Preventing Gun Violence in America: What Works and What is Possible

The ANNALS Volume 704 (Nov. 2022)

Special Editors

Cassandra Crifasi
Johns Hopkins
Bloomberg School of Public Health
Assistant Professor of Health Policy and Management
Deputy Director of the Center for Gun Violence Prevention and Policy

Jennifer Necci Dineen
University of Connecticut
Department of Public Policy
Associate Professor In-Residence
ARMS for Gun Violence Prevention, Associate Director

Kerri M. Raissian
University of Connecticut
Department of Public Policy
Associate Professor of Public Policy
ARMS for Gun Violence Prevention, Director

This summer, The ANNALS of the American Academy of Political and Social Science published a sweeping collection of work from a group of gun violence prevention scholars that is unique in its eminence and scope. Under the leadership of special editors Kerri M. Raissian, Cassandra Crifasi, and Jennifer Necci Dineen, The ANNALS’ 14 pieces of original empirical work and summative essays outline the history of Americans’ relationship with guns, the current dimensions and dynamics of gun violence in our nation, and how state and federal governments have sought to reconcile public safety with individual rights. The authors of this collection come from the fields of law, public health, medicine, psychology, sociology, social work, criminology, and economics. Their work is a valuable resource for understanding the whole picture of gun violence in America. The Niskanen Center is proud to partner with AAPSS and the special editors to promote this important achievement.

Too often, Americans are confronted with stories of violence in the news. Senseless mass shootings, entrenched violence in often disadvantaged communities, and tragic suicides seem to have become daily occurrences. Guns are intrinsically dangerous objects, but despite the prevalence of guns in America and our long history of private gun ownership, gun violence is not uniformly distributed across the nation or time. Policies seem to make a difference. The authors of this volume agree that there is much to learn from past and present gun laws and how they have shaped and been shaped by America’s relationship with firearms. Unique for a topic that so polarizes our political establishment, this volume sticks to the facts and advances no particular agenda or cause – except that of achieving fewer gun injuries and deaths. Instead, the authors present fresh research and suggest workable solutions, making it essential reading for policymakers, practitioners, and voters alike. We congratulate them on their contribution to this crucial national conversation.

As part of Niskanen’s mission to provide policymakers with relevant, timely, and rigorous research on policies around which transpartisan appeal is possible, we have worked with the volume editors to condense their scholarship into a series of briefs. Each corresponds to a paper published in the volume, and taken together, they serve as an introduction and guide to this wide-ranging collection of research, which is available to the public free of charge. We hope this volume of essays and accompanying briefs can encourage a better understanding of gun violence and a more reasoned conversation about policy solutions that work for all Americans.

Gun Violence and Gun Policy in the United States: Understanding American Exceptionalism
Cassandra Crifasi, Jennifer Dineen, and Kerri Raissian

Gun Culture 2.0: The Evolution and Contours of Defensive Gun Ownership in America
David Yamane

Economics and Public Health: Two Perspectives on Firearm Injury Prevention
Nathaniel Glasser, Harold Pollack, Megan Ranney, and Marian Betz

The Number and Type of Private Firearms in the United States
Jonathan Berrigan, Deborah Azrael, Matthew Miller

The Effect of Permissive Gun Laws on Crime
John Donohue

Effectiveness of Firearm Restriction, Background Checks, and Licensing Laws in Reducing Gun Violence
April Zeoli, Alex McCourt, and Jennifer Paruk

Research on the Effects of Hospital-Based Violence Intervention Programs: Observations and Recommendations
Daniel Webster, Joseph Richardson, Nicholas Meyerson, Christopher St. Vil, and Rachel Topazian

Prevention Strategies for Policing Gun Violence
Anthony A. Braga, Philip J. Cook, and Stephen Douglas

Mass Shootings in the United States: Prevalence, Policy, and a Way Forward
Jaclyn Schildkraut and Lisa B. Geller

Understanding Risk and Implementing Data-Driven Solutions for Firearm Suicide
Michael D. Anestis, Allison E. Bond, and Shelby L. Bandel

Social and Structural Determinants of Community Firearm Violence and Community Trauma
Shani Buggs, Nicole Kravitz-Wirtz, and Julia Lund

How Multi-disciplinary Research Centers and Networks Can Advance the Science of Firearm Injury Prevention
Carissa Schmidt, Leigh Rauk, Rebecca Cunningham, Marc A. Zimmerman, and Patrick Carter

Social Media Data for Firearms Research: Promise and Perils
Lisa Singh and Carole Greene

Balancing Rights and Responsibilities: The Role of Government and Citizens in Combatting Gun Violence
Michael R. Ulrich

Gun Violence and Gun Policy in the United States: Understanding American Exceptionalism

Cassandra Crifasi, Jennifer Dineen, and Kerri Raissian

The United States has the highest rates of gun circulation and gun deaths of any developed country, but patterns of gun possession and violence differ immensely across place and demographics. Though gun violence has remained a relatively rare occurrence among most portions of the population, many communities face surges of homicide, suicide, and other gun-related injuries. Intractable violence among young people in disadvantaged neighborhoods, periodic mass shootings in schools and other civic spaces, the rapid increase in gun ownership sparked by the COVID-19 pandemic, and rising rates of suicide among White males and veterans have each contributed to America’s gun violence epidemic.

