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The Scope of the Problem: Gun Violence in the USA

Abstract

Purpose of Review

To update current understanding of the extent and impact of firearm violence in the USA.

Recent Findings

In the past decade, rates of firearm injury have increased in the USA, both absolutely and in comparison to other high-income countries. Firearm homicides, firearm suicides, and public mass shootings have all been increasing. Firearm homicide rates remain highest for young non-White males in urban areas, and firearm suicide rates remain highest for older White males in rural areas. The burden of all these shootings falls not only directly on the victims themselves but also can impact their families, friends, and communities. These more indirect costs include medical care, grief, fear, hopelessness, and PTSD. The negative effects of exposure to firearm violence have been highlighted in the literature. Individual and community efforts to prepare for and prevent the shootings entail additional costs and burdens.

Summary

The scope of the US gun problem in 2019 is far greater than is indicated merely by medical costs and body counts.

Introduction

In this chapter we discuss the scope of the firearm-related public health problems in the United States, focusing on the findings from the recent (2016–2019) scientific literature. We divide the discussion into two parts: the direct effects of firearm shootings (i.e., injury and death), and the more indirect effects (e.g., on medical care resources, ramifications of exposure to violence).

Direct Effects: Death and Injuries from Firearms

International Comparisons

Worldwide, it is estimated that, in 2016, over 250,000 people died directly from being shot: 64% were homicides, 27% were suicides, and 9% were unintentional shootings [1]. Six countries, all in the Americas, accounted for over half of these deaths (Brazil, the USA, Mexico, Columbia, Venezuela, and Guatemala). In the USA, by contrast to most other countries, firearm suicides outnumber firearm homicides.

In terms of firearm deaths, the USA is an outlier among high-income countries, and not in a good way. In 2015, the overall firearm death rate in the USA was 11.4 times higher than the rate in the 28 other populous high-income countries combined (e.g., Australia, Canada, Chile, Czech Republic, France, Germany, Italy, Japan, Republic of Korea, New Zealand, Slovak Republic, Spain, Sweden, Switzerland, the UK) [2••]. Over 91% of women killed by guns and 92% of youth (aged 15–24) killed by guns in all populous high-income countries were US women and US youth. Table 1 provides a comparison of the violent deaths to US 15–24-year-olds with similar aged young people from the other populous high-income countries combined.

Table 1 Violent deaths to 15–24-year-olds

In 2015, the homicide rate in the USA was 7.5 times higher than the homicide rate in the other 28 populous high-income countries combined, largely attributable to a firearm homicide rate that was 24.9 times higher. For US Whites, the firearm homicide rate was 12 times higher than the firearm homicide rate for the other high-income countries—and within the USA, the non-White firearm homicide rate was 5.7 times higher than the White homicide rate [2••].

International comparisons that focus on specific types of firearm violence are equally disturbing for the United States. For example, US rates of public mass shootings are extremely high relative to other countries [3••, 4••, 5, 6]. In addition, police in the USA are much more likely to be killed on the job, and to kill civilians, than police in comparable countries. For example, one comparison finds that in 2016 US police were killing civilians at 4.6 times the rate of Canadian police, 40 times higher than German police, and 125 the rate of police in England and Wales [7]. Guns are used in the overwhelming majority of police being killed by civilians and police killing civilians. “…(T)he dominant threat that police are responding to when they use lethal force is that of guns in the hands of their adversaries….the proliferation of concealable firearms in the civilian population is a major source of the singularly high rate of killings by police in the United States” [7 pp. 56–57]. Within the USA, empirical studies find that the major explanation for the differences across US states both in rates of fatal shootings of police and rates of fatal shootings of civilians by police is the level of household gun ownership in the state [8,9,10].

Deaths, injuries, and criminal victimization

In the USA, gunshot wounds killed almost 40,000 people in 2017 [11]. That represented an estimated national life-expectancy loss from firearms of 2.5 years for white Americans and 4.1 for black Americans [12].

