidal thoughts and severe PTSD. 17 Henrik Lysell et al., “Killing the Mother of One’s Child: Psychiatric Risk Factors among Male Perpetrators and Offspring Health Consequences,” Journal of Clinical Psychiatry 77, no. 3 (2016): 342–47, https://doi.org/10.4088/JCP.14m0956 . Domestic violence survivors in the focus group not only struggled to navigate support services for their children’s trauma, but they also prioritized keeping them safe. A survivor of domestic violence discussed this:

“My daughter is now living far away, and as much as I miss her, I at least feel like… I have some sense of safety for her there. But that’s my current anxiety is like, what are the odds… that they’re going to make it.”

Survivors of domestic violence strive to protect their children against the “odds” : nearly one-third of children under age 13 who are victims of gun homicide are connected to intimate partner or family violence. 18 Katherine A Fowler et al., “Childhood Firearm Injuries in the United States,” Pediatrics 140, no. 1 (2017): e20163486., https://doi.org/10.1542/peds.2016-3486 . And research from 16 states shows that nearly two-thirds of child fatalities involving domestic violence were caused by firearms. 19 Avanti Adhia et al., ”The Role of Intimate Partner Violence in Homicides of Children Aged 2–14 years,” American Journal of Preventive Medicine 56, no. 1 (2019): 38–46, https://doi.org/10.1016/j.amepre.2018.08.028 .

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Our research on the intersection of domestic violence and gun violence.

• Guns and Violence Against Women: America’s Uniquely Lethal Intimate Partner Violence Problem Report

Feeling unsafe and living in fear extends beyond those who are shot and wounded to those who witnessed gun violence, who were threatened, and who cared for someone that experienced gun violence. Survivors continue to live with these lasting impacts daily, longing to feel safe.

“We have families dealing with it, schools dealing with it, communities… we have the whole (city) dealing with the gun violence….So the trauma, I think, is just beyond numbers.” —Bereaved parent of a daughter who died by domestic violence with a firearm

Community Trauma

Community trauma, an understudied area, is a product of persistent exposure and interactions of many forms of violence, including gun violence. Community trauma is not only the sum of trauma that individuals experience; it is also the collective trauma experienced in communities with elevated levels of violence . There are three dimensions of violence that combine to produce community trauma: interpersonal violence, structural violence, and historical and intergenerational violence. 20 Howard Pinderhughes, Rachel Davis, and Myesha Williams, “Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma,” Prevention Institute , 2015, https://www.preventioninstitute.org/sites/default/files/publications/Adverse%20Community%20Experiences%20and%20Resilience.pdf . Each of these forms of violence can be linked to firearms.

Trauma from gun violence reverberates through the nation of survivors as collective trauma. Collective trauma refers to the psychological reactions to a traumatic event that affect an entire society. In this case, after an incident, a collective traumatic memory is produced that is remembered and recollected by community members through various times and spaces. 21 Gilad Hirschberger, “Collective Trauma and the Social Construction of Meaning,” Frontiers in Psychology 9, August 10, 2018, https://doi: 10.3389/fpsyg.2018.01441 . For example, an LGBTQ+ survivor whose friend died in a mass shooting discussed the collective trauma among LGBTQ+ survivors by drawing on their experiences from the Pulse shooting:

“The ripple effect from the Pulse shooting… It was the thousands of us who were friends with the people who were lost. It’s the queer community in general that is afraid to go to gay clubs because there are so many people out there who are working to legislate against our lives. People are afraid to go to drag shows… And all of that is a ripple effect from Pulse… it widens out to the entire community in the wake of the shooting being afraid to go out and be themselves.”

Trauma extends beyond the victims and survivors to their families, communities, and extended communities that share the same identities as the survivors and victims of gun violence and people with similar experiences. Gun violence instills trauma responses such as hopelessness, fear, numbness, and hypervigilance in communities across the nation—permeating through social and interpersonal systems and creating lasting effects.

Disproportionate Impact on Communities of Color

Black, Latinx, and other communities of color bear a disproportionate burden of gun violence, and they struggle to cope with the impacts. Trauma from gun violence is compounded with other forms of violence, such as structural violence, which includes under-or-disinvestment in health care, the education system, social and protective services, and housing. Structural violence also encompasses historical violence , such as the legacy of slavery, predatory housing practices, and banking practices. 22 Howard Pinderhughes, Rachel Davis, and Myesha Williams, “Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma,” Prevention Institute, 2015, https://bit.ly/3na6R95 . Therefore, it is essential to recognize the layers of trauma experienced by communities with high rates of gun violence.

Black and Latinx survivors or someone they cared about were more likely to experience gun violence by law enforcement officers compared to other respondents. A key contributor to trauma in the Black and Latinx communities is police violence .

Every year, police in America shoot and kill more than 1,000 people. 23 Everytown analysis of 2018-2022 Mapping Police Violence data, accessed February 22, 2023, https://mappingpoliceviolence.org . Black Americans are 2.77 times more likely to be shot and killed by police than white Americans, 24 Everytown analysis of 2018-2022 Mapping Police Violence , accessed February 22, 2023, and population data from the US Census . National Violent Death Reporting System 2009-2012 (17 states participating) and also shows Black Americans killed by police at a rate 2.8 times higher than white Americans, see DeGue et al., 2016 . CDC’s data on 2010-2014 deaths categorized as legal intervention shows a rate of police killing of Black males aged 10+ 2.8 times higher than white males 10+ years old, see Buehler, 2017 . and, in an average year, police shoot and kill over 180 Latinx people, a rate higher than white people. 25 Everytown for Gun Safety Support Fund analysis of Mapping Police Violence 2018–2022, accessed February 22, 2023; US Census Bureau, accessed February 22, 2023, https://data.census.gov/cedsci/table?hidePreview=true&tid=ACSDT1Y2019.B03002 . On average, police shot and killed 181 Latinx Americans per year; this is a rate of 3.1 fatal police shootings per million Latinx Americans. During the same time, police shot and killed an average of 430 non-Latinx white Americans each year; this is a rate of 2.2 per million non-Latinx whites. Survivors in the focus groups shared experiences of physical assaults and threats by law enforcement officials who were armed with guns, and loved ones who were killed by a law enforcement officer with a gun.

Focus group participants also experienced stigma, racism, and discrimination from law enforcement during the post-incident investigation process. A Latinx survivor whose brother died by gun homicide stated, “[The police] already had a theory and assumption and a bias. And that’s what led their work.” During the investigation process, Black and Latinx survivors reported experiencing less attention, yet more blame from law enforcement. They also experienced law enforcement’s disbelief as they were persistently questioned about the validity of their experiences with gun violence. Black and Latinx participants were also more likely to report that their cases were less prioritized than white survivors. As a result, Black and Latinx survivors were more likely to have a loved one whose homicide remains unsolved. A Black survivor whose son died by gun homicide reflected on this:

“I feel when it’s a Black or non-white [victim]… it’s just… not enough urgency to solve the case, to work on the case… from what I’ve seen in these past 14 years that the people who can do something about solving cases really aren’t that interested when it’s a Black male or when it’s a Black person.”

