A Nation of Survivors: The Toll of Gun Violence in America

February 1, 2019

Everytown for Gun Safety would like to acknowledge all gun violence survivors, especially those who shared their personal stories for this report.

 

“The fact is gun violence has taken so many lives. And not just in Florida or D.C. or Chicago. Gun violence is everywhere and, as a nation, we need to be paying more attention to the problem.”
– Zion, gun violence prevention advocate

Introduction

America’s gun death rate is tragic and unique – 10 times higher than other high-income countries.Grinshteyn E, Hemenway D. Violent death rates: The U.S. compared with other high-income OECD countries, 2010. The American Journal of Medicine. 2016; 129(3): 266-273. In other words, by early February more Americans are killed with guns than are killed in our peer countries in an entire calendar year.

The U.S. Gun Death Rate is 10 Times That of Other High-Income Countries.Ibid.

The U.S. gun death rate is 10 times that of other high-income countries

Every year, over 36,000 Americans are killed in acts of gun violenceCenters for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. and approximately 100,000 more are shot and injured.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. With death and injury tolls this high, America is undeniably a nation of gun violence survivors. But the impact of gun violence extends far beyond those killed or injured.

58% of American adults or someone they care for have experienced gun violence in their lifetime.

Gun violence in any form – whether a person witnessed an act of gun violence, was threatened or wounded with a gun, or had someone they know or care for wounded or killed – can leave a lasting impact on individuals. Forms of gun violence can include, but are not limited to: gun suicides, gun homicides, domestic violence involving a gun, and unintentional shootings. Defined this way, a recent national poll estimated that 58 percent of American adults responded that they or someone they care for have experienced gun violence in their lifetime.SurveyUSA Market Research Study. Data collected from December 7, 2018 to December 11, 2018. https://bit.ly/2ExxpyZ. See question 39. Yet, as a country we do not talk enough about the lifelong impact of these many forms of gun violence.

In addition to the emotional toll, gun violence can also be financially devastating, affecting both individuals and communities. While survivors bear direct costs such as healthcare and lost income, gun violence also hurts local economies by lowering property values, slowing new business creation, and reducing available jobs,Irvin-Erickson Y, Lynch M, Gurvis A, Mohr E, Bai B. A neighborhood-level analysis of the economic impact of gun violence. https://urbn.is/2GQ18oA. Urban Institute. June 2017. thereby creating the very economic and social conditions that are associated with higher violence.Beyer K, Wallis AB, Hamberger LK. Neighborhood environment and intimate partner violence: A systematic review. Trauma, Violence, & Abuse. 2015; 16(1): 16-47.,Haynie DL, Silver E, Teasdale B. Neighborhood characteristics, peer networks, and adolescent violence. Journal of Quantitative Criminology. 2006; 22: 147-169.

Executive Summary

The United States is a nation of survivors. In a recent national poll, 58 percent of adult respondents reported that they or someone they care for have experienced gun violence in their lifetime. Everytown for Gun Safety has compiled scientific research on the impacts of gun violence on this country coupled with stories of gun violence from Americans of all backgrounds, to demonstrate the magnitude of such violence and its lasting impacts on Americans and the communities we call home. This report covers the following topics:

  • Gun suicides – More than 22,000 Americans die of firearm suicide every year, leaving countless Americans to grieve the death of their loved ones.
  • Gun homicides – The burden of gun homicide falls heaviest on communities already facing structural disadvantages. Within cities, gun homicides are most prevalent in racially segregated neighborhoods with high rates of poverty and low educational attainment. As a result, homicides disproportionately affect people of color.
  • Gun injuries – Every year, approximately 100,000 Americans survive a gunshot wound and are faced with a life-long process of physical and emotional healing, as well as heavy economic costs for both survivors, communities, and society as a whole.
  • Gun violence and children and teens – Firearms are the second leading cause of death for children and teens and the first leading cause of death for Black children and teens in the U.S. Every year, nearly 3,000 children and teens are shot and killed and approximately 15,600 are shot and injured.
  • Domestic violence and guns – Approximately 4.5 million American women alive today have been threatened with a gun by an intimate partner.
  • Hate crimes with guns – In an average year, over 10,300 violent hate crimes involve a gun – more than 28 each day. The vast majority of hate crimes are directed against communities of color, religious minorities, and LGBTQ people.
  • Costs of gun violence – The various costs paid by victims, communities, businesses, taxpayers, and every American who feels the pain, fear, and distress from the increasing frequency of gun violence amount to tens of billions annually and impact people in every community across the country.

AVERAGE YEARLY GUN DEATHSCenters for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. While it is broadly considered to be the most comprehensive firearm fatal injury source, two of the intent categories – Shootings by law enforcement and Unintentional Deaths – are estimated to be greatly underreported. This underreporting is largely due to missing information on death certificates, which may result in misclassification of intent. Multiple media sources and nonprofit groups have tracked shootings by law enforcement but no reliable public database captures unintentional shootings. Intent category averages may not total to yearly average due to rounding. See also: Fatal Force. The Washington Post. Fatal Force. Data reflects a 4-year average (2015 to 2018) of deaths attributed to police shootings. https://wapo.st/2QlEZOo.

Average yearly gun deaths

*This intent category is believed to be underreported and is likely being misclassified as homicide. The Washington Post’s database is widely cited and estimates that 986 civilians are fatally shot by police in an average year—nearly twice as many as recorded by the CDC.

AVERAGE YEARLY GUN INJURIESCenters for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Intent category averages may not total to yearly average due to rounding.

Average yearly gun injuries
Gun Suicides

Read: Jennifer’s Survivor Story

Every day I have worked to make our family whole and bring some joy and normalcy to their lives.
—Jennifer

Scott was the smartest person Jennifer ever met.This narrative is derived from an interview with Jennifer Lugar, a volunteer with the Everytown Survivor Network and Moms Demand Action for Gun Sense in America. He was a great father to their two daughters. He loved the outdoors and hiking in the mountains of Utah and Nevada. He also struggled with depression.

Scott had a handgun, which he kept for protection and sport. They argued about it – Jennifer didn’t want to live in a home with a firearm, but he managed to convince her by offering a compromise. The gun would be kept locked in a safe, and he would only take it out when they went to the woods in North Carolina, where he liked to set up targets and practice his aim.

At the age of 42, Scott made a suicide attempt using alcohol and pills. He was taken to the emergency room, treated in an intensive care unit, and held for supervision. “Then they send you home with a bunch of worksheets encouraging you to seek help. It’s all very overwhelming and you don’t really know what to do.” One of the worksheets directed family members to remove all firearms. Jennifer bought a different safe for the gun, and hid it inside the house. When Scott arrived home, he was furious at her. “He said he was fine now, and why didn’t I trust him? It became a thing.”

