Gun Violence Research Articles

Discrepancies in Mass Shootings and Access to Trauma Care Across the United States, 2014-2018.

The United States has one of the highest rates of gun violence and mass shootings. Timely medical attention in such events is critical. The objective of this study was to assess geographic disparities in mass shootings and access to trauma centers. Data for all Level I and II trauma centers were extracted from the American College of Surgeons and the Trauma Center Association of America registries. Mass shooting event data (4+ individuals shot at a single event) were taken from the Gun Violence Archive between 2014 and 2018. A total of 564 trauma centers and 1672 mass shootings were included. Ratios of the number of mass shootings vs trauma centers per state ranged from 0 to 11.0 mass shootings per trauma center. States with the greatest disparity (highest ratio) included Louisiana and New Mexico. States in the southern regions of the US experience the greatest disparity due to a high burden of mass shootings with less access to trauma centers. Interventions are needed to increase access to trauma care and reduce mass shootings in these medically underserved areas.

Staggered deployment of gunshot detection technology in Chicago, IL: a matched quasi-experiment of gun violence outcomes

Abstract Objectives We examine the potential effects of gunshot detection technology longitudinally in Chicago through a synthetic control quasi-experiment. Methods Police districts receiving gunshot detection technology were compared to a synthetic control unit via a staggered difference-in-difference design. Across eleven unique gunshot detection technology deployment phases, the analyses produce results for aggregate, initial versus expanded, and phase-specific deployment effects across five gun violence outcome measures. Results Gunshot detection technology had no effect on fatal shootings, non-fatal shootings, general part I gun crimes, or shots fired calls for service. Gun recoveries significantly increased in the aggregate, initial, and expanded models, and in several individual phases relative to controls. Conclusions The results align with prior literature that has found a procedural benefit, but not a crime prevention benefit, of gunshot detection technology. Law enforcement agencies seeking crime prevention or reduction solutions may be better served by investing in other options.

Codeveloping theories of change for improved community-based violence intervention evaluation.

Community-based violence intervention (CVI) programs are considered important strategies for preventing community violence and promoting health and safety. Mixed and inconclusive results from some prior CVI evaluations, as well as our general lack of understanding about the reasons for such varied findings, may be explained in part by misalignment of program theories of change and evaluation measures. Furthermore, most prior evaluations have focused solely on deficit-based outcomes; this narrow focus is inconsistent with the premise of CVI and may fail to capture improvements in health and well-being that are on the hypothesized pathway from intervention to violence reduction. This article describes the process and results of codeveloping a theory of change for community-based youth firearm violence intervention and prevention programs in Washington state through a community-researcher partnership. We followed a multistep iterative process, involving (1) CVI program documentation review, (2) individual meetings, and (3) a day-long workshop. The theory of change included six key domains: (1) root causes, (2) promotive factors, (3) activities, (4) intermediate outcomes, (5) longer-term outcomes, and (6) multilevel context (youth/family, staff/organizational, community, and societal). Root causes were social and structural drivers of community violence. Promotive factors were assets and resources among the community, youth/their families, and community organizations that promote health and safety. Activities were supports and services the program provided to youth and their families, staff, and, potentially, the broader community. Intermediate and longer-term outcomes were the changes among youth, their families, staff, and the community that resulted from program activities. Intermediate outcomes may be felt within 6 months to 1 year, and longer-term outcomes may be felt after 1 to 2 years and beyond. The theory of change we codeveloped provides a common lens to conceptualize, compare, and evaluate CVI programs in Washington state and may support more rigorous and equity-centered evaluations. Diagnostic Test/Criteria; Level V.

AOA Critical Issues Symposium: Gun Violence as a Public Health Crisis.

Gun violence is an epidemic throughout the United States and is increasing around the world-it is a public health crisis. The impact of gun violence is not limited to the victims (our patients); it also extends to the physicians and caregivers who are taking care of these patients every day. Even more broadly, gun violence affects those living and going to work in potentially dangerous environments. The "vicarious trauma" that is experienced in these situations can have long-term effects on physicians, nurses, and communities. Importantly, socioeconomic disparities and community deprivation strongly correlate with gun violence. Systemic factors that are deeply ingrained in our society can increase concerns for these underrepresented patient populations and cause increased stressors with substantial health consequences, including delayed fracture-healing and poorer overall health outcomes. It is incumbent on us as physicians to take an active role in speaking up for our patients. The importance of advocacy efforts to change policy (not politics) and continue to push for improvement in the increasingly challenging environments in which patients and physicians find themselves cannot be overstated. Multiple national organizations, including many orthopaedic and general surgery associations, have made statements advocating for change. The American College of Surgeons, in collaboration with many other medical organizations, has supported background checks, registration, licensure, firearm education and training, safe storage practices, red flag laws, addressing mental health issues, and more research to better inform an approach going forward and to address the root causes of violence. We encourage the orthopaedic surgery community to stand together to protect each other and our patients, both physically and mentally, with agreement on these principles.