In 2017 in the USA, there were 23,854 firearm suicides, accounting for 51% of all suicide deaths. There were 15,095 firearm homicides, accounting for 75% of all homicides. And there were 486 unintentional firearm deaths. Firearm homicide and firearm suicide rates have all increased over the past decade [11].

Rates of firearm suicide were highest in rural settings, much higher for men than women, higher for White than Blacks, and increased with age. The number of firearm suicides rose steadily from 16,599 in 1999 to 23,854 in 2017. Non-firearm suicides rose at an even faster clip, from 12,600 in 1999 to 23,319 in 2017.

Rates of firearm homicide victimization were highest in urban settings, were much for higher Blacks than Whites, were much higher for men than women, and peaked at age 20–24. Over 60% of all homicide victims in 2017 were in the 20-year age span 15–34. After a significant decline in the 1990s, the number of firearm homicides rose from 11,127 in 1999 to 15,095 in 2017, with almost all the increase occurring 2014–2017. Non-firearm homicides fell from 6160 in 1999 to 5031 in 2017.

Data on firearm fatalities are reliable, and the USA will soon add the final states into the National Violent Death Reporting System—a data system that provides rich circumstantial information on firearm and other violent deaths—making it a truly national system [13].

By contrast, data on non-fatal shootings are more suspect. For example, the CDC estimates that in 2015, there were about 85,000 non-fatal shootings; unfortunately, CDC point estimates of the number of non-fatal shootings cannot be used with any confidence (the 95% confidence interval for 2015 was 37,000–133,000). CDC estimates for 2017 were higher than for 2015, but these 2017 figures are no longer available on the CDC website as they were deemed “unstable.” Hospital billing data (e.g., Healthcare Cost and Utilization Project HCUP) are now often used to provide general estimates of rates of non-fatal shootings (75,000 in recent years).

Estimates of gun use in crime from the National Crime Victimization Surveys are that in 2017 there were over 400,000 violent crimes where the offender possessed, showed, or used a firearm [14]. This figure is an underestimate as it requires the victim to know that the perpetrator had a gun and many gun intimidations during intimate partner violence are not reported to the interviewers.

To summarize, on a typical day in 2017, guns were used in crimes more than 1000 times, there were probably 310 or more Americans shot, and over 100 died, including 65 by suicide and 41 by homicide.

Specific victims, places

Recent articles have focused on some specific types of firearm violence, victims, and places, including homicides of intimate partners [15] and of prostitutes [16], suicides among veterans [17], violent deaths of children [18], as well as shootings at schools [19] and workplaces. Here we briefly summarize workplace homicides.

A study of workplace firearm homicides (of the 500 workers murdered on the job in 2015, 79% were killed by firearms) found that non-robbery situations now account for almost half of these deaths [20••]. Arguments were the most common circumstance of the non-robbery workplace firearm homicides, typically customer-employee or employee-employee disputes. “While customers and co-workers who commit these crimes are often armed at the time of the argument, many are not and retrieve a firearm…Immediate and nearby firearm access plays a large role in argumentative workplace deaths. Limiting firearm access in the workplace is one possible way to prevent firearm workplace homicides” [20•• p. 8].

Indirect Effects

In this section, we discuss other aspects of the firearm-related public health problem that extend its burden beyond the physical injury to the victim. We first consider some of the ways these indirect effects can impact individuals, their families and friends, and the community at large. Many of these effects have received little study. Here we briefly describe them, as was done in Hemenway, 2011 [21]. We then review recent published studies that have explored some of these aspects in more depth.

Overall Costs of Firearm Injury

For the victim, getting shot may result in pain, suffering, lost quality of life, and psychological costs such as post-traumatic stress disorder. Trauma increases the future risk of psychiatric, emotional, behavioral, and health problems [22••]. In addition to PTSD, psychiatric problems include depression, anxiety, intrusive thoughts, sleep problems, and personality change. Emotional problems include anger, nervousness, withdrawal, loneliness, and despair. Behavioral problems include low academic performance [23], risky sexual behavior, substance abuse, delinquency, and violence. Finally, exposure to violence has been linked to such health problems as asthma, heart disease, and low birth weight babies.