Three weeks later, Scott made another suicide attempt with pills. This time, when Scott woke up in the hospital, he was “his old self” again. “He asked me to go to the bookstore and get him all of these books on depression. He felt sure that if he could just learn enough about what was going on, he could solve it.”

Scott soon convinced Jennifer to return his firearm. They were planning a trip to the family’s vacation home in the mountains of North Carolina, and he told her that shooting would make him “feel normal” again. Months later, Scott’s depression returned, and he used his gun to kill himself.

Jennifer attending a national conference of gun violence prevention advocates
Jennifer attending a national conference of gun violence prevention advocates. Atlanta, GA, August 10, 2018 Associated Press

“He left behind two beautiful daughters, and every day I have worked to make our family whole and bring some joy and normalcy to their lives. The pain never goes away and I constantly worry about the long-term effects on them.”

Until a couple of years ago, Jennifer never considered herself a survivor of gun violence. But over the years, she learned about the relationship between suicide risk and access to firearms – and how it leaves so many families like hers grieving a loved one who might be alive if it weren’t for easy access to a gun.

Like other forms of gun violence, this country suffers disproportionately from firearm suicide – the firearm suicide rate in the U.S. is eight times that of other high-income countries.Grinshteyn E, Hemenway D. Violent death rates: The U.S. compared with other high-income OECD countries, 2010. The American Journal of Medicine. 2016; 129(3): 266-273. Firearm suicide is a significant public health crisis that leaves countless Americans to grieve the death of their loved ones. Nearly two-thirds of firearm deaths are suicides – over 22,000 Americans every year.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Firearm suicide victims are typically white, older males, and those who live in rural areas. In fact, white men represent 74 percent of firearm suicide victims in the United States.Ibid. Analysis includes gun deaths by suicide among males of all ages. White defined as non-Hispanic only.

Access to a gun increases the risk of suicide, but there are steps that can be taken to mitigate risk. A meta-analysis of 14 different scientific studies concluded that having access to a firearm triples one’s risk of death by suicide. This elevated risk applies not only to the gun owner but everyone in the household.Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: A systematic review and meta-analysis. Annals of Internal Medicine. 2014; 160(2): 101-110. States with higher rates of household gun ownership also have higher rates of firearm suicide: people who live in these states are almost four times more likely to die by firearm suicide than in states where fewer households own guns. This relationship remains strong even when controlling for other factors associated with suicide, like poverty, unemployment, serious mental illness, and substance abuse.Opoliner A, Azrael D, Barber C, Fitzmaurice G, Miller M. Explaining geographic patterns of suicide in the U.S.: The role of firearms and antidepressants. Injury Epidemiology. 2014; 1(1): 6. And these tragic deaths carry high economic costs, as well. Estimates from one study suggest that each suicide by firearm results in $1.0 million in lost productivity due to the victim’s inability to work in the labor market or the home.Corso PS, Mercy JA, Simon TR, Finkelstein EA, Miller TR. Medical costs and productivity losses due to interpersonal and self-directed violence in the United States. American Journal of Preventive Medicine. 2007; 32(6): 474-482.

Most people who attempt suicide do not die – unless they use a gun.

Most people who attempt suicide do not die – unless they use a gun. Across all suicide attempts not involving a firearm, less than 5 percent will result in death.Miller M, Azrael D, Barber C. Suicide mortality in the United States: The importance of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health. 2012; 33: 393-408. But for gun suicides, those statistics are flipped: approximately 85 percent of gun suicide attempts end in death. And the vast majority of all those who survive do not go on to die by suicide.Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm: Systematic review. British Journal of Psychiatry. 2002; 181: 193-199. This suggests that a reduction in suicide attempts by firearm would result in an overall decline in the suicide rate.Soffen K. To reduce suicides, look at guns. The Washington Post. July 13, 2016. https://wapo.st/29SfvVY.,Yip PS, Caine E, Yousuf S, Chang SS, Wu KC, Chen YY. Means restriction for suicide prevention. The Lancet. 2012; 379(9834): 2393-2399. Given the unique lethality of firearms as a means of suicide, addressing firearm suicide is an essential element of any strategy to reduce gun violence in this country.

85% of suicide attempts by gun result in death, < 5% of suicide attempts by all other means result in death

However, mental illnesses and suicide are often stigmatized, leaving many survivors feeling alone.Carpiniello B, Pinna F. The reciprocal relationship between suicidality and stigma. Front Psychiatry. 2017; 8: 35. Yet in a recent poll, 16 percent of respondents – or an estimated over 40 million American adults – reported that someone they care for attempted or died by suicide with a gun.SurveyUSA Market Research Study. Data collected from December 7, 2018 to December 11, 2018. https://bit.ly/2ExxpyZ. See question 36.

Gun Homicides

Read: Zion’s Survivor Story

We will be the change.
—Zion

Zion still gets chills thinking about his speech to the crowd of 850,000 at the March for Our Lives rally in Washington, D.C.This narrative is derived from an interview with Zion Kelly, a gun violence prevention advocate. “Zaire was the outgoing twin. He was the kind of person who would light up a room. I was always more reserved. I didn’t like a lot of attention or being in the spotlight.” But ever since his twin brother Zaire was killed on September 20, 2017, Zion has become his voice. “Before he died, I never would have spoken to a small crowd. But now I try to seize every opportunity to speak my mind, like he did. In that way, Zaire continues to live on through me.”

Growing up in Northeast Washington, D.C., Zion had heard about gun violence, but it wasn’t until high school when he saw the effects up-close. “It was pretty prevalent. D.C. had once been the murder capital. We all knew kids who were robbed at gunpoint or shot and killed. Just a month before my brother was killed, a 17-year-old girl was struck by a stray bullet just a half mile from my home.”

But nothing could have prepared Zion for the death of his twin brother. Zion, who was sixteen at the time, was walking home from school when a suspicious man tried to mug him. Zion ran the few hundred feet to his house, told his mother, and texted his brother, warning him to be careful. On his way home, Zaire was shot in the head by the man police believe to be the same attacker who tried to rob Zion hours before.

Zaire’s death affected every aspect of Zion’s life. He didn’t want to ride public transportation or walk anywhere, constantly looking back to see who was coming. He couldn’t focus on his schoolwork, and when he tried to study, his mind would wander and he’d think about his brother or someone else getting shot.