Discussion.

Discussion.

Gun violence: A public health issue

Nurses have a key role to play.

Pediatric trauma volume fell during the initial COVID-19 wave but rebounded to new highs for the remainder of 2020.

Previous studies have shown a reduction in pediatric trauma volume during COVID-19, but many have looked at a limited number of facilities, analyzed a narrow timeframe, or both. The objective of this analysis was to assess the impact of COVID-19 on pediatric trauma volume for a statewide sample during 2020. Based on previous literature, researchers hypothesized a reduction in volume during the implementation of these policies. Retrospective cross-sectional analysis of five years (2016 - 2020) of Indiana's statewide trauma patient registry. Patients under age 15 were included. Those who were transfer patients or missing key data were excluded. In total, 10,926 patients were included in analysis. Baseline years (2016 - 2019) were compared to 2020 to estimate the impact of COVID-19 on pediatric trauma volume. Overall monthly volume of pediatric traumas were lower than baseline in March and April 2020 (though not significantly), but rebounded quickly and were above trend in the latter half of the year. Injury patterns differed in both mechanism and location from previous years. Gunshot wounds were more prevalent than previous years, while the volume of non-accidental traumas fell slightly. Injuries that occurred in private residences rose significantly, while fewer took place in schools. Results indicated an initial drop in injury volume consistent with previous findings, but these were offset by increased volume in the second half of 2020. The growth in gun violence is concerning and warrants additional research. Changes in behavior in response to the pandemic such as reduced participation in sports and use of playgrounds, reduced driving, and increased time at home help explain the changes observed in injury patterns. These findings emphasize the continued need for pediatric trauma care during the pandemic.

Traumatic spinal cord injury: A four-year study in Puerto Rico

Objective Assess the occurrence of traumatic spinal cord injury (TSCI) in Puerto Rico, a geographically delimited territory. Design Retrospective review of data from all encounters with ICD-10-CM codes S12-14, S22-24, S32-34, G82.2 and G82.5 for years 2019-2022. Setting Puerto Rico Trauma Hospital. Outcome measures Patient (sex, age) and injury characteristics (neurological level, mechanism of injury, severity score, length of stay, mortality, and disposition). Results Annual incidence rates did not change over time with an increasing trend among older adults (P = 0.08). Median age was 44 yrs and 85% were men. The most frequent neurological level was thoracic (P = 0.03). Falls were the most common mechanism and was associated with age (P < 0.0001). In-hospital mortality was 24.8%, higher (P = 0.05) in 2020-2021. Median length of stay was 26 days, higher (P = 0.014) in 2020-2021. An increase (P < 0.001) over time in discharges to inpatient rehabilitation was observed. The SARS-CoV-2 lockdown resulted in fewer and older patients; more cervical injuries and falls; longer length of stay, and higher in-hospital mortality. Conclusion The risk of TSCI in Puerto Rico was 74% lower than in the United States. The incidence of TSCI in older adults in Puerto Rico appears to be on the rise due to falls. Preventive strategies should include fall prevention education and social interventions to decrease motor vehicle accidents and firearm violence. Disasters such as the COVID-19 pandemic, can change demographic trends in TSCI. Trauma centers should consider implementing a physiatry consult service to improve patient disposition.

Healthcare’s role in reducing gun violence

Focus neutral discussions on safety and education.

Medical student advocacy and action: a student-led initiative to prevent firearm violence

Firearm violence continues to substantially increase, yet medical education is largely devoid of firearm injury prevention efforts. We evaluated reactions to Gun Violence Prevention Week (GVPW) sessions to initiate a longitudinal curriculum. All 280 participants were invited to evaluate GVPW through post-session surveys and 158 responded; 77% (124/158) were medical students. One hundred nine participants reported no prior training. Themes from open-ended questions confirmed GVPW significance by noting importance of (1) advocacy/community, (2) personal narratives, and (3) skill-based strategies. Participants expressed need for further training. Future directions include required firearm violence prevention training for all medical students.

Engaging a Team of Rivals to Address the Problem of Gun Violence.

Gun violence in the United States is a serious problem. Addressing the problem will require not only strong leadership but also a unique approach. One such approach was utilized by U.S. President Abraham Lincoln, who assembled a "Team of Rivals" with positions different than his own that provided helpful perspective in finding solutions to the problems of the time. This article applies the team of rivals approach to the problem of gun violence.

Defining the Problem: 53 Years of Firearm Violence Afflicting America's Schools.