The shooter also has costs—and there is always a person other than the victim involved in firearm assaults (including homicides) and often in unintentional shootings. The psychological costs to accidental killers are only beginning to be explored [24]. Intentional shooters are often caught, convicted, and incarcerated. The perpetrators’ life chances are severely diminished. The shooter may also be traumatized. Friends and family of the shooter as well as those of the victim may be devastated.

The community often bears the greatest costs. These include paying for many of the medical costs through Medicaid, general insurance premiums, and bad debt. For gun crime, there are the costs associated with criminal law enforcement, including the costs of police, district attorneys, judges, parole officers, and prisons.

Community members may be exposed to firearm violence—something that is common for firearm homicides, of which some 80% occur outside the home. Simply witnessing firearm violence can have many of the same long-term mental and physical health problems as being victimized.

Most important, there are large community costs from firearm assaults as people and institutions try to protect themselves from future shootings. For example, street firearm violence affects commercial and residential location decisions. Businesses do not want to locate in areas of high gun crime, tourists do not want to go there, and people do not want to live there. This leads to fewer jobs and flight from the neighborhood of higher-income people who can afford to leave. The loss of jobs, retail outlets, community social capital, and positive role models lead to neighborhood deterioration.

To avoid being shot, residents may change their behavior concerning recreation, shopping, leisure, and other activities. Children are not allowed to play outside, urban park space is unused [25], and residents are both less likely to go out at night and less likely to accept evening work. People live behind locked doors. Having fewer people on the street further reduces the safety of being on the street.

When people and institutions cannot avoid the danger, they often try to protect themselves from the danger (e.g., “target hardening”). Schools use metal detectors and practice lock-down drills [26]; police wear bulletproof vests. To protect themselves, juveniles may obtain guns and join gangs, which may lead to more firearm violence.

Two decades ago, two economists valiantly tried to put a single dollar value on the overall costs of firearm violence [27]. They asked a representative sample of Americans how much they would pay a year to reduce gun violence by 10% that year. They then extrapolated the sum to the entire population, multiplied by 10, and concluded that firearm violence cost Americans more than $200 billion a year. Whatever one thinks of this estimating method, given the rapid increase in public mass shootings, along with inflation and increasing population, the estimated number today would undoubtedly be substantially higher.

Some Specific Costs

Three types of indirect effects of firearm injuries and violence analyzed in the recent literature are (a) medical care costs, (b) effects of exposure to gun violence, and (c) the repercussions of mass shooting, particularly school shootings.

Medical Care Costs

Many recent articles examined the medical costs of treating gunshot wounds [28, 29••, 30]. Between 2006 and 2014, some 78,000 patients per year with gunshot wounds presented alive to the ED for firearm-related injuries; 37% were admitted to inpatient care; and 8% died in the ED or hospital [30]. If you can make it alive to the ED, your chance of survival is good. Not surprisingly—at least for data from two level-1 trauma centers—gunshot wound patients generally arrive more severely injured and require more operations, more ICU admissions, and longer hospital stays than other victims of interpersonal injury [31]. National medical costs of initial hospitalizations for firearm injury—about $750 million per year—are absolutely large, but small compared to overall US hospital expenditures. Medicaid pays about 1/3 and self-pay about 1/4 of the initial hospitalization bill [28, 29]. Ninety-day re-admission rates (sometimes to different hospitals) for firearm injuries are above 10% [32, 33].

Exposure to Guns and Violence

Exposure to guns and gun violence can have serious health consequences. Among other issues, recent articles have examined the “weapons effect” (i.e., simply seeing firearms may change one’s behavior) and have provided more evidence on the health effects of witnessing violence.