Unsolved cases in Black and Latinx communities can further fuel community mistrust of law enforcement officials. Research consistently shows that homicides committed with a gun take longer to solve, and are solved less often than when committed with other weapons. 26 Lauren Korosec, “The Changing Nature of Homicide and its Impact on Homicide Clearance Rates: A Qualitative Analysis of Two Trends from 1984-2009.” Additionally, cases are less likely to be cleared when the victim of gun violence is Black 27 Murders with Black victims are 23.2% less likely to be cleared. Jeffrey Fagan and Amanda Geller, “Police, Race, and the Production of Capital Homicides,” Berkeley Journal of Criminal Law 23, no. 3 (2018): 261–313; Alonzo DeCarlo, “A Reason for Reasonable Doubt in Social Justice: The Weight of Poverty, Race and Gender in Lopsided Homicide Case Clearances Outcomes,” Contemporary Social Science 11, no. 4 (October 1, 2016): 362–72, https://doi.org/10.1080/21582041.2014.997275 ; Lauren Korosec, “The Changing Nature of Homicide and Its Impact on Homicide Clearance Rates: A Quantitative Analysis of Two Trends From 1984-2009,” Electronic Thesis and Dissertation Repository, April 4, 2012, https://ir.lib.uwo.ca/etd/422 . and/or male. 28 Case closure is 2.5 times more likely when the victim is female. Tom McEwen and Wendy Regoeczi, “Forensic Evidence in Homicide Investigations and Prosecutions,” Journal of Forensic Sciences 60, no. 5 (2015): 1188–98, https://doi.org/10.1111/1556-4029.12787 ; and Korosec, “The Changing Nature of Homicide and its Impact on Homicide Clearance Rates: A Qualitative Analysis of Two Trends from 1984-2009.” As a result, survivors are left with no closure, no accountability for the deaths of people they care about, and no justice. When this lack of justice is compounded with experiences of trauma, survivors have difficulty coping for not just years but lifetimes.

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• Invisible Wounds: Gun Violence and Community Trauma among Black Americans Report
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• Gun Violence and the Police Fact Sheet

Generational Loss

Another effect of gun violence on communities described by survivors is generational loss. Survivors described themselves as “being in the ripple” as family members died by guns. Many did not get a chance to meet family members who died, and bereaved parents are raising the grandchildren of a missing generation. Survivors have a heightened concern about the generational loss for the youth in the United States. A Black survivor whose son died by gun homicide stated:

“It just seems that gun violence is the worst that it has ever been in my lifetime that I’m aware of and the perpetrators seem to be so young. We’re losing generations. Generations. We’re not only losing the lives of the victims, but the ones who are… convicted, their lives are lost as well.”

Firearms are the leading cause of death for children and teens in the United States. Every year, nearly 4,000 children and teens (ages 0 to 19) are shot and killed, and 15,000 are shot and wounded. 29 Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using four years of the most recent available data: 2018 to 2021. Children and teens aged 0 to 19. Everytown for Gun Safety Support Fund, “A More Complete Picture: The Contours of Gun Injury in the United States, December 2020, https://everytownresearch.org/report/nonfatals-in-the-us/ . This generational loss impacts communities witnessing the death and wounds of their friends and classmates. A bereaved parent whose son died by gun homicide stated that when youth die by violence, “we never know what their full potential would have been.”

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Survivors described themselves as “being in the ripple” as family members died by guns. Many did not get a chance to meet family members who died, and bereaved parents are raising the grandchildren of a missing generation.

Loss of Community

A loss of community is also felt among survivors as networks and structures in their environments erode due to trauma and gun violence’s ripple effects. One factor that influences this breakdown of community as a result of trauma is the normalization and desensitization of gun violence. A Latinx survivor whose brother died by gun homicide stated that people in a neighborhood with gun violence “just chalk it up as, like, another incident of violence that happens in the community, right?”

Participants and their communities feel “numb” to gun violence. Feelings of numbness also stem from the lack of investment and attention to their realities of gun violence from policymakers and the media. As a result, some people may ignore or avoid talking about gun violence in their area, which leads to fewer chances for solidarity to create safer communities and fewer outlets to rebuild trust.

Participation in advocacy for policy changes and gun violence prevention presented survivors with new possibilities to “change things” as they cultivated new interests and new perspectives.

Post-Traumatic Growth

The horrors and heartbreak of gun violence cannot be overstated. As this report outlines, the adverse effects of trauma from gun violence can be profound and far-reaching. For some people who experience the trauma from gun violence, there may be an additional component of their experience that illustrates the phenomenon of “post-traumatic growth.”

Researchers Richard Tedeschi and Lawrence Calhoun coined the term “post-traumatic growth” (PTG) to examine the positive changes some individuals experience following their struggles with trauma. 30 Lawrence G. Calhoun and Richard G. Tedeschi, “Beyond Recovery from Trauma: Implications for Clinical Practice and Research,” Journal of Social Issues 54, no. 2 (1998): 357-371. This type of growth can be measured by introduction of new possibilities for one’s life, improved relationships, a greater sense of personal strength and spiritual development, and a greater appreciation for life. 31 Richard G Tedeschi and Lawrence G. Calhoun, “The Posttraumatic Growth Inventory: Measuring the Positive Legacy of Trauma,” Journal of Traumatic Stress 9, (1996): 455-471.

This can also occur as a paradox; individuals may experience both a heightened sense of vulnerability and valuable gains at the same time. 32 Lawrence G. Calhoun and Richard G. Tedeschi, eds., Facilitating Posttraumatic Growth: A Clinician’s Guide. Routledge, 1999. Some people may never experience post-traumatic growth.

Positive Changes

Nearly half of the focus group participants mentioned experiencing elements of post-traumatic growth in their lives after experiencing gun violence.

Forty-six survivors, or nearly half of the focus group participants, mentioned positive changes in their lives after experiencing gun violence. Many survivors reported feeling stronger and gaining confidence. Living through trauma(s) from gun violence created self-reliance, especially for survivors isolated from friends and family. Participants said that they gained greater confidence in handling difficult situations and doing so with assertiveness. This confidence extended to all kinds of situations, including future traumas.

An LGBTQ+ survivor whose friend died by gun homicide stated that they now face their traumas “head-on” by seeking out trauma-specific therapists and sharing their experiences with others. A Latinx survivor whose brother died by gun homicide also stated that they now have the confidence to take risks in their life, “When something that you’re really scared of happening on a consistent basis actually does happen so young… I’m more [likely to] risk everything.” Such confidence also shaped their growth and appreciation of life. A Latinx survivor of domestic violence stated:

“As I started to… go through my journey… I just enjoy my little walks around town, and I’m like, oh, the sun is out, there’s the mountains, a blue sky… I love it so much. I’m so appreciative of where I am right now.”

Some survivors developed an appreciation and gratitude for life. These feelings also extended toward their family, friends, and community, as well as to their journey. For example, a student survivor who witnessed a shooting on campus stated that, after the incident, “I’m more appreciative of my relationships that I have.”

Gun Violence Prevention Advocacy

Survivors also joined the gun violence prevention movement in a variety of ways, such as mentoring and working with youth in their communities, developing community-based organizations to advocate for gun safety and create support services, and joining Moms Demand Action , Students Demand Action , and the Survivor Network at Everytown for Gun Safety Support Fund. A Latinx survivor who was threatened with a gun by a law enforcement official discussed how joining the gun violence prevention movement helped their growth:

“Being a volunteer in the gun violence prevention movement has really given me an outlet to do something and feel like I’m not helpless and that I don’t just need to sit around and hope that it ends and that I have a way to change things.”

Participation in advocacy for policy changes and gun violence prevention presented survivors with new possibilities to “change things” as they cultivated new interests and new perspectives, and as they were open to new ways to honor their loved ones, their experiences, and other survivors of gun violence across the nation. A Black domestic violence survivor stated that she experienced post-traumatic growth by educating others about the different types of domestic violence, including “digital control, stalking, and by taking advantage of opportunities with Everytown and sharing [my story on] Moments That Survive.”

These new life possibilities were intertwined with advocacy and research for gun violence prevention and support for other survivors of gun violence. A bereaved parent whose son was killed in a homicide sums up these experiences by citing a famous quote from Dr. Martin Luther King Jr.: “Out of the mountain of despair, a stone of hope,” demonstrating the growth of hope and resilience.”

Survivors of gun violence play an important role in trauma care and post-traumatic growth.