While national trends underscore the urgency of the issue, state-by-state gun death rates vary dramatically. In 2020, Mississippi experienced a gun death rate of 28.6 per 100,000 residents, while Massachusetts and Hawaii saw rates as low as 3.7 and 3.4 gun deaths per 100,000 residents, respectively – rates comparable to those of Finland and Sweden. While some states have seen rapid increases in gun violence, at least 20 states have seen steady or decreasing trends over the past 40 years. The diversity of gun violence within the United States suggests that there are lessons to be learned from the laboratories of state and local policymaking, which might inform effective local, state, and federal responses.

State responses to gun violence occur within national gun policymaking, and America’s federal response has been inconsistent over the past century. The right to bear arms was originally framed as a communal right, subject to regulations on individual ownership. By the late 1990s and early 2000s a distinct shift in this perspective had occurred. Shortly after the creation of a national background check system in 1994, the firearms industry expanded its influence, which corresponded with the atrophy of government research and regulation. The landmark 2008 case, DC v. Heller, defined gun ownership as an individual right, limiting the government’s regulatory scope. In 2022, the Supreme Court limited gun regulations further in the Bruen decision, which drew on historical tradition rather than empirical evidence or societal demands to define the bounds of gun rights.

Guns present a serious public health risk. They are now the leading cause of death for people under age 18. Congress has taken small steps to address the issue, including resumed funding for gun control research and the Bipartisan Safer Communities Act of 2022, but the need for effective prevention remains urgent. Mass shootings and neighborhood violence have not abated, and public demand for reform has grown. Despite, or perhaps because of, the fear and tragedy guns often provoke, more guns are in private hands than ever before. The successes and failures of state and local governments that attempt to address gun misuse, and the research based on these attempts, offer lessons for federal policymakers. This collection of articles describes the problem from several disciplinary perspectives, evaluates the policy landscape, and presents the best evidence-based practices available to date.

Kerri M. Raissian is an associate professor of public policy in the School of Public Policy at the University of Connecticut and director of UConn’s ARMS Center for Gun Injury Prevention. Raissian’s interdisciplinary research focuses on child and family policy with an emphasis on understanding how policies affect family violence.

Jennifer Necci Dineen is an associate professor in residence in the University of Connecticut School of Public Policy and associate director of UConn’s ARMS Center for Gun Injury Prevention. Dineen is a survey methodologist whose research focuses on understanding stakeholder attitudes as mechanism for intervention uptake and policy change.

Cassandra Crifasi is an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health and serves as the codirector of the Center for Gun Violence Solutions. Crifasi’s research focuses on gun violence and policy and attitudes on gun violence solutions.

Gun Culture 2.0: The Evolution and Contours of Defensive Gun Ownership in America

David Yamane

While the predominant motivations behind it have changed over time, gun ownership is a unique and longstanding part of American culture. In the early republic, as many as 75% of households possessed guns. Until the 1970s, most people bought guns for hunting or collecting. Contemporary gun culture, on the other hand, is increasingly motivated by self-defense. The percentage of Americans who report self-defense as a primary cause for gun ownership rose from 26% in 1999 to 48% in 2013 and 67% in 2017. Further, according to a 2013 ABC/Washington Post poll, more Americans believe guns make them personally safer (51%) than less safe (29%). This shift marks the transition from what sociologist David Yamane calls Gun Culture 1.0 to Gun Culture 2.0, from a culture of hunting, recreation, and collecting to a culture of what Light calls “do-it-yourself (DIY)-security citizenship.”