Zion speaking at a March for Our Lives rally in memory of his brother, Zaire, who was killed in Northeast Washington, D.C.
Zion speaking at a March for Our Lives rally in memory of his brother, Zaire, who was killed in Northeast Washington, D.C. Washington, D.C., March 24, 2018 Associated Press

After meeting with a group of students from Marjory Stoneman Douglas High School, Zion was inspired and determined to raise awareness of the violence that affects his community. During his March for Our Lives speech, Zion asked the crowd to raise their hands if they had been affected by gun violence. The sea of hands that went up was astonishing. “I really didn’t know what to expect, but I wanted to prove a point. It didn’t matter if it had been 20 hands or 200 or 2,000. The fact is gun violence has taken so many lives. And not just in Florida or D.C. or Chicago. Gun violence is everywhere and, as a nation, we need to be paying more attention to the problem.”

Since his brother’s death, Zion has done everything he can to keep Zaire’s name alive. “Zaire was captain of the track team, running for student government president, and a youth council member. He was a leader, an inspirer, not just another statistic.” In the summer of 2018, Zion received the Washington, D.C. Attorney General’s Right Direction Award honoring youth who have overcome difficult challenges and are making a positive difference in their communities. His brother had received the same award in 2017, just one month before his death. Zion told the crowd in his acceptance speech, “We will be the change.”

In the United States, homicides account for one-third of gun deaths – over 13,000 per year.

The disparity between the United States and other high-income countries is most stark when it comes to gun homicides. While the overall gun death rate of the United States is 10 times that of other high-income countries, the gun homicide rate is 25 times higher than these peer countries.Grinshteyn E, Hemenway D. Violent death rates: The U.S. compared with other high-income OECD countries, 2010. The American Journal of Medicine. 2016; 129(3): 266-273. In the United States, homicides account for one-third of gun deaths – over 13,000 per year.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Analysis includes gun deaths by homicide, including legal intervention.

Gun homicides happen disproportionately in cities. One analysis found that in 2015, half of the more than 13,000 gun homicides in the U.S. took place in just 127 cities, which contain less than a quarter of the population.Aufrichtig A, Beckett L, Diehm J, Lartey J. Want to fix gun violence in America? Go local. The Guardian. January 9, 2017. https://bit.ly/2i6kaKw. The burden of gun homicide falls heaviest on communities already facing structural disadvantages. Within cities, gun homicides are most prevalent in racially segregated neighborhoods with high rates of poverty and low educational attainment.Ibid.

Black males are 16X more likely than white males to be shot and injured in assaults involving guns.

Hence, gun homicide disproportionately affects people of color.Everytown for Gun Safety. Gun Violence in America. https://every.tw/2pRcld6. August 8, 2018. Black Americans represent the majority of gun homicide victimsCenters for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Analysis includes gun deaths by race among all ages, non-Hispanic only, and homicide including legal intervention. and are 10 times more likely than white Americans to die by gun homicide.Ibid. Young Black men in particular are even more at risk as they are 19 times more likely than young white men to die by gun homicide.Ibid. Analysis includes gun deaths by race among men ages 18 to 34, non-Hispanic Black only, and homicide including legal intervention. This has a lasting impact on the thousands of families and communities impacted by gun homicides – 23 percent of Black American adults and 22 percent of Hispanic American adults report that someone they cared for has been killed with a gun.SurveyUSA Market Research Study. Data collected from December 7, 2018 to December 11, 2018. https://bit.ly/2ExxpyZ. See question 35.

Gun violence is further concentrated in small social networks.Papachristos AV, Wildeman C, Roberto E. Tragic, but not random: The social contagion of nonfatal gunshot injuries. Social Science & Medicine. 2015; 125: 139-150.,Corsaro N. Most challenging of contexts: Assessing the Impact of focused deterrence on serious violence in New Orleans. Criminology and Public Policy. 2015; 14(3). Within these social networks, the spread of violence looks much like the spread of a contagious disease – when an individual is victimized by or exposed to violence, it increases the likelihood that they will be victimized again or resort to gun violence themselves.Tracy M, Braga AA, Papachristos AV. The transmission of gun and other weapon-involved violence within social networks. Epidemiology Review. 2016; 38(1): 70-86.,Green B, Horel T, Papachristos AV. Modeling contagion through social networks to explain and predict gunshot violence in Chicago, 2006 to 2014. JAMA Internal Medicine. 2017; 177(3): 326-333.

Gun homicides can also have severe economic consequences on cities and towns. Residents of communities impacted by gun violence experience lower property values, fewer business startups, and loss of jobs. One study estimated that surges in gun homicides slowed home value appreciation by 4 percent relative to communities which did not experience a surge in violence.Irvin-Erickson Y, Lynch M, Gurvis A, Mohr E, Bai B. A neighborhood-level analysis of the economic impact of gun violence. https://urbn.is/2GQ18oA. Urban Institute. June 2017. Study analyzed data from Baton Rouge, Minneapolis, Oakland, San Francisco, and Washington, D.C. In Washington, D.C., each gun homicide in a given year was associated with two fewer retail and service establishments the next year.Ibid. In Minneapolis, each homicide in a given year led to 80 fewer jobs the following year.Ibid.

Gun Injuries

Read: DeAndra’s Survivor Story

He inspires me every day to help others.
—DeAndra

DeAndra often jokes she’s a mother who won’t shut up.This narrative is derived from an interview with DeAndra Yates, a volunteer with the Everytown Survivor Network and Moms Demand Action for Gun Sense in America. That’s because she’s on a mission to prevent other mothers from burying their children or providing total care as she does to her 18-year-old son, Dre. “Children don’t deserve to be gunned down in our streets, mothers don’t deserve to feel the raw pain of having a child taken, fathers don’t deserve to cry through sleepless nights, and siblings shouldn’t have to live in fear for their lives.”

Her oldest son, Dre (short for DeAndre) was shot in Indianapolis on February 1, 2014 by a stray bullet at the tender age of 13. Dre wasn’t at the wrong place at the wrong time, in fact, he was doing what any teenager should be safe doing – celebrating at a friend’s birthday party. “Because of one bullet, one pull of a trigger, my son is a quadriplegic who is unable to speak.”

Before he was shot, Dre was a high-honor roll student and an outstanding football and basketball player whose smile would light up a room. “People say to me all the time, ‘You are so lucky he is alive.’ Yes, I’m blessed my son was not killed. But there is nothing lucky about Dre’s condition. He’s not the same Dre.”