Support Services

Mental health services.

Nearly half of survivors in our focus groups said they needed support, services, or assistance to cope with the impact of gun violence within the first six months or longer after the incident of gun violence. Access to mental health services, peer support, legal help, and logistical and financial support such as relocation costs and funeral arrangements is instrumental in a survivors’ path to recovery and healing.

Survivors Expressed the Following Needs:

The need for trauma-informed mental health services was not only discussed for short-term care but also for long-term assistance to cope with trauma’s lasting impact. An LGBTQ+ survivor whose friend died by gun homicide and cousin died by gun suicide discussed the importance of counseling and long-term support:

“I feel like I’ve had a lot of positive growth… after years and years and years of therapy have also really evolved and grown as a person and from these things. And I feel like I’ve been able to really understand myself better and my needs, my concerns, and my emotions.”

More specifically, nearly one in three focus group participants indicated that mental health counseling services were their largest unmet need. Gun violence survivors needed trauma-informed counseling for both short-term and long-term support. Without it, the trauma of gun violence does not end when the shooting stops . This reflects the reality of gun violence survivors across the nation, as various mental health services and resources are instrumental for healing and growth for individuals, families, and communities that experience gun violence. However, several barriers prevent survivors from accessing services and trauma-informed care.

Nearly half of survivors in our focus groups said they needed support, services, or assistance to cope with the impact of gun violence within the first six months or longer after the incident of gun violence.

Nearly one in three focus group participants indicated that mental health counseling services were their largest unmet need.

Survivors who identified as Black or Latinx in the focus groups were less likely to have access to short- and long-term support from mental health services. Even with access to services, they experienced stigma and discrimination, and providers who were not culturally attuned to their communities. A Latinx survivor whose uncle died by gun homicide discussed the stigmatization of mental health in their community:

“In our culture, we don’t seek help. You know, we keep everything within. I mean, even personally. But if we do share, it’s within the family, and we don’t let others know what’s going on. I mean, that’s something that I was always told, and it was modeled in my family as well, so whenever I was hurting… I didn’t share it, kept it in… I needed to be strong.”

People’s access to mental health services can be uniquely stigmatized in some communities, leading to isolation and an inability to share their experiences. As a result, individuals who need mental health services are reluctant to seek help because of the potential rejection by others. 33 Patrick Corrigan, “How Stigma Interferes with Mental Health Care.” American Psychologist 59, no. 7 (2004): 614. Moreover, communities that already confront economic discrimination, 34 Angela Hanks, Danyelle Solomon, and Christian E. Weller, “Systemic Inequality: How America’s Structural Racism Helped Create the Black-White Wealth Gap,” Center for American Progress, February 21, 2018, https://ampr.gs/2JqzLmG . lack of access to health care and social services, 35 Allan S. Noonan, Hector Eduardo Velasco-Mondragon, and Fernando A. Wagner, “Improving the Health of African Americans in the USA: An Overdue Opportunity for Social Justice,” Public Health Reviews 37, no. 12 (2016), https://doi.org/10.1186/s40985-016-0025-4 ; Samuel Bieler et al., “Engaging Communities in Reducing Gun Violence: A Road Map for Safer Communities,” Urban Institute, the Joyce Foundation, and Joint Center for Political and Economic Studies, April 2016, https://bit.ly/3jYdg58 ; “African Americans Have Limited Access to Mental and Behavioral Health Care,” American Psychological Association, September 2017, https://bit.ly/3k6wENi . discrimination within the criminal justice system, 36 “Regarding Racial Disparities in the United States Criminal Justice System,” Report of the Sentencing Project to the United Nations Special Rapporteur on Contemporary Forms of Racism, Racial Discrimination, Xenophobia, and Related Intolerance, The Sentencing Project, March 2018, https://bit.ly/3tm4oet ; Margaret Kovera, “Racial Disparities in the Criminal Justice System: Prevalence, Causes, and a Search for Solutions.” Journal of Social Issues 75, no. 4 (2019): 1139-1164. and prejudice, suffer from double-stigma. The combination of experiencing stigma to seek mental health services and discrimination because of race, ethnicity, 37 Gary, Faye A. “Stigma: Barrier to mental health care among ethnic minorities.” Issues in Mental Health Nursing 26, no. 10 (2005): 979-999. sexual orientation, and identity can impede treatment.

Peer Support Groups

Peers are uniquely positioned to support survivors by drawing on their lived experiences. Studies have shown that peer support programs positively impact survivors by providing psychological and emotional support through community building, the credibility of lived experiences, and positive changes in acceptance of self and quality of life. 38 B.M. Haas, L. Price, J.A. Freeman. “Qualitative Evaluation of a Community Peer Support Service for People with Spinal Cord Injury,” Spinal Cord 51, (2013): 295-299. Goregens T. Davis et al., “Making Meaning in a Burn Peer Support Group: Qualitative Analysis of Attendee Interviews,” J Burn Care Res 35, (2014): 416-425. Mary R. Hibbard et al., “Peer Support in the Community: Initial Findings of a Mentoring Program for Individuals with Traumatic Brain Injury and their Families,” The Journal of Head Trauma Rehabilitation 17, no. 2 (2002): 112-131. However, no research examines the effects of peer-to-peer support among gun violence survivors.

Survivors of gun violence play an important role in trauma care and post-traumatic growth. Everytown’s Survivor Network played a critical role in empowering many of the focus group survivors to process their experiences and gain a support network. Peer support groups became especially helpful for survivors who were isolated from their communities and families and/or who had experienced strains in their relationships after an incident of gun violence. A bereaved parent whose son died by gun homicide discusses this:

“With my son’s death and the isolation from some of my friends and family who didn’t know what to say… it gave me a place to put the empathy. I could contact someone else who lost a son… knowing that not everybody understands.”

Peers play an important role in trauma care and post-traumatic growth by enhancing collaboration, building trust, establishing safety and hope, and sharing stories of lived experiences to promote recovery and healing. As a result, respondents in this study who participated in peer support groups were more likely to experience post-traumatic growth as they saw improvements in their quality of life, general outlook, and their ability to cope with trauma. The Everytown Survivor Network and other programs that support survivors of gun violence serve as an important resource to connect survivors with one another and promote healing and resilience.

Family Support

While support may be offered to those directly affected, family members also experienced difficulty accessing care. Parents whose children died by gun violence struggle to navigate their identities as parents. A Latinx survivor described this feeling after their teenage daughter died from intimate partner violence with a firearm:

“We don’t have a word for ex-parent. We have widows, widowers. We have orphans. We don’t really have, ‘used to be a parent but is no longer.’”

Bereaved parents echoed these feelings throughout the focus groups: They struggled with their identity as parents because support services and systems did not recognize their need for care and support. In addition, family members are tasked with navigating social service agencies, the criminal justice system, and court proceedings. A bereaved parents shared that, “there weren’t enough resources to support them” in navigating myriad systems. This involved maintaining communication with law enforcement officials; completing logistical tasks, such as arranging flights for loved ones; preparing documents for life insurance; funeral arrangements; arranging the care of children whose parents died; and ensuring that media outlets published correct information about the incident.

Financial Burdens

Financial burdens placed on families serve as an additional barrier when navigating systems and services of support. In the United States, the economic cost of gun violence is high. Survivors need financial support to cover the direct costs of gun violence, such as assistance with medical bills, funeral expenses, legal fees, loss of income, and compensation for job loss and relocation of their homes. This need was conveyed more frequently by Black and Latinx survivors than by survivors who identified as white. A Latinx survivor whose brother died by gun homicide reflected on this, saying, “When you don’t know about financial resources available to victims, you’re… overwhelmed at the same time as you’re overwhelmed with your own emotions.”