Regarding the “weapons effect,” a large series of psychological studies suggest that the mere presence of a gun may make the person more prone to desire to use a gun—in essence, that “the gun may pull the trigger”. A recent meta-analysis of 78 studies on this issue concluded that the evidence indicated that presence of a weapon increases (1) aggressive thoughts and (2) hostile appraisals of others’ intent [34••]. After accounting for publication bias and outliers, it was less clear whether the presence of weapons increase actual aggressive behavior.

Among youth, the mental health and behavioral impact of exposure or access to guns raises additional concerns. One recent cross-sectional study found that adolescents living in homes where a gun was present for protection had higher aggressive attitudes and behaviors than counterparts living in homes with no gun present [35]. No information was available on when the family had acquired the firearm. Another study examined families that had recently acquired firearms. That study found that the teenage children in those families were subsequently more likely to have increased depressive symptoms, with the link between in-home firearm access and depression more pronounced for female compared to male adolescents. The study found suggestive evidence that perceptions of safety at school comprised a possible mechanism linking in-home firearm access to adolescent depression [36]. While such studies do not necessarily indicate causation from guns to aggression and depression, depressed and aggressive adolescents are not those we would like to see have ready access to firearms. It is also disconcerting that another study found that about 10% of individuals who self-report angry or impulsive behavior also report possession of guns at home or carrying them outside the home [37].

Exposure to violence (e.g., high rates of violence in one’s community; parental domestic violence) is associated with multiple negative long-term consequence. A recent scoping review found 31 articles focused on the effects of youth exposure to firearm violence and concluded that “the behavioral and physical health consequences of youth exposure to firearm injury are consistently reported as high… Youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury” [38]. A recent study of children seeing or hearing gun violence found that over half reported being very or extremely afraid, sad, or upset as a result of the indirect gun violence [39]. Another study suggested that exposure to gunshots may reduce school achievement [23].

An interesting qualitative study asked 16 victims of gun violence to tell their story. Themes that emerged included the prevailing nature of everyday violence, feeling abandoned by the institutions of society, and evolving psychological effects. “The presence of gun violence in their neighborhoods has had an everlasting impact on their wellbeing” [22].

Effects of Mass Shootings

Many articles discussed various indirect effects of mass shootings, particularly school shootings. Evidence indicates that gun sales increase in the months immediately following mass shootings [40]. Shootings receiving extensive media coverage were associated with handgun purchase increases [41,42,43]. On the other hand, there is also some evidence that the deadliest shootings may have a negative impact on the stock prices of the manufacturers of the specific firearms used [44].

One article found a large spike in Google searches for “clean gun” and “buy guns” following the Sandy Hook mass shooting along with a significant increase in child accidental firearm deaths in those states with the largest spikes [45].

A review of 49 articles on the mental health consequences of public mass shootings concluded that these events are associated with adverse psychological outcomes in survivors and members of the affected communities. Suicides of friends and family of school shooting victims demonstrate the potential for profound and lasting suffering [46]. While less is known about the psychological effects of mass shootings on indirectly exposed populations, there is evidence that such events lead to increases in fears and declines in perceived safety [47].

With the increase in mass school shootings, there has been debate about the proper response by schools. Most schools now have active shooter drills, and many are considering bringing more guns into schools, such as by arming teachers. Not surprisingly, increasing the number of guns in school is quite controversial [39, 48, 49]. A literature review of current practices regarding school firearm violence prevention concluded that while hundreds of millions of dollars have been spent to harden schools, “none of the currently employed school firearm prevention methods have empirical evidence to show that they actually diminish firearm violence in schools” [50].

On a more hopeful note, evidence of an effective prevention policy comes from studies finding that banning large capacity magazines is associated with lower rates of rates of high-fatality mass shooting deaths [51••, 52].