Firearm violence and school shootings remain a significant public health problem. This study aimed to examine how publicly available data from all 50 states might improve our understanding of the situation, firearm type, and demographics surrounding school shootings. School shootings occurring in the US for 53 years ending in May 2022 were analyzed, using primary data files that were obtained from the Center for Homeland Defense and Security. Data analyzed included situation, injury, firearm type, and demographics of victims and shooters. We compared the ratio of fatalities per wounded after stratifying by type of weapon. Rates (among children) of school shooting victims, wounded, and fatalities per 1 million population were stratified by year and compared over time. A total of 2,056 school shooting incidents involving 3,083 victims were analyzed: 2,033 children, 5 to 17 years, and 1,050 adults, 18 to 74 years. Most victims (77%) and shooters (96%) were male individuals with a mean age of 18 and 19 years, respectively. Of the weapons identified, handguns, rifles, and shotguns accounted for 84%, 7%, and 4%, respectively. Rifles had a higher fatality-to-wounded ratio (0.45) compared with shooters using multiple weapons (0.41), handguns (0.35), and shotguns (0.30). Linear regression analysis identified a significant increase in the rate of school shooting victims (β = 0.02, p = 0.0003), wounded (β = 0.01, p = 0.026), and fatalities (β = 0.01, p = 0.0003) among children over time. Despite heightened public awareness, the incidence of school shooting victims, wounded, and fatalities among children has steadily and significantly increased over the past 53 years. Understanding the epidemic represents the first step in preventing continued firearm violence in our schools.

Investigating the 2016 surge in firearm violence in Illinois, USA, through community-based organisations: a qualitative study

BackgroundIllinois experienced a historic firearm violence surge in 2016 with a decline to baseline rates in 2018. This study aimed to understand this 2016 surge through the direct accounts of...

School Shootings in the United States: 1997-2022.

Gun violence in the United States is a public health crisis. In 2019, gun injury became the leading cause of death among children aged birth to 19 years. Moreover, the United States has had 57 times as many school shootings as all other major industrialized nations combined. The purpose of this study was to understand the frequency of school-related gun violence across a quarter century, considering both school shootings and school mass shootings. We drew on 2 publicly available datasets whose data allowed us to tabulate the frequency of school shootings and school mass shootings. The databases contain complementary data that provide a longitudinal, comprehensive view of school-related gun violence over the past quarter century. Across the 1997-1998 to 2021-2022 school years, there were 1453 school shootings. The most recent 5 school years reflected a substantially higher number of school shootings than the prior 20 years. In contrast, US school mass shootings have not increased, although school mass shootings have become more deadly. School shootings have risen in frequency in the recent 25 years and are now at their highest recorded levels. School mass shootings, although not necessarily increasing in frequency, have become more deadly. This leads to detrimental outcomes for all the nation's youth, not just those who experience school-related gun violence firsthand. School-based interventions can be used to address this public health crisis, and effective approaches such as Multi-Tiered Systems of Supports and services should be used in support of students' mental health and academic and behavioral needs.

Firearm Access and Gun Violence Exposure Among American Indian or Alaska Native and Black Adults

American Indian or Alaska Native and Black adults experience elevated rates of firearm injury and death, but both groups are severely underrepresented in research on firearm exposure and behaviors. To explore geodemographic differences in firearm behaviors and violence exposure among American Indian or Alaska Native and Black adults in the US. In this survey study, nationally representative samples of American Indian or Alaska Native and/or Black adults recruited from KnowledgePanel were surveyed cross-sectionally. Surveys were administered online between April 12 and May 4, 2023. Firearm access, storage, and carrying behaviors and lifetime firearm violence exposure were the primary outcomes. Demographic factors such as age, geographic location, and political affiliation were considered. Data were weighted to geodemographic distributions from the US Census Bureau's 2022 Current Population Survey. Of 3542 participants, 527 (14.9%) were American Indian or Alaska Native (280 [53.1%] female) and 3015 (85.1%) were Black (1646 [54.6%] female). Both groups exhibited high firearm access rates (American Indian or Alaska Native adults: 238 [45.4%; 95% CI, 39.4%-51.7%]; Black adults: 909 [30.4%; 95% CI, 28.0%-32.9%]), predominantly owning handguns for home protection. The groups demonstrated similar firearm storage patterns, and a substantial proportion endorsed always or almost always carrying firearms outside the home (American Indian or Alaska Native adults: 18.9%; Black adults: 15.2%). Self-protection was a common reason for carrying a firearm (American Indian or Alaska Native adults: 104 [84.9%; 95% CI, 74.1%-91.7%]; Black adults: 350 [88.3%; 95% CI, 82.3%-92.4%]), and a minority of participants cited lack of faith in the police (American Indian or Alaska Native adults: 19 [15.2%; 95% CI, 8.2%-26.7%]; Black adults: 61 [15.4%; 95% CI, 10.3%-21.2%]), indicating potential shifts in public safety dynamics. In this survey study of American Indian or Alaska Native and Black US adults, a substantial percentage of both groups reported living in homes with firearms, storing firearms loaded and unlocked, frequently carrying firearms outside the home, and having been exposed directly and indirectly to gun violence. These findings underscore the need for nuanced public health campaigns and policies and highlight challenges for law enforcement in contexts of racial disparities and changing legal frameworks.