Related Research

• The Economic Cost of Gun Violence Report

Many focus group participants stated that they lost their businesses and jobs due to their struggles. A bereaved parent said that they could not maintain their business after their son died by gun homicide; as a result, their business of over 15 years closed. An additional expense that families and survivors accrue after gun violence is the cost of relocating. Survivors and families moved their homes to “avoid persistent reminders” of the incident. These financial burdens also remain long-term. A bereaved parent whose daughter died by gun homicide stated, “I’m no longer head of household, I have no surviving children, and now I have to pay more taxes.” The death of their daughter impacts their financial stability.

Opportunities to Better Support Survivors of Gun Violence

Participants discussed what was helpful and harmful in the aftermath of their exposure to gun violence. Participants said that they are seeking safety in their communities, legislative changes, tangible resources, and better access to services. The breadth and depth of the needs survivors face require comprehensive and intentional action across various systems. Recommendations for opportunities to support survivors of gun violence and trauma include:

Developing More and Better Trauma-Informed Services

• Educate workers across systems interacting with survivors on the impact of trauma and trauma-informed best practices with a culturally responsive lens. After an incident of gun violence, victims and survivors interact with a large number of workers across many systems including healthcare, law enforcement, mental health, victim services, the courts, and the media. Unfortunately, a lack of understanding on trauma and trauma-informed best practices for actors across these systems results in further harm to victims and survivors. Additionally, it should be a priority to provide culturally responsive services based on the needs of the community being served in order to mitigate harm. Workers across various systems should be educated on historical race-based traumas in order to better serve survivors and mitigate harm caused by discrimination and racism.
• Expand the trauma recovery center model. Trauma Recovery Centers were created to restore the mental and physical health of trauma survivors who have been historically underserved by traditional mental health programs. The model was explicitly designed for survivors of violent crime and allows victims to access integrated services including mental health services, assistance filing victim compensation claims, liaising with law enforcement and more. Expanding these programs to communities experiencing the highest rates of gun violence will strategically invest resources and support and help disrupt cycles of trauma, violence and re-victimization. Trauma Recovery Centers currently exist or are under development in Illinois, California, Ohio, New Jersey, Iowa, and Georgia.
• Build on investments in trauma awareness and mental health services in the Bipartisan Safer Communities Act (BSCA). Nearly one in two survivors in our study said they needed support, services, or assistance to cope with the impact of gun violence. Access to mental health services is instrumental yet survivors discussed that this was their largest unmet need. In addition to historic provisions addressing firearms and education, BSCA appropriated millions of dollars to support community or school-based mental health treatment and trauma-informed behavioral health services across the country. As these programs are implemented, addressing trauma for victims and survivors with an understanding of historical race-based traumas is key when meeting the needs of all survivors of gun violence and people of color seeking services.
• Expand access to trauma-informed peer support programming. The overwhelming majority of participants in the focus group study credit much of their healing to peer support services and finding community in organizations. Expanding access to programs like Everytown’s SurvivorsConnect peer support program can boost resilience and post-traumatic growth for survivors of gun violence. SurvivorsConnect is a national program for survivors of gun violence that matches gun violence survivors with trained, trauma-informed leaders who are also survivors of gun violence.

Addressing Police Violence and Unsolved Gun Crimes

Increase efforts to solve gun crimes and address police violence. Solving gun crimes increases community trust in law enforcement, breaks cycles of violence, and helps address trauma and promote healing among survivors of gun violence. Addressing unsolved shootings can be complex, as much of this work is occurring at the local level, and every city and town has a different combination of considerations and factors that may impact the rates at which shootings are solved. However, it is essential that our solutions to unsolved shootings center on —and do not negatively impact—the communities most impacted by gun violence. Any policing strategy must include strong guardrails for when police may use force against civilians and ensure police are held accountable when force is used. It must prioritize de-escalation, dignity, and respect.

Conducting Original Research

Conduct ongoing research on the needs and experiences of gun violence survivors at the local, state and national levels. This study illustrates the breadth and depth of how trauma from gun violence has shaped the needs and experiences of survivors. However, variations among communities exist based on access to resources, gun violence trends, and demographics. The more research we conduct, the better we can support gun violence survivors.

Training for Local Violence Interventionists

Expand technical assistance programs on trauma for Community Violence Interruption (CVI) practitioners. The trauma of experiencing violence can change how individuals respond to threats. It can increase their fear and desire to protect themselves, as well as their likelihood of engaging in violence. When an individual is victimized by or exposed to violence, the likelihood that they will be victimized again, resort to carrying a gun, or engage in retaliatory gun violence increases. More must be done to disrupt cycles of trauma and violence. Elevate the critical work the Roca Impact Institute is doing to train CVI practitioners to use brain science young people at the center of violence to understand why they do what they do and how they can change their behaviors over time.

Emphasizing the Importance of New Legislation

Pass legislation to address the trauma survivors experience from gun violence. Congress should pass the Resources for Victims of Gun Violence Act ( H.R. 1560 / S. 556 ) sponsored by US Rep. Dwight Evans (D-PA-03) and US Sen. Bob Casey (D-PA). This bill establishes the Advisory Council to Support Victims of Gun Violence. Among other things, the advisory council must assess the needs of victims of gun violence and disseminate information about helpful resources.

Gun violence has lasting traumatic impacts on survivors. Every survivor has their unique experience of coping with trauma, which varies depending on the frequency of gun violence in their communities and their access to support networks and support services. Trauma interferes with survivors’ ability to thrive and live healthy lives in safe and sustainable communities. This research expands our understanding of trauma by illustrating the short- and long-term impacts of gun violence, the ripple effects of trauma, and experiences of post-traumatic growth. The reverberations of trauma from gun violence are felt across the nation as other survivors of gun violence, people who share similar identities with the victim or survivor, and people who bear witness through the news and social media continue to cope with daily gun violence.

The results of this study add to the urgency of preventing gun violence and interrupting cycles of violence by demonstrating the breadth and depth of the impact of trauma for our country’s individuals, families, communities, and support systems. It is vital to conduct research, advocate for laws, and ensure access to resources to prevent gun violence and help those in its aftermath. To support survivors, there needs to be more availability of trauma-informed care, access to peer support networks, police accountability, and legislation that addresses the trauma survivors’ experiences with gun violence.

Everytown for Gun Safety Support Fund would like to gratefully acknowledge the work of Aurrera Health Group for their work to analyze the focus groups findings and their expert review of this report. We also honor the gun violence survivors for their willingness to share their stories.

Read the Methodological Note

• Methodological Note for Beyond Measure: Gun Violence Trauma Methodological Note

Everytown Support Fund’s Resources for Gun Violence Survivors

Everytown survivor network.

The Everytown Survivor Network is a nationwide community of survivors working together to end gun violence.

Resources for Victims and Survivors of Gun Violence

This page offers basic resources and information to help victims and survivors of gun violence.

Moments That Survive

Moments that Survive is a story wall for those whose lives have been forever changed by gun violence.

Our Prior Research on the Impact of Gun Violence on Survivors

When the shooting stops: the impact of gun violence on survivors, gun violence survivors in america.

Everytown Research & Policy is a program of Everytown for Gun Safety Support Fund, an independent, non-partisan organization dedicated to understanding and reducing gun violence. Everytown Research & Policy works to do so by conducting methodologically rigorous research, supporting evidence-based policies, and communicating this knowledge to the American public.

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Everytown's Gun Law Rankings show a clear correlation between states with strong gun laws and lower rates of gun violence.

Did you know?

Every day, more than 120 people in the United States are killed with guns, twice as many are shot and wounded and countless others are impacted by acts of gun violence.

Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using four years of the most recent available data: 2018 to 2021.