Conclusions

While mass shootings receive much media attention, they account for only a tiny percentage of our firearm deaths. And the USA is an outlier in terms of firearm deaths compared to all the other high-income nations. Worse still, US firearm death rates have increased in recent years. The scope of our problem is far greater than suggested by merely counting dead bodies. These include financial, social, psychological, and physical health costs imposed on victims, shooters, families, friends, and communities throughout the nation. What has been missing is a societal response commensurate with the size of our firearm-related problems.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. The Global Burden of Disease 2016 Injury Collaborators. Global Mortality from Firearms, 1990–2016. JAMA. 2018;320(8):792–814. https://doi.org/10.1001/jama.2018.10060.

    Article  PubMed Central  Google Scholar 

  2. •• Grinshteyn E, Hemenway D. Violent death rates in the US compared to those of the other high-income countries, 2015. Prev Med. 2019;123:20–6. https://doi.org/10.1016/j.ypmed.2019.02.026This paper updates previous findings and shows that, compared to other high-income countries, the US has become even more of an outlier since 2003 in terms of overall homicide and overall firearm death rates. The study also finds that US states with relatively low levels of gun ownership (and low firearm-related problems compared to the high-gun ownership states) still have violent firearm death rates much higher than those of the other high-income countries.

    Article  PubMed  Google Scholar 

  3. •• Lankford A. Public mass shooters and firearms: a cross-national study of 171 countries. Violence Vict. 2016;31(2):187–99. https://doi.org/10.1891/0886-6708.VV-D-15-00093Examining open-source data from 171 countries, this study demonstrates that the US, though having less than 5% of the global population, experiences more than 30% of public mass shootings worldwide. A follow-up paper (see next reference) finds that other authors, while attempting to refute these original findings, instead corroborate them.

    Article  PubMed  Google Scholar 

  4. •• Lankford A. Confirmation that the United States has six times its global share of public mass shootings. Econ J Watch. 2019;16(1):69–83 (see last reference for note of importance).

    Google Scholar 

  5. Lemieux F. Effect of gun culture and firearm laws on gun violence and mass shootings in the United States: a multi-level quantitative analysis. Int J Crim Just Sci. 2014;9:74–93.

    Google Scholar 

  6. Bockler N, Seeger T, Sitzer P, Heitmeyer W. School shootings: conceptual framework and international empirical trends. In: Bockler N, Seeger T, Sitzer P, Heitmeyer W, editors. School shootings: international research, case studies, and concepts for prevention. New York: Springer; 2013.

    Chapter  Google Scholar 

  7. Zimring F. When police kill. Cambridge: Harvard University Press; 2017.

    Book  Google Scholar 

  8. Swedler DI, Simmons MM, Dominici F, Hemenway D. Firearm prevalence and homicides of law enforcement officers in the United States. Am J Public Health. 2015;105(10):2042–8. https://doi.org/10.2105/AJPH.2015.302749.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hemenway D, Azrael D, Conner A, Miller M. Variation in rates of fatal police shootings across US states: the role of firearm availability. J Urban Health. 2019;96(1):63–73. https://doi.org/10.1007/s11524-018-0313-z.

    Article  PubMed  Google Scholar 

  10. Nagin DS. Firearm availability and police use of lethal force. Ann Am Acad Polit SS. 2019; In press.

  11. National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention. Web-Based Injury Statistics Query & Reporting System (WISQARS) fatal injury reports. Available at http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html. Accessed Aug 2019.

  12. Kalesan B, Vyliparambil MA, Zuo Y, Siracuse JJ, Fagan JA, Branas CC, et al. Cross-sectional study of loss of life expectancy at different ages related to firearm deaths among black and white Americans. BMJ Evid Based Med. 2019a Apr;24(2):55–8. https://doi.org/10.1136/bmjebm-2018-111103.