Unpacking Firearm Access and Firearm Violence Exposure Among American Indian or Alaskan Native and Black Adults

Unpacking Firearm Access and Firearm Violence Exposure Among American Indian or Alaskan Native and Black Adults

Do Poems about Guns Make Guns Poetic?

Abstract Poems by Dean Rader, Montana Ray, Danez Smith, Brian Turner, and Elizabeth Willis register a perplexing trend in American poetry: the use of gun and bullet tropes in poems indirectly or not at all about guns. Many of the poets employing these tropes publicly oppose gun violence and promote poetry as a refuge from it, yet their poetry, paradoxically, affirms guns’ literary power. The five poets selected for this study represent different styles emitting from diverse histories, ages, and literary backgrounds. Their poems likewise branch across a range of contexts and levels of abstraction. Studied together, their poetry exposes the centrality of guns not only to US America's collective self-image as a social body and national power but also to the American literary imagination. In light of this apparent contradiction, this essay considers what the pervasiveness of gun and bullet tropes suggests about the efficacy of poetry as enemy, accomplice, or rival of guns.

Urban scaling of firearm violence, ownership and accessibility in the United States

Urban scaling of firearm violence, ownership and accessibility in the United States

Geographic and Demographic Differences in the Proportion of Individuals Living in Households With a Firearm, 1990-2018

Measures of the proportion of individuals living in households with a firearm (HFR), over time, across states, and by demographic groups are needed to evaluate disparities in firearm violence and the effects of firearm policies. To estimate HFR across states, years, and demographic groups in the US. In this survey study, substate HFR totals from 1990 to 2018 were estimated using bayesian multilevel regression with poststratification to analyze survey data on HFR from the Behavioral Risk Factor Surveillance System and the General Social Survey. HFR was estimated for 16 substate demographic groups defined by gender, race, marital status, and urbanicity in each state and year. Survey responses indicating household firearm ownership were analyzed and compared with a common proxy for firearm ownership, the fraction of suicides completed with a firearm (FSS). HFR, FSS, and their correlations and differences. Among US adults in 2018, HFR was significantly higher among married, nonurban, non-Hispanic White and American Indian male individuals (65.0%; 95% credible interval [CI], 61.5%-68.7%) compared with their unmarried, urban, female counterparts from other racial and ethnic groups (7.3%; 95% CIs, 6.0%-9.2%). Marginal HFR rates for larger demographic groups also revealed important differences, with racial minority groups and urban dwellers having less than half the HFR of either White and American Indian (39.5%; 95% CI, 37.4%-42.9% vs 17.2%; 95% CI, 15.5%-19.9%) or nonurban populations (46.0%; 95% CI, 43.8%-49.5% vs 23.1%; 95% CI, 21.3%-26.2%). Population growth among groups less likely to own firearms, rather than changes in ownership within demographic groups, explains 30% of the 7 percentage point decline in HFR nationally from 1990 to 2018. Comparing HFR estimates with FSS revealed the expected high overall correlation across states (r = 0.84), but scaled FSS differed from HFR by as many as 20 percentage points for some states and demographic groups. This survey study of HFR providing detailed, publicly available HFR estimates highlights key disparities among individuals in households with firearms across states and demographic groups; it also identifies potential biases in the use of FSS as a proxy for firearm ownership rates. These findings are essential for researchers, policymakers, and public health experts looking to address geographic and demographic disparities in firearm violence.

Violence and suicide risk behavior in a nationally representative sample of youth aged 12-17: What does it mean to be at-risk?

Suicide attempts and school violence, including gun violence, are now leading causes of death in youth 12-17. This study applied a latent class analytic approach to investigate how heterogenous subgroups of youth differed regarding patterns of violence engagement and suicide risk behavior and how geographic, demographic, and socioeconomic predictors related to subgroup membership. Data were drawn from the youth subsample of the 2021 National Survey on Drug Use and Health (N = 10,743). A suicide risk subgroup had low probabilities of violence engagement but high probabilities of suicide ideation and plan. A violence + suicide risk subgroup had high probabilities of violence engagement, suicide ideation, and suicide plan. A violence risk subgroup had high probabilities of violence engagement and carrying a handgun, but low probabilities of suicide ideation or plan. The largest subgroup had low probabilities across all class indicators. Demographic, geographic, and socioeconomic variables uniquely predicted subgroup membership.