Last updated: 2.13.2023

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Disentangling Gun Ownership and Leanings to Political Violence in Unstable Times

• 1 Harvard University, Cambridge, Massachusetts
• 2 University of Cambridge, Cambridge, United Kingdom
• Original Investigation Firearm Ownership and Support for Political Violence in the United States Garen J. Wintemute, MD, MPH; Andrew Crawford, PhD; Sonia L. Robinson, PhD, MPH; Elizabeth A. Tomsich, PhD; Paul M. Reeping, PhD, MS; Julia P. Schleimer, MPH; Veronica A. Pear, PhD, MPH, MA JAMA Network Open

Wintemute et al 1 tackle a timely question: what is the link between gun ownership and support for political violence under conditions of social instability? Much has been written on political extremism and violence in the United States in recent years, but detailed data on specific forms of political violence and type of gun ownership are lacking. Filling this gap, the authors designed a large and nationally representative survey in the spring of 2022 to assess whether firearm owners are more supportive of and willing to engage in political violence compared with nonowners. Perhaps surprisingly, the differences are muted even though they run in expected directions. Firearm owners are more likely than nonowners to agree that violence is needed for social change and to imagine a coming civil war, but as the authors emphasize, the differences are modest overall. For example, owners were approximately 7 percentage points (or roughly a third) more likely to consider violence justified to achieve at least 1 of 17 specified political objectives compared with nonowners. However, the base rates for each objective were generally quite low (most under 10%), and owners were only more likely to endorse 5 specific objectives. Additionally, there were no differences between owners and nonowners in reported willingness to engage in types of violence such as damaging property or killing people.

While these results are somewhat reassuring, more decisive differences were seen for types of gun ownership and the timing of gun purchases. Owners who recently purchased firearms, frequently carry loaded firearms, and own assault-type rifles reported greater support for political violence than comparison owners. Sometimes these differences are notable; for example, gun carriers were from 11 to 19 percentage points more likely to report that the use of force or violence is justified to advance a political objective compared with noncarriers. Compared with other owners, recent purchasers and those who carry loaded guns in public are also more willing to kill or injure someone in situations where they deem force is justified to advance important political objectives. These findings converge with other trends to portend potentially troubling implications for the future. Indeed, gun purchases and firearm violence increased sharply in the period 2015 to 2021 and during COVID-19. The civil turmoil surrounding January 6, 2021, and increasing political polarization add to the combustible mix. 2 , 3

Limitations of the study include its cross-sectional design, potential nonresponse bias, and measures with unknown reliability and validity. Selection into web-based surveys may induce potential unknown biases, for example, and it is not possible to know with certainty whether those supportive of political violence were more or less likely to respond. Weighting is used to adjust for nonresponse and selection, but response rates are relatively low, and the weighting procedures require assumptions. Furthermore, as is typical in these kinds of designs, even though important demographic factors were adjusted, support for political violence could be influenced by unmeasured factors (eg, mental health, extremist beliefs). The authors forthrightly recognize these limitations, which are endemic to contemporary survey research, and they do not make causal claims. This is a careful descriptive study and a much needed one.

The findings should prompt further research. One question is whether gun ownership and the subgroup differences that the article found among owners vary by key features of social stratification in the United States, such as race and socioeconomic status. Some research indicates that race and gun ownership interact in predicting political attitudes toward violence, with White gun owners outliers in viewing the insurrection of January 6. 2021, most favorably. Black gun owners, on the contrary, viewed it most negatively. 4 Evidence on gun purchases during the pandemic further motivates disaggregation by race, class, sex, and urban vs rural residence. 3

Another need is for researchers to probe more deeply into the cultural meanings attributed to gun ownership and carrying in public under changing social conditions. Before the Trump presidency and before COVID-19, ethnographic research showed how gun carrying is subjectively perceived as a means of being a good citizen in the face of the inability of police to guarantee safety. 2 If armed citizens are cynical of the law and view themselves as reluctant “citizen protectors,” this may explain some of the upsurge in firearms purchase during the turbulent period of the pandemic and the rise in violence, especially if driven by fear of uncertainty and fear of crime. Yet research has long shown that fear of crime is only tenuously linked to variations in crime rates. 5 Something deeper is at work. A consistent theme across qualitative work with gun owners and carriers is that guns provide a means to reclaim feelings of security amid perceived economic, social, and political decline. 2 , 6 , 7 The large-scale changes circa 2020 to 2021 exacerbated multiple insecurities by isolating people from each other, stoking fears of oppressive government, and reducing faith in the police. 3 , 7 These insecurities are reflected in the situations that the gun owners in Wintemute et al 1 were more likely to consider violence justified: preserving the “American way of life,” stopping illegal immigration, preventing the government from taking private land for public uses, and reinforcing police.

It follows from these patterns that we need to study more directly the effects of rapid social change on gun ownership and citizens’ willingness to carry loaded guns in public, including how such changes interact with culture and social inequality. Cross-sectional surveys confound aging and cohort effects, and longitudinal studies confound period effects with aging. We need more studies that can separate changes in gun use over the life course from social changes. Who carries, when, and why? Does adult gun use arise from the same processes as juvenile gun carrying? And under what changing conditions and for which subgroups as defined by race and class? These are essential questions for the future.

Published: April 9, 2024. doi:10.1001/jamanetworkopen.2024.5066

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Sampson RJ et al. JAMA Network Open .

Corresponding Author: Robert J. Sampson, PhD, Department of Sociology, Harvard University, William James Hall, 33 Kirkland St, Cambridge, MA 02138 ( [email protected] ).

Conflict of Interest Disclosures: None reported.

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Sampson RJ , Lanfear CC. Disentangling Gun Ownership and Leanings to Political Violence in Unstable Times. JAMA Netw Open. 2024;7(4):e245066. doi:10.1001/jamanetworkopen.2024.5066

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Many Americans who recently bought guns open to political violence, survey finds

Study of 13,000 Americans finds particular risk among certain types of gun owners, including those who carry weapons in public

Large numbers of Americans who have bought guns over the past four years or who regularly carry their loaded weapons in public are willing to engage in political violence, even to the extent of shooting a perceived opponent, a new mega-survey has found.

The study of almost 13,000 Americans, drawn from across the US and weighted for demographics, provides alarming evidence of the openness of certain types of gun owners to the idea – and possibly the practice – of violence as a political act.

The risk of violent behavior rose dramatically, the researchers found, with certain subsets of gun owners.

In particular, Americans who have bought their weapons since the disruptions of Covid in 2020 and those who often or always carry guns in public expressed high levels of susceptibility to political violence. A similar, though less marked, trend was visible among owners of assault-style rifles of the sort used frequently in mass shootings.

The study, Firearm Ownership and Support for Political Violence in the United States, was conducted by the violence prevention research program at the University of California, Davis. Its findings will ring alarm bells at an already exceptionally tense time for the country.

With seven months to go to the presidential rematch between Donald Trump and Joe Biden, the US is not only in the early stages of what promises to be a fiery election, but the prevalence of gun ownership as well as mass gun rampages are also running at all-time highs. A country awash with weapons and facing a fraught political clash, which both sides are portraying as an existential fight for the future of America, poses extreme challenges for law enforcement .

Since Trump announced his candidacy in November 2022, he has taken his inflammatory rhetoric to a new level. He has recast his supporters who have been jailed for the violent attack on the US Capitol on 6 January 2021 as “hostages” and promised to pardon many of them.

At the same time, gun purchases have soared since the start of the pandemic. Last year the US endured a record number of mass shootings .

The authors of the study draw conclusions from their findings that will give federal and state officials pause. It is plausible, they say, that recent gun purchasers may be “arming up for anticipated civil conflict. Our findings strongly suggest that large numbers of armed individuals who are at least potentially willing to engage in political violence are in public places across the US every day.”

Participants in the UC Davis survey were asked whether they believed that violence was justified in the pursuit of a range of specific political objectives. About 39% of gun owners said yes, compared with 30% of non-owners.