    Article  PubMed  Google Scholar 

  13. Fowler KA, Jack SPD, Lyons BH, Betz CJ, Petrosky E. Surveillance for violent Deaths -- National Violent Death Reporting System, 18 states, 2014. MMWR Surveill Summ. 2018;67(2):1–36. https://doi.org/10.15585/mmwr.ss6702a1.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Morgan RE, Truman JT. Criminal victimization 2017. US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2018. https://www.bjs.gov/content/pub/pdf/cv17.pdf.

  15. Zeoli AM, Malinski R, Turchan B. Risks and targeted interventions: firearms in intimate partner violence. Epidemiol Rev. 2016;38(1):125–39. https://doi.org/10.1093/epirev/mxv007.

    Article  PubMed  Google Scholar 

  16. Chan HCO, Beauregard E. Prostitute homicides: a 37-year exploratory study of the offender, victim, and offense characteristics. Forensic Sci Int. 2019 Jan;294:196–203. https://doi.org/10.1016/j.forsciint.2018.11.022.294:196-203.

    Article  PubMed  Google Scholar 

  17. Anglemyer A, Miller ML, Buttrey S, Whitaker L. Suicide rates and methods in active duty military personnel, 2005 to 2011: a cohort study. Ann Intern Med. 2016;165(3):167–74. https://doi.org/10.7326/M15-2785.

    Article  PubMed  Google Scholar 

  18. Fowler KA, Dahlberg LL, Haileyesus T, Gutierrez C, Bacon S. Childhood firearm injuries in the United States. Pediatrics. 2017;140(1). https://doi.org/10.1542/peds.2016-3486.

    Article  Google Scholar 

  19. Kalesan B, Lagast K, Villarreal M, Pino E, Fagan J, Galea S. School shootings during 2013-2015 in the USA. Inj Prev. 2017 Oct;23(5):321–7. https://doi.org/10.1136/injuryprev-2016-042162.

    Article  PubMed  Google Scholar 

  20. •• Doucette ML, Bulzacchelli MT, Frattaroli S, Crifasi CK. Workplace homicides committed by firearm: recent trends and narrative text analysis. Inj Epidemiol. 2019;6:5. https://doi.org/10.1186/s40621-019-0184-0This paper presents the first national-level epidemiologic investigation of firearm workplace homicides. Its focus on specifically how shooters obtained their guns in the course of shootings allows the inference that limiting access to guns in the workplace can help to prevent such homicides.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hemenway D. Measuring the cost of injury: underestimating the costs of street violence. Inj Prev. 2011;17(5):289–90. https://doi.org/10.1136/injuryprev-2011-040114.

    Article  PubMed  Google Scholar 

  22. •• Francis M. A narrative inquiry into the experience of being a victim of gun violence. J Trauma Nurs. 2018;25(6):381–8. https://doi.org/10.1097/JTN.0000000000000406Through a “narrative inquiry” technique of gathering personal stories of victims of gun assault, this study offers insight from victims’ perspectives into the relentless cyclical nature of gun violence in an urban setting. It provides a deeper understanding of the persistent fearfulness and hopelessness that gun violence can bring to both individuals and communities.

    Article  PubMed  Google Scholar 

  23. Bergen-Cico D, Lane SD, Keefe RH, Larsen DA, Panasci A, Salaam N, et al. Community gun violence as a social determinant of elementary school achievement. Soc Work Public Hlth. 2018;33:439–48. https://doi.org/10.1080/19371918.2018.1543627.

    Article  Google Scholar 

  24. Connorton E, Miller M, Perry MJ, Hemenway D. Mental health and unintentional injurers: results from the national co-morbidity survey replication. Inj Prev. 2011 Jun;17(3):171–5. https://doi.org/10.1136/ip.2010.028464.

    Article  PubMed  Google Scholar 

  25. Han B, Cohen DA, Derose KP, Li J, Williamson S. Violent crime and park use in low-income urban neighborhoods. Am J Prev Med. 2018;54(3):352–8. https://doi.org/10.1016/j.amepre.2017.10.025.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Reed TS. Locked Down After A School Shooting. Health Aff (Millwood). 2018;37(10):1701–4. https://doi.org/10.1377/hlthaff.2018.0646.

