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Katelyn Jetelina

We need solutions for firearm morbidity and mortality in the U.S. Firearm violence is a leading cause of premature death in the U.S. and the leading cause of death overall among kids, recently surpassing car crashes, cancer, and drug overdoses. We need to and we want to do things. But it’s not clear how.

We are all familiar by now with the swiss cheese approach for COVID-19. The same model can be applied to gun violence. I adapted it below. The overarching theme is that no solution is perfect, but we can add enough layers to slow down or eventually block the opportunity for the disease (i.e., firearm deaths). This needs to be executed at the individual level but also the community and policy levels. Here are some ways how…

Individual-level approaches
Gun safety. Forty-two percent of homes have at least one firearm. In addition, 4.6 million kids live with unlocked, loaded guns. Between 2015 and 2020, there were at least 2,070 unintentional shootings by children, and people are at an increased risk for suicide and homicide when a gun is in the home. This means:

Firearm owners need to focus on safe storage and understand risk factors that lead to crises and signs that someone is in a crisis. Firearm owners also need to change cultural norms around what safe, responsible firearm ownership looks like. Some are already engaged, but their voices are not being heard.

Non-firearm owners need heightened awareness of guns in other people’s homes. If you’re a parent, there’s a 1 in 3 chance your kid is going to a friend’s house with firearms. Just as you’d ask about pets, allergies, and supervision before your child visits another home, ask one more important question: “Is there an unlocked gun in your house?”

Build relationships and mentor young people. One of the main predictors of mass shootings, and violence altogether, is isolation. Long-term frustrations coupled with lack of support leads to social isolation, which can be devastating. We need to create healthy, honest, long-term relationships with kids in the community. You can help by volunteering as a mentor at after-school programs, like the Boys and Girls club (find one near you here) or One Trusted Adult.

Hear something, say something. According to data from the Violence Project, 86% of mass shooters leaked their plans. Most of these leaked to strangers (22%), but also to coworkers (18%), partners (18%), and friends and neighbors (11%). These were cries for help—evidence of a crisis—that went unanswered. It’s better to overreact than under-react. If someone comes to you with a crisis, know what to do. For example, you can anonymously report it here. The Sandy Hook Promise empowers youth to “know the signs.”

Be cognizant of media. One study compared perpetrators of seven mass shootings to 600 celebrities over the same time period. Mass killers received more coverage than professional athletes and only slightly less than television and film stars. Fame-seeking mass shootings are on the rise; a criminologist deems it “performance crimes.” Do not like or click news stories that show the perpetrator’s face or describe, in detail, their plans. Don’t watch or share mass shooting videos posted on social media or YouTube. The perpetrators were hoping they would be widely distributed. And future shooters are watching how we react. Here is more information on stamping out notoriety.

Clinicians: Physicians have conversations about car seats and vaccinations. They need to have conversations about firearms. The American Academy of Pediatrics recommends that pediatricians start asking about firearms in the home when children are 3 years old. There’s also a lot clinicians can do to reduce suicide by firearm (read more here).

Community-level approaches
Health care. Health care organizations and care teams need to have a complete picture of a patient’s life situation. One way to do this is to integrate trauma-informed care or social determinants of health into medicine. This can include, for example, screening for trauma and violence and connecting to free, accessible resources. We also need to integrate behavioral health with primary care to improve access and treatment to mental illness. These have to be a organizational-level priority in order to work.

Schools. We can do a lot with schools. Active shooter drills are not evidence-based, and some research suggests the risks outweigh benefits. (I have a full post coming this week if you want to read more about this topic.) But there are other evidenced-based solutions. For example, we can implement P3 Campus—a school safety app that allows students, parents, and community members to submit secure and anonymous safety concerns. But this is just the first step, then schools need to do something. Schools need to create multi-disciplinary crisis response teams rather than leveraging disciplinary measures. Here is an online training for K-12 educators and leaders who are seeking holistic violence prevention training and solutions for schools. We also need to implement expert-endorsed school security upgrades, like access control and interior door locks.

Crisis support teams. We need to create crisis teams at universities, workplaces, and places of worship, too, so that people can bring up concerns in a place of trust. Here is a training for workplaces.

Community change. There are a number of innovative, evidence-based approaches that reduce community violence and firearm violence in particular. For example, research shows replacing vacant spaces with green spaces reduces firearm violence. Programs like Cure Violence reduced firearm violence by 63% in New York City, 30% in Philadelphia, and 48% in Chicago. Other successful programs include Advance Peace and Minneapolis’ Blueprint for Action to Prevent Youth Violence. Support and encourage planning and implementation of community violence prevention and interventions.

Firearm retailers and gun ranges. Retailers can help change cultural norms around safe, responsible firearm storage, identify signs of crisis, and disseminate information about suicide prevention. Some retailers and gun ranges are already engaged in solutions. We need more.

Policy-level approaches
Firearm policies. As a VOX article displayed below, there is bipartisan support for many common sense gun policies, including background checks and red flag laws. Push for these. Changes in policy reduce firearm deaths.

Health care policies. We need to let doctors talk about firearms in the house. Minnesota, Missouri, and Montana, for example, limit doctors’ ability to address guns with patients. There was a long fight in Florida (the case was coined Docs v. Glocks) after a law threatened physicians with suspending medical licenses if they inquired about and discussed a family’s firearms. The federal court eventually sided with physicians and overturned the law.

Safety-net policies. We need to strengthen safety-nets in the U.S., like Medicaid and unemployment, so losing a job or going broke from back surgery is not a crisis.

Support research. We need to empower researchers to actually research firearm injuries and effective prevention solutions. NIH and CDC funding is controlled through the congressional budget. Non-profits that you can donate to also support firearm research, like the UC Davis Violence Prevention Research Center (donate here), National Collaborative on Gun Violence Research (donate here), and Affirm Research (donate here).

Advocate for these policy changes.

Write your senator here. A template is even provided if you don’t know what to say.

Go vote for people who are pro-common sense laws.

If you want to help move policy, get into advocacy work. For example, here you can find your local Moms Demand Action chapter.

Bottom line
There is a lot we can do. This is certainly not a comprehensive list, but a menu from which you can choose how to start. You can help make change surrounding firearms in the U.S.

Love, YLE

In case you missed it, previous YLE posts on this topic include:

It’s hard to explain (and fix) evil

We can reduce gun violence in the U.S.

Epidemiology of mass shootings

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, biostatistician, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank, and at night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members.