That differential is moderate. But the gap becomes far more serious when the same question is put to subsets of gun owners.

About 42% of owners of assault-type rifles said political violence could be justified, rising to 44% of recent gun purchasers, and a staggering 56% of those who always or nearly always carry loaded guns in public.

The extent to which those subgroups said they were prepared to go in actually carrying out political violence was even more stark. The survey takers were asked to imagine they were in a situation in which political violence was perceived as justified.

In that scenario, 16.5% of gun owners who carried loaded firearms in public in the 12 months before the survey was conducted said they would go as far as to shoot someone. The proportion was also high among Americans who had bought weapons since 2020 (8.9%) and owners of assault-style rifles (7.9%), compared with those who do not possess guns at all (3.3%).

“Recent purchasers and always- or nearly-always-carriers were more willing to kill to advance political objectives,” the researchers conclude.

The political mindset of the gun-owning subgroups is also skewed to more extreme positions lending themselves to political violence. Asked whether they believed that the US would erupt in civil war within the next few years, 29% of public gun carriers said yes, with the same answer given by 22% of recent purchasers and 20% of assault-type rifle owners, compared with only 13% of non-owners.

The study, published by Jama Network Open on Tuesday, was based on a survey carried out in May and June 2022. It is part of a series of peer-reviewed articles and papers from the violence prevention research program that has explored views on political violence in the US including by party affiliation and political ideology and among Republicans who support Trump’s Make America Great Again (Maga) movement.

The research team, led by Garen Wintemute, a professor of emergency medicine at UC Davis, approaches political violence as a public health problem. They hope that their findings will act as a guide to preventive measures as federal and state officials brace themselves for what lies ahead.

The scientists draw comfort from their finding that most Americans, whether or not they own firearms, bluntly reject political violence as an acceptable option. They say that result should give hope, as it suggests that violence prevention measures could be effective among gun owners and non-owners alike who “publicly repudiate political violence” and could “help identify, dissuade, deter, and incapacitate likely perpetrators”.

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Why Gun Violence Research in the U.S. is Limited

Giving compass' take:.

• Christine Spolar explains why public funding for the gun violence crisis in the U.S. is very limited and highlights research that is being done in spite of this barrier.
• What role can you play in supporting further gun violence research? What actions can you take to address gun violence based on existing research?
• Learn how gun violence and racial bias are interconnected .

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We connect donors to learning resources and ways to support community-led solutions. Learn more about us .

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.

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.

Read the full article about America's gun violence by Christine Spolar at NPR. Read the full article

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Doctors can do more to help prevent gun violence, USF paper says

• Sam Ogozalek Times staff

Doctors can do more to help prevent gun violence and offer counseling on firearms safety, according to a review by University of South Florida researchers, including a medical student who survived the 2018 mass shooting at Marjory Stoneman Douglas High School in Parkland.

The review, published in February in the journal Advances in Pediatrics, noted that many doctors believe they should talk to patients about firearms, but often don’t because of time constraints, a lack of training and discomfort with the topic.

In Florida, a law passed in 2011 limited what questions doctors could ask patients about guns. But a federal appeals court found the restrictions to be unconstitutional and struck them down six years later.

The law “had a very chilling effect I think for a lot of providers,” said Cameron Nereim, one of the review’s authors and an assistant professor of pediatrics at USF who focuses on patients ages 12 to 25 in Tampa.

The review noted that the American Medical Association calls gun violence a public health crisis and firearm-related injuries were the leading cause of death for U.S. children in 2020, surpassing motor vehicle crashes.

Doctors can ask patients about whether guns are kept at home and if they are locked, unloaded and separated from ammunition, according to the review.

USF medical student Nikhita Nookala, who survived the shooting at Marjory Stoneman Douglas High School and covered it as a reporter at The Eagle Eye, the school’s student newspaper, contributed to the review.

The Tampa Bay Times spoke with Nereim and Nookala about their work, which was published with two other authors from North Carolina and Texas medical centers.

The interviews have been edited for clarity and length.

What are the major takeaways you hope physicians get from this paper?

Nookala: It’s important to assess patients’ risks and to see if you can do some harm reduction in terms of encouraging safe storage or just telling kids to be careful around guns.

It doesn’t have to be super political. It’s just about children’s safety at the end of the day.

The paper noted some of the major barriers to physicians counseling on firearms safety are the lack of formal training, lack of confidence that patients will follow their recommendations and low perceived self-efficacy. Are there any ways to address that?

Nereim: I think there are. ... One of the things is how do we do a better job of incorporating this into our training, whether that’s while you’re going through your residency program, while you’re going through your medical school, making sure these things are actually being plugged into our curricula.

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Is there a particular stage of education where you think this would be best emphasized?

Nereim: I think medical school, before students have even differentiated in terms of what specialty or subspecialty they’ll be choosing, that’s a great opportunity to make sure we’re relaying this information.

In school so far, have people talked about gun violence as a public health issue?

Nookala: Everyone acknowledges that it’s become a problem and it’s getting worse. I think a lot of people feel very helpless because it’s something that is hard to bring up.

You’re not accusing someone of “You don’t store your gun safely, you’re putting your child in danger.” ... You want to (tread) the line of “Oh, you have guns in the home, that’s fine, are you storing them safely, are (you) using gun locks?”

It’s just small things that you can remind people, nicely, without discouraging them from coming back.

During routine visits, do you ask patients or patients’ parents whether there are guns in the home, if they are locked, securely unloaded (and) separated from ammunition?

Nereim: Yes, we do.

With the ongoing mental health crisis that’s involving young people ... I think it becomes even more critical that we do our due diligence and we ask those questions about things like firearm ownership ... how ammunition is being stored, what level of training the family members or the kids themselves have in terms of actually using these objects.

How do those conversations normally go for you? Are they difficult?

Nereim: When you’re able to successfully create that nonjudgemental space ... the vast majority of patients and families are really receptive to the questions we’re asking.

Do you ask patients more often than not? Or do you ask their parents?

Nereim: I tend to do both.

Do you ask firearm-related questions in every visit with a patient, or do you only ask them with someone who would be considered high risk?

Nereim: I wouldn’t say we ask it at every visit. I think we’re getting better at making this more a universal thing that we’re screening for, in the same way that 15, 20 years ago we would make sure at every visit we’re asking “Are you wearing your safety helmet if you’re riding your bike? Are you buckling your seat belt if you’re riding in a car?” We’re moving in that direction.

It happens a lot more consistently in these higher-risk situations, so if you have a patient who’s experiencing mood symptoms, depression or maybe even anger, irritability, impulsive behaviors.

(The paper suggested) that physicians can link those at risk of gun violence to other programs that offer support in the community. Do you do that regularly? How common is that?

Nereim: It’s extremely common. ... In the space where I work, probably anywhere from 50 to 70% of patients may have some significant social need. ... A lot of young people confide in me that they’re fearful just to be outside and to be walking in the place where they live because there have been times where they’ve heard gunshots. Or they know there was a shooting that occurred in that same square, that same block.

As you can imagine, when you have these kinds of social needs that manifest over time, there can be pretty major health consequences.

Why is this research important to you?

Nookala: In the aftermath of the (Marjory Stoneman Douglas High School) shooting, the focus was on Parkland, and Parkland became this beacon of gun violence prevention. But the reality is that outside of that one incident, which was horrible, gun violence doesn’t really occur in cities like Parkland every day. It occurs in cities like Tampa every day in marginalized communities. … The focus needs to be shifted back to that.

Training to be a doctor, I wanted to know more about ways you could make changes on an interpersonal level with your patients without being involved in these really political movements that oftentimes (are) just kind of doing nothing or (do) a little something and it gets reversed a few years later. It’s frustrating to watch that.