The rise of Gun Culture 2.0 closely aligns with the popularity and proliferation of handguns. Florida’s 1986 “shall-issue” concealed carry law kickstarted the first wave of gun policy liberalization. In 2021, approximately 8.3% of American adults held concealed carry permits, over 21.5 million people—a 10.5% increase from 2020. As concealed carry became less restrictive in most states, more gun owners sought small, personal guns. A 1978 survey found 29% of gun owners surveyed carried handguns. Within four decades, the proportion nearly doubled to 57%. The share of gun-owning households with a handgun increased from fewer than 1-in-7 in the 1950s to a quarter in the 1970s and two-thirds in 2015. Most newly bought guns today are handguns. As demand has increased, so has production. The production of handguns quadrupled from 2005 to 2015 while production of easily concealable .380 pistols increased 12-fold. Gun marketing has similarly mirrored and molded demand, as studies of advertising trends over the past century in magazines such as The American Rifleman make clear. From the 1920s to the 1960s, most ads appealed to hunting and recreational shooting themes, but in the 1970s, self-defense narratives increasingly appeared, becoming dominant by the mid-2010s.

A broad swath of Americans has embraced the change in gun culture. Gun owners are increasingly diverse—that is, less likely to be male, white, and politically conservative than gun owners were fifty years ago. They are also less likely to have grown up with a gun in the home. New gun owners are more likely to own only a handgun and to have bought it for protection. Although women are less likely to own firearms than men, women who do are twice as likely as men to own only handguns.

Similarly, although a higher percentage of white people own guns than ethnic and racial minorities, Black gun owners are three times as likely, and Hispanic gun owners are twice as likely as white gun owners to own only handguns. Unsurprisingly, the political orientations of this increasingly diverse group of handgun owners are far from aligned, which Yamane suggests might lead to a great schism in American gun culture. Still, the motivations for new gun ownership seem relatively homogenous. According to a California-based study, 76% of people who bought guns in response to the pandemic cited “lawlessness” as their motivation.

This broadly held perception that disorder exists and that handguns offer protection from it is driving further gun law liberalization, especially in red state legislatures. Moreover, blue state laws that do allow consideration of subjective criteria (“may-issue” laws) are increasingly vulnerable to legal challenges. In New York State Rifle & Pistol Association v. Bruen (2022), the Supreme Court deemed New York’s law allowing denial of a permit for lack of “good cause” unconstitutional. This changing legal environment hints at the new frontier for gun policy liberalization: permitless carry. In 25 states, where nearly 40% of the U.S. population lives, permitless carry of concealed weapons is allowed. Given the unabated growth in the popularity of firearms for self-defense, Yamane predicts Gun Culture 2.0 will likely continue to expand. This means that more people will own more guns and more of those guns will be brought into public situations.

David Yamane is a professor of sociology at Wake Forest University. He is currently completing a book, Gun Curious: A Journey into America’s Evolving Culture of Firearms, based on his 10+ years observing and participating in American gun culture.

Economics and Public Health: Two Perspectives on Firearm Injury Prevention

Nathaniel Glasser, Harold Pollack, Megan Ranney, and Marian Betz

Over the past few decades, with growing acknowledgement of the failure of drug prohibition in the United States and the rise of mass incarceration, scholars, activists, and policymakers have increasingly moved toward perspectives that frame crime and other harmful activities in terms of rational behavior or pathology. In their joint article, Glasser, Pollack, Ranney, and Betz discuss the merits of two influential perspectives applied to gun violence: the economic perspective and the public health perspective.

Gun violence is commonly reported in terms of deaths and injuries and often does not account for intangible costs sustained. The direct costs, those that involve medical care, law enforcement, and incarceration of offenders, are estimated to be about $24 billion annually. A broader accounting, which includes indirect costs such as lost productivity, outmigration, and negative educational outcomes, raises the figure by more than a factor of 16, to about $392 billion. An economic perspective provides tools to estimate the wider impacts of gun violence that are difficult to otherwise measure.

The economic perspective, focusing on incentives, tradeoffs, and resource constraints, also provides behavioral insights into the reasons why people buy and use firearms. Often, people buy firearms not because they have violent or criminal goals in mind but because they live in environments where lack of a firearm places them at risk of victimization. Hence, firearm possession is a rational response to social environment. Similarly, basic microeconomic principles of supply and demand curves can help policymakers understand why and how illicit gun markets occur and how to mitigate them.

The public health perspective frames gun violence as an issue that can be objectively quantified and studied. In this sense, the public health perspective sidesteps some of the politization that has long stymied gun policy and research. It accepts that firearms will be a part of civil society, that this carries a certain level of risk, but that the risk level can be managed and reduced.

The four key steps to addressing gun violence through a public health lens are: 1) Intervention strategies must be evaluated using empirical data; 2) The predictors of risk—that is, what makes a person, a group, or a geographic area vulnerable to gun violence—must be identified from empirical data; 3) Intervention strategies must adapt as empirical evidence is generated, and they must be designed to maximize harm reduction; and 4) If an intervention is shown to have a significant effect on harm, it should be retained or expanded, and it should be scrapped if not. The public health approach directs scholarship and policy toward the largest reductions in harm through policy interventions.