    Article  Google Scholar 

  27. Cook PJ, Ludwig J. Gun violence: the real costs. New York: Oxford University Press; 2000.

    Google Scholar 

  28. Spitzer SA, Staudenmayer KL, Tennakoon L, Spain DA, Weiser TG. Costs and financial burden of initial hospitalizations for firearm injuries in the United States, 2006-2014. Am J Public Health. 2017;107(5):770–4. https://doi.org/10.2105/AJPH.2017.303684.

    Article  PubMed  PubMed Central  Google Scholar 

  29. •• Peek-Asa C, Butcher B, Cavanaugh JE. Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States. Inj Epidemiol. 2017;4(1):20. https://doi.org/10.1186/s40621-017-0120-0This study reports on firearm hospitalization costs by intent of injury, type of firearm, and patient insurance status. Legal intervention injuries and assault weapon injuries produce the highest costs per individual case, respectively, but assaults and handgun injuries account for by far the highest total costs. Uninsured and government-insured patients accrue almost 2/3 of the total $622 million of annual hospitalization costs for firearm injuries.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gani F, Sakran JV, Canner JK. Emergency department visits for firearm-related injuries in the United States, 2006-14. Health Aff. 2017;36(10):1729–38. https://doi.org/10.1377/hlthaff.2017.0625.

    Article  Google Scholar 

  31. Foran CP, Clark DH, Henry R, Lalchandani P, Kim DY, Putnam BA, et al. Current burden of gunshot wound injuries at two Lost Angeles county level 1 trauma centers. J Am Coll Surg. 2019;229(2):141–9. https://doi.org/10.1016/j.jamcollsurg.2019.02.048.

    Article  PubMed  Google Scholar 

  32. Kalesan B, Zuo Y, Vasan RS, Galea S. Risk of 90-day readmission in patients after firearm injury hospitalization: a nationally representative retrospective cohort study. J Int Violence Res. 2019;11(1):65–80. https://doi.org/10.5249/jivr.v11i1.979.

    Article  Google Scholar 

  33. Rattan R, Parreco J, Namias N, Pust GD, Yeh DD, Zakrison TL. Hidden costs of hospitalization after firearm injury: national analysis of different hospital readmission. Ann Surg. 2018 May;267(5):810–5. https://doi.org/10.1097/SLA.0000000000002529.

    Article  PubMed  Google Scholar 

  34. •• Benjamin AJ Jr, Kepes S, Bushman BJ. Effects of weapons on aggressive thoughts, angry feelings, hostile appraisals, and aggressive behavior: a meta-analytic review of the weapons effect literature. Pers Soc Psychol Rev. 2018;22:347–77. https://doi.org/10.1177/1088868317725419A meta-analysis of the recent academic psychology literature confirms the validity of the “weapons effect,” by which the mere viewing of weapons can arouse or prime aggression in individuals. The effect can occur either with or without prior provocation and has its clearest impact in arousing aggressive thoughts and in creating hostile appraisals of others’ intents.

    Article  PubMed  Google Scholar 

  35. Lian B, Abiero B, Kamara P. Guns in the home and the possibility of aggressive tendencies: exploring a community sample of adolescents in low-income communities. Soc Work Public Health. 2017;32(4):301–9. https://doi.org/10.1080/19371918.2017.1289873.

    Article  PubMed  Google Scholar 

  36. Kim J. Beyond the trigger: the mental health consequences of in-home firearm access among children of gun owners. Soc Sci Med. 2018;203:51–9. https://doi.org/10.1016/j.socscimed.2017.11.044.