Nereim: Violence leads to more violence. The only really, truly effective way for us to move forward as a society is we just have to realize that prevention is incredibly important. … I just don’t think we can ignore the role this is playing in the lives of our patients and their families.

Sam Ogozalek is a reporter covering the healthcare system and mental health. He can be reached at [email protected].

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Methodology, the american trends panel survey methodology.

The American Trends Panel (ATP), created by Pew Research Center, is a nationally representative panel of randomly selected U.S. adults. Panelists participate via self-administered web surveys. Panelists who do not have internet access at home are provided with a tablet and wireless internet connection. Interviews are conducted in both English and Spanish. The panel is being managed by Ipsos.

Data in this report is drawn from ATP Wave 129, conducted from June 5 to June 11, 2023, and includes an oversample of Hispanic men, non-Hispanic Black men, and non-Hispanic Asian adults in order to provide more precise estimates of the opinions and experiences of these smaller demographic subgroups. These oversampled groups are weighted back to reflect their correct proportions in the population. A total of 5,115 panelists responded out of 5,865 who were sampled, for a response rate of 87%. The cumulative response rate accounting for nonresponse to the recruitment surveys and attrition is 3%. The break-off rate among panelists who logged on to the survey and completed at least one item is 1%. The margin of sampling error for the full sample of 5,115 respondents is plus or minus 1.7 percentage points.

Panel recruitment

The ATP was created in 2014, with the first cohort of panelists invited to join the panel at the end of a large, national, landline and cellphone random-digit-dial survey that was conducted in both English and Spanish. Two additional recruitments were conducted using the same method in 2015 and 2017, respectively. Across these three surveys, a total of 19,718 adults were invited to join the ATP, of whom 9,942 (50%) agreed to participate.

In August 2018, the ATP switched from telephone to address-based recruitment. Invitations were sent to a stratified, random sample of households selected from the U.S. Postal Service’s Delivery Sequence File. Sampled households receive mailings asking a randomly selected adult to complete a survey online. A question at the end of the survey asks if the respondent is willing to join the ATP. In 2020 and 2021 another stage was added to the recruitment. Households that did not respond to the online survey were sent a paper version of the questionnaire, $5 and a postage-paid return envelope. A subset of the adults who returned the paper version of the survey were invited to join the ATP. This subset of adults received a follow-up mailing with a $10 pre-incentive and invitation to join the ATP.

Across the five address-based recruitments, a total of 23,176 adults were invited to join the ATP, of whom 20,341 agreed to join the panel and completed an initial profile survey. In each household, one adult was selected and asked to go online to complete a survey, at the end of which they were invited to join the panel. Of the 30,283 individuals who have ever joined the ATP, 12,402   remained active panelists and continued to receive survey invitations at the time this survey was conducted.

The U.S. Postal Service’s Delivery Sequence File has been estimated to cover as much as 98% of the population, although some studies suggest that the coverage could be in the low 90% range. 1 The American Trends Panel never uses breakout routers or chains that direct respondents to additional surveys.

Sample design

The overall target population for this survey was non-institutionalized persons ages 18 and older living in the U.S., including Alaska and Hawaii. It featured a stratified random sample from the ATP in which Hispanic men, non-Hispanic Black men, and non-Hispanic Asian adults were selected with certainty. The remaining panelists were sampled at rates designed to ensure that the share of respondents in each stratum is proportional to its share of the U.S. adult population to the greatest extent possible. Respondent weights are adjusted to account for differential probabilities of selection as described in the Weighting section below.

Questionnaire development and testing

The questionnaire was developed by Pew Research Center in consultation with Ipsos. The web program was rigorously tested on both PC and mobile devices by the Ipsos project management team and Pew Research Center researchers. The Ipsos project management team also populated test data that was analyzed in SPSS to ensure the logic and randomizations were working as intended before launching the survey.

All respondents were offered a post-paid incentive for their participation. Respondents could choose to receive the post-paid incentive in the form of a check or a gift code to Amazon.com or could choose to decline the incentive. Incentive amounts ranged from $5 to $20 depending on whether the respondent belongs to a part of the population that is harder or easier to reach. Differential incentive amounts were designed to increase panel survey participation among groups that traditionally have low survey response propensities.

Data collection protocol

The data collection field period for this survey was June 5 to June 11, 2023. Postcard notifications were mailed to all ATP panelists with a known residential address on June 5. 

Invitations were sent out in two separate launches: soft launch and full launch. Sixty panelists were included in the soft launch, which began with an initial invitation sent on June 5. The ATP panelists chosen for the initial soft launch were known responders who had completed previous ATP surveys within one day of receiving their invitation. All remaining English- and Spanish-speaking sampled panelists were included in the full launch and were sent an invitation on June 6.

All panelists with an email address received an email invitation and up to two email reminders if they did not respond to the survey. All ATP panelists who consented to SMS messages received an SMS invitation and up to two SMS reminders.

Data quality checks

To ensure high-quality data, the Center’s researchers performed data quality checks to identify any respondents showing clear patterns of satisficing. This includes checking for very high rates of leaving questions blank, as well as always selecting the first or last answer presented. As a result of this checking, six ATP respondents were removed from the survey dataset prior to weighting and analysis.

The ATP data is weighted in a multistep process that accounts for multiple stages of sampling and nonresponse that occur at different points in the survey process. First, each panelist begins with a base weight that reflects their probability of selection for their initial recruitment survey. These weights are then rescaled and adjusted to account for changes in the design of ATP recruitment surveys from year to year. Finally, the weights are calibrated to align with the population benchmarks in the accompanying table to correct for nonresponse to recruitment surveys and panel attrition. If only a subsample of panelists was invited to participate in the wave, this weight is adjusted to account for any differential probabilities of selection.

Among the panelists who completed the survey, this weight is then calibrated again to align with the population benchmarks identified in the accompanying table and trimmed at the 1st and 99th percentiles to reduce the loss in precision stemming from variance in the weights. Sampling errors and tests of statistical significance take into account the effect of weighting.

The following table shows the unweighted sample sizes and the error attributable to sampling that would be expected at the 95% level of confidence for different groups in the survey.

Sample sizes and sampling errors for other subgroups are available upon request. In addition to sampling error, one should bear in mind that question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of opinion polls.

Dispositions and response rates

© Pew Research Center, 2023

• AAPOR Task Force on Address-based Sampling. 2016. “ AAPOR Report: Address-based Sampling .” ↩

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Table of contents, what the data says about gun deaths in the u.s., about a third of k-12 parents are very or extremely worried a shooting could happen at their children’s school, republicans in congress are about three times as likely as democrats to indicate that they own a gun, broad public approval of new gun law, but few say it will do a lot to stem gun violence, wide differences on most gun policies between gun owners and non-owners, but also some agreement, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

The Doctor Will Ask About Your Gun Now

More physicians are making gun safety part of routine visits. But should they be?

Updated at 3:23 p.m. ET on April 3, 2024

A man comes to Northwell Health’s hospital on Staten Island with a sprained ankle. Any allergies? the doctor asks. How many alcoholic drinks do you have each week? Do you have access to firearms inside or outside the home? When the patient answers yes to that last question, someone from his care team explains that locking up the firearm can make his home safer. She offers him a gun lock and a pamphlet with information on secure storage and firearm-safety classes. And all of this happens during the visit about his ankle.

Northwell Health is part of a growing movement of health-care providers that want to talk with patients about guns like they would diet, exercise, or sex—treating firearm injury as a public-health issue. In the past few years, the White House has declared firearm injury an epidemic, and the CDC and National Institutes of Health have begun offering grants for prevention research. Meanwhile, dozens of medical societies agree that gun injury is a public-health crisis and that health-care providers have to help stop it.