Since the shooting, Dre has survived eight strokes, a traumatic brain injury, multiple seizures, and nine surgeries, including one to replace the right side of his skull. He lives in a youth rehabilitation facility about a half hour from home and is still learning to communicate. But he has gone back to public school where he receives speech and physical therapy, and will graduate on time with his class in 2019.

DeAndra tabling at the Indiana Black Expo Summer Celebration
DeAndra tabling at the Indiana Black Expo Summer Celebration. Indianapolis, IN, July 2017 Eric Dycus

“The cost of surviving a gunshot wound is astronomical.” Dre’s initial hospital stay was 37 days – that’s 37 days of missed work for DeAndra. She lost her job after he was hospitalized another time for 21 days. In the five years since Dre was shot, DeAndra estimates their medical bills to be in the millions. Even with Medicare, it costs her approximately $1,000 per month out-of-pocket to have Dre in rehab, which she had to weigh against quitting her job to provide full-time care for him at home. “People don’t think about everything the family goes through. I’d love to get him out in the community and improve his quality of life, but Dre needs a van with a wheelchair lift to transport him.” Raising the $25,000 in funds to replace their old one that broke down is DeAndra’s goal for 2019.

DeAndra calls Dre her hero. “Dre’s fight for survival has touched so many lives. His spirit and smile remain and give me strength I never knew I had. The mom in me will never give up on him, and he inspires me every day to help others who have suffered great pain to find purpose.”

Every year, approximately 100,000 Americans survive a gunshot wound and face a life-long process of healing.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. The overwhelming majority of non-fatal gunshot wounds – three-quarters – are caused by assaults.Ibid. According to a recent national poll, 4 percent of American adults alive today, or an estimated 10 million people, have been shot and injured in their lifetimes. Beyond physical injuries, another 12 percent of American adults, or an estimated over 30 million people, report having been shot at, but not physically injured. Overall, one quarter of American adults say they have been threatened or intimidated with a gun. And one in five reported that they personally know more than one person who has been shot.SurveyUSA Market Research Study. Data collected from December 7, 2018 to December 11, 2018. https://bit.ly/2ExxpyZ. See question 37.

As with other forms of gun violence, firearm assaults and victimization are strongly connected to race and locality. Black males are 15 times more likely than white males to be shot and injured in assaults involving guns.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Reports. Data reflect a five-year average (2013 to 2017) of gun deaths by intent. Analysis includes males of all ages, non-Hispanic white and Black only, and assault including legal intervention. And there is evidence that those with firearm assault victims in their social networks are more likely to be victimized as well.Papachristos AV, Wildeman C, Roberto E. Tragic, but not random: The social contagion of nonfatal gunshot injuries. Social Science & Medicine. 2015; 125: 139-150. One study found that 70 percent of non-fatal gunshot injuries in Chicago occur within social networks containing only 6 percent of the city’s population. Even small amounts of direct and indirect exposure to gunshot victimization significantly increase the odds of being a victim.Ibid.

Survivors of gunshot injuries experience difficulties ranging from psychological trauma, loss of work, and steep medical costs. One study estimated that between 2003 and 2013, there was an annual average of 30,617 hospital admissions for firearm injuries in the United States. For each admission, average costs ranged from $19,175 per handgun injury to $32,237 per assault weapon injury.Peek-Asa C, Butcher B, Cavanaugh JE. Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States. Injury Epidemiology. 2017; 4: 20. Even after the immediate hospital costs, for survivors of gunshot injuries, there are lifetime medical care costs including readmission(s) to the hospital and nursing care. Several studies have found that the lifetime costs of providing care following a gunshot injury are more than twice the costs of providing acute care; one study put the lifetime costs of treating gunshot injuries incurred in a single year at $2.3 billion.Cook PJ, Lawrence BA, Ludwig J, Miller TR. The medical costs of gunshot injuries in the United States. Journal of the American Medical Association. 1999; 282(5): 447-454.,Peek-Asa C, Butcher B, Cavanaugh JE. Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States. Injury Epidemiology. 2017; 4: 20.

One study put the overall societal cost for each gun-related assault at $1.2M.

Gun violence continues to financially burden survivors by diminishing wages and productivity. Estimates suggest that productivity loss – the sum of the value of wage and household work lost due to short or long-term disability in the recovery phase – totals an average of $28,478 for each survivor of an assault by firearm.Corso PS, Mercy JA, Simon TR, Finkelstein EA, Miller TR. Medical costs and productivity losses due to interpersonal and self-directed violence in the United States. American Journal of Preventive Medicine. 2007 Jun; 32(6): 474-482. These productivity losses do not include additional productivity lost by family, friends, and professionals caring for the injured, as well as time spent investigating, prosecuting, and punishing violent perpetrators. One study put the overall societal cost for each gun-related assault at $1.2 million.Cook PJ, Ludwig J. The benefits of reducing gun ownership: evidence from contingent-valuation survey data. The Journal of Risk and Uncertainty. 2001; 22(3): 207-226.

Of course, the challenges of surviving a gunshot extend beyond financial cost. In a study of children and young adults who were hospitalized for nonfatal firearm-related injuries, nearly half of patients were discharged from the hospital with some disability.DiScala C, Sege R. Outcomes in children and young adults who are hospitalized for firearms-related injuries. Pediatrics. 2004; 113(5): 1306-1312. Among those who were discharged with short-term disability, the cause was mostly attributed to wounds of the extremities, while injury to the central nervous system was the main cause of long-term disability. It is estimated that over 3,200 children develop a disability as the result of a firearm-related injury each year.Ibid. And the disabilities sustained from firearm-related injuries are not limited to physical disabilities. For example, many gun injury survivors are left to live with bullets retained inside their bodies, which may serve as a constant physical reminder of the traumatic injury. One study of Black male gunshot survivors in Philadelphia, PA found that those with retained bullets experienced more adverse psychological consequences, such as severe depressive symptoms, than those who had their bullets removed.Smith RN, Seamon MJ, Kumar V, et al. Lasting impression of violence: Retained bullets and depressive symptoms. Injury. 2018; 49(1): 135-140.

Gun Violence and Children and Teens

Read: Sari’s Survivor Story

I want everyone to believe they have the ability to make a difference on things that matter most to them.
—Sari

February 14, 2018 started off as a normal day for Sari, a junior at Marjory Stoneman Douglas High School in Parkland, FL.This narrative is derived from an interview with Sari, a volunteer with Students Demand Action and the Everytown Survivor Network. Her mom dropped her off at school and a fire drill during second period was routine. But when another alarm sounded two periods later, she and her classmates looked at each other in confusion. “We were lined up on the grass when I heard five sounds. They sounded like gunshots. But I didn’t want to believe my school was under attack.” Parkland had been voted Florida’s safest city the prior year. No one thought something like a school shooting would ever happen there.