    Article  PubMed  Google Scholar 

  37. Swanson JW, Sampson NA, Petukhova MV, Zaslavsky AM, Appelbaum PS, Swartz MS, et al. Guns, impulsive angry behavior, and mental disorders: results from the national comorbidity survey replication (NCS-R). Behav Sci Law. 2015;33(2–3):199–212. https://doi.org/10.1002/bsl.2172.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ranney M, Karb R, Ehrlich P, Bromwich K, Cunningham R, Beidas RS. What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review. J Behav Med. 2019;42(4):724–40. https://doi.org/10.1007/s10865-019-00035-2.

    Article  PubMed  Google Scholar 

  39. DeMitchell TA, Rath CC. Armed and dangerous—teachers? A policy response to security in our public schools. Brigham Young U Educ Law J. 2019;63:93.

    Google Scholar 

  40. Callcut RA, Robles AM, Kornblith LZ, Plevin RE, Mell MW. Effect of mass shootings on gun sales—a 20 year perspective. J Trauma Acute Care. 2019;87(3):531–40. https://doi.org/10.1097/TA.0000000000002399.

    Article  Google Scholar 

  41. Liu G, Wiebe DJ. A time-series analysis of firearm purchasing after mass shooting events in the United States. JAMA Netw Open. 2019;2(4):e191736. https://doi.org/10.1001/jamanetworkopen.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Studdert DM, Zhang Y, Rodden JA, Hyndman RJ, Wintemute GJ. Handgun acquisitions in California after two mass shootings. Ann Intern Med. 2017;166(10):698–706. https://doi.org/10.7326/M16-1574.

    Article  PubMed  Google Scholar 

  43. Porfiri M, Sattanapalle RR, Nakayama S, Macinko J, Sipahi R. Media coverage and firearm acquisition in the aftermath of a mass shooting. Nat Hum Behav. 2019;3:913–21. https://doi.org/10.1038/s41562-019-0636-0.

    Article  PubMed  Google Scholar 

  44. Steeves G, da Costa Jr N. Shareholder response to mass shootings in the United States firearms industry. Cogent Econ Finan. 2017.

  45. Levine PB, McKnight R. Firearms and accidental deaths: evidence from the aftermath of the sand hook school shooting. Science. 2017;358(6368):1324–8. https://doi.org/10.1126/science.aan8179.

    CAS  Article  PubMed  Google Scholar 

  46. Rowhani-Rahbar A, Zatzick DF, Rivara FP. Long-lasting consequences of gun violence and mass shootings. JAMA. 2019;321(18):1765–6. https://doi.org/10.1001/jama.2019.5063.

    Article  PubMed  Google Scholar 

  47. Lowe SR, Galea S. The mental health consequences of mass shootings. Trauma Violence Abus. 2017;18:62–82. https://doi.org/10.1177/1524838015591572.

    Article  Google Scholar 

  48. Sanfilippo M. Concealed carry on campus—research can inform the national debate. Campus Law Enforcement J. 2017;47(3):45–8.

    Google Scholar 

  49. Swedler DI. A public health argument against arming teachers. Health Behav Res. 2018;1(3) article 2). https://doi.org/10.4148/2572-1836.1023.

  50. Price JH, Khubchandani J. School firearm violence prevention practices and policies: functional or folly? Violence gender 2019; epub ahead of print.

    Google Scholar 

  51. •• Klarevas L. Rampage nation: securing America from mass shootings. Amherst: Prometheus; 2016. The author analyzes the nature and characteristics of public mass shootings, including human targets, sites, shooters, and weapons used. Policy proposals include bans of high-capacity magazines and buy-back programs.

    Google Scholar 

  52. Klarevas L, Conner A, Hemenway D. The effect of large-capacity magazine bans on high-fatality mass shootings, 1990-2017. Am J Public Health:2019 epub ahead of print.

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Hemenway, D., Nelson, E. The Scope of the Problem: Gun Violence in the USA. Curr Trauma Rep 6, 29–35 (2020). https://doi.org/10.1007/s40719-020-00182-x

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Keywords

  • Firearm suicide
  • Firearm homicide
  • Firearm costs
  • Exposure to firearm violence
  • Medical costs
  • Weapons effect