Asking patients about access to firearms and counseling them toward responsible storage could be one part of that. “It’s the same way that we encourage people to wear seat belts and not drive while intoxicated, to exercise,” Emmy Betz, an emergency-medicine physician and the director of the University of Colorado’s Firearm Injury Prevention Initiative, told me. An unsecured gun could be accessible to a child, someone with dementia, or a person with violent intent—and may increase the chance of suicide or accidental injury in the home. Securely storing a gun is fundamental to the National Rifle Association’s safety rules , but as of 2016 , only about half of firearm owners reported doing so for all of their guns.

Some evidence shows that when health-care workers counsel patients and give them a locking device, it leads to safer storage habits. Doctors are now trying to figure out the best way to broach the conversation. Physicians talk about sex, drugs, and even (if your earbuds are too loud) rock and roll. But to many firearm owners, guns are different.

Not so long ago, powerful physicians argued that if guns were causing so much harm, people should just quit them. In the 1990s, the director of the CDC’s injury center said that a public-health approach to firearm injury would mean rebranding guns as a dangerous vice, like cigarettes. “It used to be that smoking was a glamor symbol—cool, sexy, macho,” he told The New York Times in 1994. “Now it is dirty, deadly—and banned.” In the 2010s, the American Academy of Pediatrics’ advice was to “NEVER” have a gun in the home, because the presence of one increased a child’s risk of suicide or injury so greatly. (“Do not purchase a gun,” the group warned bluntly.) And when asked in 2016 whom they would go to for safe-storage advice, firearm owners ranked physicians second to last, above only celebrities.

In the past couple of decades, some states have toyed with laws that curtail doctors’ ability to talk with patients about firearms and the information they can collect, to assuage gun owners’ privacy concerns. Only in Florida did the most restrictive version—what physicians call a “gag law”—pass, in 2011; six years later, a federal court struck it down. But “I think the gag orders, even though they’re not in effect now, really scared people,” Amy Barnhorst, an emergency psychiatrist and firearm-injury-prevention researcher at UC Davis, told me. A smattering of studies have found that doctors—particularly pediatricians —generally think talking with their patients about firearm safety is important, but most of the time, they’re not doing it. As of 2019, only 8 percent of firearm owners said their doctor had ever brought it up.

That year, in California, Barnhorst launched the state-funded BulletPoints Project, a free curriculum that teaches health-care workers how and when to talk about firearms with their patients. The program instructs them to keep politics and personal opinions out of the conversation, and to ask only those patients who have particular reasons for extra caution—including people with children, those experiencing domestic violence, or those living with someone with a cognitive impairment. It also suggests more realistic advice than “Do not purchase a gun.” Maybe a patient has a firearm for self-defense (the most common reason to have one), so they’d balk at the idea of storing a gun unloaded and locked, with the ammunition separate. A health-care worker might recommend a quick-access lockbox instead.

Researchers are now testing whether these firearm conversations have the best outcome if doctors broach them only when there’s a clear reason or if they do it with every patient. Johns Hopkins is trialing a targeted approach, talking about firearms and offering gun locks in cases where pediatric patients have traumatic injuries. Meanwhile, Northwell Health, which is New York State’s largest health system, asks everyone who comes into select ERs about gun access and offers locks to those who might need them. Both of these efforts are federally funded studies testing whether doctors feel confident enough to actually talk with patients about this, and whether those conversations lead people to store their firearms more securely.

For doctors, universal screening means “there’s no decision point of who you’re going to ask or when you’re going to ask,” Sandeep Kapoor, an assistant professor of emergency medicine who is helping implement the program at Northwell Health, told me. So far, Northwell’s trial has screened about 45,000 patients, which signals that the approach can be scaled up. Kapoor told me that with this strategy, gun-safety conversations could eventually become as routine for patients as having their blood pressure taken. When she was in primary pediatrics, Katherine Hoops, a core faculty member at Johns Hopkins’s Center for Gun Violence Solutions, worked firearm safety into every checkup, as she would bike helmets and seat belts. (The American Academy of Pediatrics still maintains that the safest home for a child is one without a gun, but the organization now recommends that pediatricians talk about secure storage with every family, and offers a curriculum on how to have this conversation.) Universal screening can also find people whom a targeted approach might miss: The team at Northwell recently learned through screening questions that a 13-year-old who came in with appendicitis had been threatened with guns by bullies, and brought in his parents, a team of social workers, and the school to help.

But a patient in the ER for a sprained ankle may understandably wonder why a doctor is asking about firearms. “There’s no context,” says Chris Barsotti, an emergency-medicine physician and a co-founder of AFFIRM at the Aspen Institute, which aims to reduce firearm injuries through health-focused interventions. The firearm community, he said, remembers when “the CDC wanted to stigmatize gun ownership,” so any movement for health care workers to raise these questions needs nuance. To his mind, these should be tailored conversations. Betz, of the University of Colorado, raises the question only when a patient is at risk, and believes that firearm safety can otherwise be in the background of a practice—for example, in a waiting room where secure-storage brochures are displayed alongside pamphlets on safe sex and posters on diabetes prevention.

About half of firearm-owning patients agree that it’s sometimes appropriate for a doctor to talk with them about firearms, according to a 2016 study by Betz and her colleagues. They’re even more okay with it if they have a child at home. The physicians I asked said that the majority of the time, these conversations go smoothly. But Betz’s study also found that 45 percent of firearm-owning patients thought doctors should never bring up guns. Paul Hsieh, a radiologist and a co-founder of the group Freedom and Individual Rights in Medicine, wrote in an email that gun owners he’s spoken with “find the question about firearms ownership intrusive in a different way than questions about substance use or sexual partners.”

Chethan Sathya, a pediatric trauma surgeon and the director of Northwell Health’s Center for Gun Violence Prevention, pointed out that those topics used to be contentious for physicians to talk about. To treat guns as a public-health issue, “we can’t be uncomfortable having conversations,” he told me. But doctors have more power in this situation than they do in others. They might tell someone with diabetes to stop having soda three times a day, but they can’t literally take soda away from a patient. With guns, they might be able to. In states with extreme-risk laws, if a health-care provider believes that their patient poses an immediate threat to themselves or others, they can work with law enforcement to petition the court to temporarily remove someone’s firearms; a handful of states allow medical professionals to file these petitions directly. There are many people “across America right now who own guns and won’t come to counseling, because they don’t want their rights taken away for real or imagined reasons,” Jake Wiskerchen, a mental-health counselor in Nevada who advocates for such patients, told me. They worry that if their doctor includes gun-ownership status in their medical record, they could be added to a hypothetical national registry of firearm owners. And if questions about guns were to become truly routine in a doctor’s office—such as on an intake form—he said owners might just lie or decide they “don’t want to go to the doctor anymore.”

Physicians accordingly choose their words carefully. They talk about preventing firearm injury instead of gun violence —both because the majority of gun deaths are suicides, not homicides, and because it’s a less loaded term. Telling a diabetic patient to cut back on soda might work, but people “are not just going to throw their guns in the trash,” Barnhorst, of UC Davis, told me. “There’s a lot more psychological meaning behind firearms for people than there is for sodas.”

Barsotti says a public-health approach to firearm safety requires more engagement with the upwards of 30 percent of American adults who own a firearm. Owners of shooting ranges and gun shops are already “practicing public health without the benefit of medical or public-health expertise,” he told me. They’re running their own storage programs for community members who don’t want their guns around for whatever reason; they’re bringing their friends for mental-health treatment when they might be at risk. Betz’s team collaborated with gun shops, shooting ranges, and law-enforcement agencies in Colorado to create a firearms-storage map of sites willing to hold guns temporarily, and she counsels gun clubs on suicide prevention, as a co-founder of the Colorado Firearm Safety Coalition . Exam-room conversations can be lifesaving, but in curbing gun injury, Betz told me, health-care workers “have one role to play. We’re not the solution.”