Sirens and police cars descended on the campus. She was told to run. At the same time, she was getting snapchats from friends still inside the school – two people dead, then three, then four. Someone saw one of her friends taken out on a stretcher. “We were told to keep running because they didn’t know where the shooter was.”

Two months before the mass shooting at her high school that gripped the nation and sparked a new generation of student activists, Sari debated the policy of background checks on gun sales for her debate team. “I had to argue both sides and we threw out a lot of statistics. But I learned the hard way; gun violence is not all about statistics. It’s about the impact on human life.”

A screenshot of Sari, a student from Marjory Stoneman Douglas High School, in a video speaking at a March for Our Lives rally.
A screenshot of Sari, a student from Marjory Stoneman Douglas High School, in a video speaking at a March for Our Lives rally. Parkland, FL, March 24, 2018

Sari knew she wanted to be part of the solution, so a week after the shooting she traveled to Tallahassee to meet with state legislators, urging them to pass common sense gun safety legislation. A few weeks after that, she went to Washington, D.C.

Coming back to school was another challenge Sari had to face. The empty desk in her math class where one of the victims sat was covered in flowers left there by the girl’s best friend. “We didn’t really know how to react. We were all just trying to figure out a new way to be.” The shooting also brought a new sense of awareness. If a book dropped in class, it would be startling. Lockdown drills would cause students to break down in tears.

Sari and a friend threw themselves into organizing the Parkland, FL March for Our Lives. “We needed a way to channel the negative energy into something positive.” They organized every aspect of the event, reaching out to voter registration organizations and the media. “The month before, I was at the lowest point in my life. But that day, I looked out into the crowd and saw my friends’ faces. And the crowd kept going and going.” Thirty-five thousand people turned out for the event and there were hundreds of cameras. For the 15-year-old, it was an overwhelming sense of accomplishment.

Sari gets calls and text messages daily from students across the country who want to get involved in the effort to end gun violence. “I want to increase voter education and participation for high school and college students. But above all, I want everyone to believe they have the ability to make a difference on things that matter most to them.”

Every year, nearly 3,000 children and teens (ages 0 to 19) are shot and killedCenters for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Analysis includes children and teens defined as 0 to 19. and approximately 15,600 are shot and injuredCenters for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Analysis includes children and teens defined as 0 to 19. – an average of 51 American children and teens shot every day. Firearms are the second leading cause of death for children and teens and the first leading cause of death for Black children and teens in the U.S.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Leading Causes of Death, 2017. Analysis includes children and teenagers aged 1 to 19, Black defined as non-Hispanic, Age 0 to 1 calculated separately by the CDC because leading causes of death for newborns and infants are specific to the age group. Indeed, gun violence disproportionately impacts Black children and teens, who are 14 times more likely than white children and teens of the same age to die by gun homicide.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. Analysis includes gun homicides including legal intervention by non-Hispanic race among children and teens aged 0 to 19.

Firearms are the second leading cause of death for American children and teens.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Leading Causes of Death, 2017. Analysis includes children and teenagers aged 1 to 19, number of deaths by known intent (homicide, suicide, unintentional deaths). Age 0 to 1 calculated separately by the CDC because leading causes of death for newborns and infants are specific to the age group.

Deaths in 2017: motor vehicle 3,669; firearm 3,430; cancer 1,740; suffocation 1,633; poisoning 1,064

This level of violence on youth amounts to a staggering financial cost and burden on the nation’s healthcare system. Over a period of nine years in the United States, over 75,000 youths were sent to the emergency room as a result of firearm injury, averaging more than 8,300 kids per year. For each of these emergency room admissions, inpatient charges averaged $44,966 – reaching an average cost of nearly $60,000.Gani F, Canner JK. Trends in the incidence of and charges associated with firearm-related injuries among pediatric patients, 2006-2014. JAMA Pediatrics. 2018; 172(12): 1195-1196.

But the impacts of gun violence on children and teens stretch far beyond just those who are shot: gun violence shapes the lives of the millions of children who witness it, know someone who was shot, or live in fear of the next shooting. An estimated 3 million American children witness gun violence every year,Fowler KA, Dahlberg LL, Haileyesus T, Gutierrez C, Bacon S. Childhood firearm injuries in the United States. Pediatrics. 2017; 140(1): e20163486. Everytown analysis derives the 3 million number by multiplying the share of children (ages 0 to 17) who are exposed to shootings per year (4.2%) by the total child population of the U.S. in 2016 (~73.5M). which can have a devastating impact. Children exposed to violence, crime, and abuse are more likely to abuse drugs and alcohol; suffer from depression, anxiety, and posttraumatic stress disorder; fail or have difficulties in school; and engage in criminal activity.Finkelhor D, Turner HA, Ormrod R, Hamby S, Kracke K. Children’s exposure to violence: A comprehensive national survey. Washington, D.C.: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention. https://bit.ly/PwXoZN. 2009.,Morris E. Youth violence: Implications for Posttraumatic Stress Disorder in urban youth. National Urban League. https://bit.ly/2KBpOyg. March 2009.

75% of high school students cited mass shootings as a primary source of stress.

Instances like the Marjory Stoneman Douglas High School shooting have created new anxieties for younger generations of students. In a recent national poll, 75 percent of high school students aged 15 to 17 cited mass shootings as a primary source of stress, and more than one in five reported that the possibility of a shooting at the school is a source of stress on a day-to-day basis.American Psychological Association. Stress in America: Generation Z. https://bit.ly/2JrCisG. October 2018. An analysis of school lockdowns in 31 of the nation’s largest cities by The Washington Post found that in the 2017-2018 school year alone, more than 4.1 million American students, including more than 1 million elementary-age children, endured at least one lockdown. These lockdowns were reactions to various threats, such as bombs or police manhunts, but at least 61 percent of school lockdowns were a result of a shooting or the perceived danger of one.Rich S, Cox JW. School lockdowns: How many American children have hidden from gun violence? The Washington Post. December 26, 2018. https://wapo.st/2F5Mw1T.

Stress related to gun violence affects student performance and wellbeing in schools. In Chicago, IL, one study found that exposure to a local homicide was associated with significant decreases in reading scores, awareness, and concentration for two to 30 days after the incidence. The study estimated that 15 percent of Black children in the sample spend a month each year functioning at low concentration, and that Black children in Chicago’s most violent neighborhoods spend at least a week out of every month functioning at lower concentration levels due to local homicides.Sharkey P. The acute effect of local homicides on children’s cognitive performance. Proceedings of the National Academy of Sciences of the United States of America. 2010; 107(26): 11733-11738. Another study found that following spikes in neighborhood violence, students in Chicago reported feeling less safe, experiencing more disciplinary problems, and having less trust in teachers.Burdick-Will J. Neighborhood violence, peer effects, and academic achievement in Chicago. Sociology of Education. 2018; 91(3): 205-223. In Syracuse, NY, test scores were 50 percent lower in elementary schools located in areas with high concentrations of gunshots than elementary schools in areas with a low concentration of gunshots. Elementary schools in high gunshot areas also had higher rates of standardized test failure.Bergen-Cico D, Lane SD, Keefe RH. Community gun violence as a social determinant of elementary school achievement. Social Work in Public Health. 2018; 33(7-8): 439-448. When neighborhoods and schools are no longer safe from gun violence, entire generations of American children are impacted.

Domestic Violence and Guns

Read: Giovanna’s Survivor Story

We’ve changed laws to prohibit domestic abusers from possessing firearms — laws that will save lives. And that gives me hope.
—Giovanna

Giovanna’s hands were shaking as she sat in front of the Rhode Island State Senate Committee on Judiciary, preparing to share intimate details of the physical and mental abuse her family suffered at the hands of her abuser.This narrative is derived from an interview with Giovanna Rodriguez, a volunteer with the Everytown Survivor Network and Moms Demand Action for Gun Sense in America. “It’s never easy to tell my story and to relive what happened, but I have more work to do. I have seen so much change in the short time since I’ve been speaking out. We’ve changed laws to prohibit domestic abusers from possessing firearms – laws that will save lives. And that gives me hope.”

Giovanna was a single mother raising her 10-year-old son when she met the man who would come to fill her life with torment and terror. She recalls every incident of abuse with painful, vivid detail. The controlling behavior and relentless intimidation. The physical violence that began as soon as she told him she was pregnant with their child. This was how Giovanna existed, in a perpetual state of fear and pain.

There were so many times throughout their relationship she wanted to leave, and many times she did. There were times the police came to her home and took a report, and even times he was subject to a restraining order or arrested. But she couldn’t bear the thought of her sons growing up without a father in the house, so she kept trying to make it work.

“He’d come home from work at midnight, and if dinner wasn’t hot on the table or he wanted to be intimate, I would wake up with a gun to my head.” The gun was always on the kitchen table like a centerpiece – a constant reminder that at any moment he could kill her, leaving her children without a mother. “That was my worst fear. Most of the time I lived day to day. I went to bed not knowing if I would live to see the next day … That I would die at the hands of an abuser and my children would be next when I wasn’t there anymore.”

Her breaking point came on a drive home from searching for a new house when a passing comment sent him into a fit of rage. When she got home, she knew it was time to leave – for good. She looked in the mirror and didn’t recognize herself. “I knew it was me in there, but I was completely lost.”

Giovanna speaking on behalf of Everytown's endorsement of Gina Raimondo for Governor of Rhode Island.
Giovanna speaking on behalf of Everytown’s endorsement of Gina Raimondo for Governor of Rhode Island. Providence, RI, September 7, 2018 Steve Ahlquist

Eight years later, Giovanna and her two sons still suffer the lasting impact of mental and emotional abuse. All diagnosed with PTSD, they have trouble sleeping and suffer from anxiety and depression. “I don’t have a mark on my body, but the emotional scars haven’t gone away. And I don’t know if they ever will.”

Working alongside other survivors to advocate for policies that keep guns out of the hands of domestic abusers has given Giovanna the confidence she had all but lost during those terrifying years. “People ask me all the time why I keep speaking out, why I keep fighting for change. Sure, there are days when it’s difficult, when I don’t want to get out of bed or let my son out of my arms. But then I think about the change that has happened. I think about the other survivors who are fighting alongside me, and the leaders who have the courage to make this change possible, and I get right back up.”

In an average year, over 600 American women are shot to death by an intimate partner, and many more are injured.

Women in the U.S. are 16 times more likely to be killed with a gun than women in other high-income countries. Put another way, 90 percent of all women killed with guns in high-income countries in 2010 were from the United States.Grinshteyn E, Hemenway D. Violent death rates: The U.S. compared with other high-income OECD countries, 2010. The American Journal of Medicine. 2016; 129(3): 266-273. In an average year in this country, over 600 women are shot to death by an intimate partner,Uniform Crime Reporting Program: Supplementary Homicide Reports (SHR), 2013-2017. Washington, D.C.: Department of Justice, Federal Bureau of Investigation. While the FBI SHR does not include data from the state of Florida for the years 2013 to 2017, Everytown obtained data directly from the Florida Department of Law Enforcement (FDLE) and included the reported homicides in the analysis. Whereas SHR includes both current and former partners in its relationship designations, FDLE does not include former partners. As a result, Florida's intimate partner violence data only includes current partners. and many more are injured. In fact, nearly one million American women alive today have been shot or shot at by an intimate partner.Sorenson SB, Schut RA. Nonfatal gun use in intimate partner violence: A systematic review of the literature. Trauma, Violence & Abuse. 2016; 1524838016668589. And while domestic abuse of any kind is devastating, the mere presence of firearms makes a violent situation more likely to turn deadly. Research shows that access to a gun in a domestic violence situation makes it five times more likely that a woman will be killed.Campbell JC, Webster D, Koziol-McLain J, et al. Risk factors for femicide in abusive relationships: Results from a multisite case control study. American Journal of Public Health. 2003; 93(7): 1089-1097. This type of violence disproportionately affects Black women, who are twice as likely to be fatally shot by an intimate partner than white women.Uniform Crime Reporting Program: Supplementary Homicide Reports (SHR), 2012-2016. Analysis includes homicides involving an intimate partner and a firearm, and compares the crude death rates for Black women (0.63 per 100,000) versus white women (0.34 per 100,000) (all ages included; Hispanic and non-Hispanic women included).

Approximately 4.5M American women alive today have been threatened with a gun by an intimate partner.

Of course, a gun does not need to be fired to inflict fear and abuse. The mere presence of a gun in a threat, even if the gun is never fired, can be terrorizing. Approximately 4.5 million American women alive today have been threatened with a gun by an intimate partner.Sorenson SB, Schut RA. Nonfatal gun use in intimate partner violence: A systematic review of the literature. Trauma, Violence, & Abuse. 2016; 1524838016668589. One study of domestic violence and coercive control found that women who had been threatened with a gun – or feared that their partner would use one against them – had more severe psychological symptoms than women who had endured other types of abuse, such as psychological or physical threats.Sullivan TP, Weiss NH. Is firearm threat in intimate relationships associated with Posttraumatic Stress Disorder symptoms among women? Violence and Gender. 2017; 4(2). According to the author, “the fear of a firearm threat – just the fear of the threat, not even the actual threat – is significantly associated with PTSD. It’s stronger even than the link between physical or sexual abuse and PTSD.”Mascia J. No shots fired. The Trace. September 12, 2018. https://bit.ly/2QAOSg7.

Hate Crimes with Guns

Read: Cheryl’s Survivor Story

I choose to change the world by helping, not hurting.
—Cheryl

On election night in 2014, Cheryl felt elated as the election was called for Washington state’s background checks ballot initiative, Initiative 594, of which she was the citizen sponsor.This narrative is derived from an interview with Cheryl Stumbo, a staff member at Everytown for Gun Safety and member of the Everytown Survivor Network. “Watching the election results come in, and knowing I was part of this effort to save lives, was one of the most rewarding experiences of my life. I had taken such a traumatic experience and turned it into something positive.”

Eight years earlier, Cheryl was flat on her stomach with her arms covering her head. She couldn’t hear anything but the overwhelming ringing in her ears. She couldn’t see anything because her face was pressed to the floor of her office in the Jewish Federation of Greater Seattle.

That afternoon, she had been expecting her 14-year-old niece, Kelsey, to show up at her office for a ride home. Instead, an armed stranger appeared in the hallway outside her office shouting hate-filled words about Israel, Jews, and wanting to get on CNN. One of Cheryl’s colleagues was killed and four others were wounded.

Cheryl didn’t see Kelsey until she woke up in the hospital a week later from a medically induced coma. She spent the next six weeks there, recovering from the hollow-point bullet that tore through her abdominal organs. Over the following three years, Cheryl underwent 20 surgeries and ongoing PTSD therapy to learn to deal with the psychological and emotional aftershocks.

She testified at the shooter’s two trials, proclaiming, “I choose to change the world by helping, not hurting.” And that’s exactly how she has persevered. Cheryl saw him sentenced to life plus 120 years with no parole for what was called the worst hate crime in Washington’s history.

Cheryl speaking at an election night party for Initiative 594.
Cheryl speaking at an election night party for Initiative 594. November 4, 2014 Associated Press

Determined to make a difference, she became the citizen sponsor of Washington’s ballot initiative requiring background checks on all gun sales – which passed with 59 percent of the vote.

“This has been a huge journey for me – to triumph over the daily physical and emotional pain that comes and goes, and to keep going. Sometimes it can be overwhelming. Each time I share my story, it’s like two sides of the same coin. My body remembers and hurts when I go back to that day, those weeks, those years. But on the other side, I experience the exhilaration of optimism for our future, healing our communities, and making a difference. It can be exhausting, but I always get back up again … when I’m ready.”

In an average year, over 10,300 violent hate crimes involve a gun.
That’s more than 28 each day.

In an average year, over 10,300 violent hate crimes involve a gun – more than 28 each day.Everytown for Gun Safety analysis of Special Report: Hate Crime Victimization, 2004-2015, BJS. June 2017. https://bit.ly/2KrFyoe. To obtain the annual and daily average of violent hate crimes involving a firearm, Everytown used a 10-year average of violent hate crime victimizations (2006 to 2015) combined with the proportion of violent hate crimes involving firearms (4.5%). Analysis was limited to violent hate crimes perpetrated against a person or persons and does not include hate crimes against property (such as defacing a victim’s home, burglary, and vehicle theft). The vast majority of hate crimes are directed against communities of color, religious minorities, and LGBTQ people.Everytown for Gun Safety. Disarm Hate. https://every.tw/2A3M4xZ. June 12, 2018. In 2017, about 58 percent of reported hate crimes were motivated by racism, nearly half of which were motivated by bias against Black people. Twenty-two percent of hate crimes were motivated by religious bias, most often anti-Semitism. And anti-LGBTQ bias motivated 17 percent of hate crimes in 2017.Hate Crime Statistics, 2017. Federal Bureau of Investigation. https://bit.ly/2CeBZ2M.

Hate crimes against each of these groups increased in 2017, contributing to a 17 percent rise overall from 2016.Ibid. These incidents not only impact individual lives, but they also have reverberating effects on entire communities. For individuals struggling against bias, news of a violent hate crime targeting members of a shared identity group can feel like a personal attack. Following the Pulse Nightclub shooting in Orlando, FL, LGBTQ individuals who were not personally present during the attack reported experiencing higher levels of emotional distress and stated they would be less likely to attend safe spaces like LGBTQ nightclubs.Jackson SD. “Connection is the antidote”: Psychological distress, emotional processing, and virtual community building among LGBTQ students after the Orlando shooting. Psychology of Sexual Orientation and Gender Diversity. 2017; 4(2): 160-168.,Croff JM, Hubach RD, Currin JM, Frederick AF. Hidden rainbows: Gay bars as safe havens in a socially conservative area since the Pulse Nightclub massacre. Sexuality Research and Social Policy. 2017; 14(2): 233-240.

More than twelve years after the anti-Semitic shooting in Seattle that Cheryl survived, another hate-fueled attack at the Tree of Life Synagogue in Squirrel Hill, PA targeted members of Pittsburgh’s Jewish community. This shooting, which left six people wounded and 11 dead, presents a terrifying reality for those seeking to assemble within their communities. When safe spaces no longer feel safe, entire communities suffer.

Hate Crime Incidents by Bias Motivation, 2017

Racial 58%, religious 22%, anti-LGBTQ 17%, other 3%

Conclusion: It Doesn’t Have to Be This Way

With more than 36,000 Americans shot and killed every year,Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. and approximately 100,000 more shot and injured,Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Reports. A yearly average was developed using five years of most recent available data: 2013 to 2017. much of this country is left with pervasive grief from our nation’s gun violence epidemic. Though the reach of gun violence in the United States is vast and impacts all communities, most Americans do not view themselves as gun violence survivors. While the statistics paint a grim and complex picture of America’s gun violence problem, it doesn’t have to be this way. While there are no simple solutions to an epidemic this complex, there are several clear, common-sense policies that we can adopt to break the pattern.

Some of these policies include:

  • Strengthen the background check system
  • Protect kids and communities
  • Disarm domestic abusers
  • Combat daily gun violence
  • Hold the gun industry accountable
Strengthen the background check system

Background checks on gun sales are the foundation of any effective effort to reduce gun violence because they are designed to keep guns away from people who are legally prohibited from possessing them. But federal law does not require individuals who are not licensed gun dealers to conduct background checks before selling a gun, and the Internet has emerged as a massive, unregulated marketplace, where hundreds of thousands of gun sales take place with no background check and no questions asked. Without a background check, individuals may unknowingly sell firearms to felons, convicted domestic abusers, people convicted of violent hate crimes, or people with violent misdemeanor convictions. These types of legal prohibitors require a comprehensive background check system without loopholes that let dangerous purchasers through the cracks.

Protect kids and communities

Research shows that policies like Red Flag laws work to reduce gun suicides,Kivisto AJ, Phalen PL. Effects of risk-based firearm seizure laws in Connecticut and Indiana on Suicide Rates, 1981-2015. Psychiatric Services. 2018; 69(8): 855-862,Swanson JW, Norko M, Lin H, et al. Implementation and effectiveness of Connecticut's risk-based gun removal law: Does it prevent suicides? Law and Contemporary Problems. 2017; 80: 179-208. and may help keep our children safe from mass shootings.Everytown for Gun Safety. Mass Shootings in the United States: 2009-2017. https://everytownresearch.org/reports/mass-shootings-analysis/. December 2018. Red Flag laws empower family members and law enforcement to take action to stop warning signs from escalating into tragedies. They enable family members and law enforcement to ask a judge to temporarily block a person’s access to guns if the court finds that they pose a risk to themselves or others by having a firearm. Further, we can reduce gun violence by limiting easy access to firearms and accessories that are capable of inflicting mass casualties, such as high-capacity magazines and assault weapons,DiMaggio C, Avraham J, Berry C, et al. Changes in US mass shooting deaths associated with the 1994-2004 Federal Assault Weapon Ban: analysis of open data. Journal of Trauma and Acute Care Surgery. 2019 Jan; 86(1): 11-19. and require safe and responsible storage of all guns.Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. The Journal of the American Medical Association. 2015; 293(6): 707-714.,Azrael D, Cohen J, Salhi C, Miller M. Firearm storage in gun-owning households with children: Results of a 2015 national survey. Journal of Urban Health. 2018; 95(3): 295-304. Study defined children as under the age of 18.

Disarm domestic abusers

Because of the risk that firearms pose when they intersect with domestic violence, a series of federal and state laws are in place to help keep guns out of the hands of domestic abusers. However, while the federal prohibitions apply to current and former spouses and certain other domestic abusers, they generally do not apply to abusive dating partners, or stalkers who have not yet been convicted of a felony. The strongest state laws prohibit the same group of domestic abusers prohibited by federal law, as well as abusive dating partners and stalkers convicted of misdemeanor stalking, and require that these dangerous people turn in guns already in their possession. Evidence shows that when these laws are in place and enforced properly, they work to reduce domestic-violence related homicides.Zeoli AM, McCourt A, Buggs S, Frattaroli S, Lilley D, Webster DW. Analysis of the strength of legal firearms restrictions for perpetrators of domestic violence and their associations with intimate partner homicide. American Journal of Epidemiology. 2018; 187(11): 2365-2371.,Díez C, Kurland RP, Rothman EF, et al. State intimate partner violence-related firearm laws and intimate partner homicide rates in the United States, 1991-2015. Annals of Internal Medicine. 2017; 167(8): 536-543.

Combat daily gun violence

Gun violence intervention programs that focus on community-level violence have been shown to reduce gunshot victimization in the neighborhoods most impacted by gun violence.Papachristos AV, Kirk DS. Changing the street dynamic: Evaluating Chicago's group violence reduction strategy. Criminology & Public Policy. 2015; 14(3): 525-558.,Heller SB, Shah AK, Guryan J, Ludwig J, Mullainathan S, Pollack HA. Thinking, fast and slow? Some field experiments to reduce crime and dropout in Chicago. National Bureau of Economic Research Working Paper Series. 2015; 21178.,Branas CC, South E, Kondo MC, Hohl BC, Bourgois P, Wiebe DJ, MacDonald JM. Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear. Proceedings of the National Academy of Sciences of the United States of America. 2018; 115 (12). Programs like Cure Violence employ a localized public health approach to fighting violence by using street outreach workers to mediate conflicts and prevent retaliatory violence.Delgado SA, Alsabahi L, Wolff K, Alexander N, Cobar P, Butts JA. The effects of Cure Violence in the South Bronx and East New York, Brooklyn. Denormalizing Violence: A series of reports from the John Jay College Evaluation of Cure Violence Programs in New York City. Research and Evaluation Center, John Jay College of Criminal Justice, City University of New York. October 2, 2017. Hospital-based violence intervention programs provide case management to individuals who have been seriously injured and who are at higher risk of engaging in retaliatory violence or suffering an additional violent injury after leaving the hospital.Cooper C, Eslinger DM, Stolley PD. Hospital-based violence intervention programs work. The Journal of Trauma. 2006; 61(3): 534-537.,Juillard C, Cooperman L, Allen I, et al. A decade of hospital-based violence intervention. Journal of Trauma and Acute Care Surgery. 2016; 81(6): 1156-1161.,Bell TM, Gilyan D, Moore BA, et al. Long-term evaluation of a hospital-based violence intervention program using a regional health information exchange. Journal of Trauma and Acute Care Surgery. 2017; 84(1): 175-182. While the evidence shows that these and other local programs reduce gun violence in their communities, they require sustainable government funding to maintain their successful operations.

Hold the gun industry accountable

Unlike any other major industry, the gun industry is largely shielded from accountability for business practices that directly threaten public safety and put American lives at risk. This lack of accountability is primarily due to the Protection of Lawful Commerce in Arms Act (PLCAA), a federal statute that prohibits certain lawsuits against gun manufacturers and retailers. Without legal accountability, the gun industry has no incentive to adopt reforms, such as developing safer gun technology or ensuring more responsible sales and marketing practices. Lawmakers can help mitigate the harms of gun violence by repealing PLCAA. Repealing this harmful law, along with similar state laws, will give survivors and victims of gun violence the ability to seek accountability and compensation in court against companies and individuals whose irresponsible behavior has caused great harm. Just like lawsuits against the tobacco and auto industries in the latter half of the previous century, litigation against the gun industry can force the gun industry to adopt safer technology and responsible business practices.

*Cover photo by Jodi Miller, March for Our Lives, Columbus, OH, March 24, 2018