Together, the economics and public health perspectives allow researchers and policymakers to approach gun violence through the lens of empirical questions answerable with data and transparent methodology. They may provide interconnected ways to avoid political and cultural gridlock and to reduce the harms caused by gun violence.

Nathaniel Glasser is a general internist, pediatrician, and health services researcher at the University of Chicago.

Harold Pollack is Helen Ross Professor at the Crown Family School of Social Work, Policy, and Practice, University of Chicago.

Megan L. Ranney is an emergency physician-researcher and deputy dean of the Brown University School of Public Health; she will be assuming the role of dean of the Yale School of Public Health in July 2023.

Marian E. Betz is an emergency physician-researcher and director of the Firearm Injury Prevention Initiative at the University of Colorado School of Medicine.

The Number and Type of Private Firearms in the United States

Jonathan Berrigan, Deborah Azrael, Matthew Miller

The United States is widely acknowledged to have the world’s most extensive stock of civilian-held firearms and the highest rate of firearm-related deaths among high-income populous nations. Yet no U.S. agency regularly collects information about the size or composition of the U.S. gun stock or how different types of guns are distributed across U.S. gun owners. To the extent that these data are available, it has come from researchers using nationally representative surveys and firearm manufacturing and import data.

The most recent detailed data about the composition of the U.S. gun stock come from the current study by Berrigan, Azrael, and Miller, who used nationally representative survey data on approximately 3,000 U.S. adult gun owners in 2019 to characterize the number and types of firearms owned by U.S. gun owners as well as the locations in which guns are stored (e.g., at home, at work). They also describe U.S. adults who owned guns concerning characteristics such as age, gender, race/ethnicity, education, household income, U.S. region of residence, rurality of residence, and the presence of children in the home.

The authors find that over 300 million guns are in private hands in the U.S., including more than 20 million semi-automatic military-style rifles. Approximately 80% of U.S. gun owners reported owning at least one handgun, of whom more than 60% owned both handguns and long guns. Of the 30% of U.S. gun owners who owned only one gun, most (70%) owned a handgun. Those who reported owning any long gun were more likely to possess multiple firearms, including handguns.

As in prior work by the authors, the current study found that the gun stock is highly concentrated among a relatively small group of gun owners (e.g., two-thirds of guns are owned by less than one-quarter of gun owners). The mean number of guns owned per respondent was five, the modal respondent owned two or fewer guns, and those who owned three or more guns accounted for 87% of the gun stock.

While approximately 90% of these guns are in their owners’ homes, 5.7 million handguns are in cars and 9.5 million rifles and shotguns are in garages.

Descriptive studies such as this one can help inform future research and provide the necessary context for gun violence policy discussions in public health, public safety, and public policy.

John Berrigan, a graduate of Northeastern University, is currently a third-year medical student at University of Kansas Medical School. He has led several firearm related peer-reviewed studies in collaboration with Drs. Azrael and Miller, including the present one. He plans on continuing to pursue and integrate his dual interests in public health research and clinical medicine.

Deborah Azrael is director of research at the Harvard Injury Control Research Center and has over 25 years’ experience conducting and leading grant-funded research on firearm violence, injury surveillance, and suicide prevention. She was the codirector of the pilot for what became the National Violent Death Reporting System.

Matthew Miller is a professor of health sciences and epidemiology at Northeastern University, adjunct professor of epidemiology at the Harvard School of Public Health, and codirector of the Harvard Injury Control Research Center. His research focuses on injury and violence prevention, with a focus on firearm-related injury and suicide prevention.

The Effect of Permissive Gun Laws on Crime

Jonathan Berrigan, Deborah Azrael, Matthew Miller

Firearms are becoming increasingly lethal in the United States at a time when many state legislatures and the U.S. Supreme Court are promoting more lax firearm safety measures. Donohue examines the empirical evidence on the effect of this greater permissiveness towards firearms and finds substantial reason for concern that these developments will continue to elevate violent crime and the death toll from mass shootings.

Understanding the impact of these developments has been contentious and empirically challenging. Still, some broad comparisons of murder rates in the three largest states suggest that more permissive gun laws are socially harmful. From 1870 through 1995, Texas banned the carrying of firearms. Since then, Texas has continually liberalized its gun laws while New York and California have pursued increasingly restrictive gun legislation. When Texas moved to a “right-to-carry” (RTC) regime in 1996, it had about the same murder rate as New York, and California had a 25% higher murder rate. By 2020, Texas’s murder rate exceeded New York’s by more than 60% and California’s by nearly 25%– an astonishing reversal in 25 years.

In the last five years, a growing literature has coalesced on a finding that these laws are associated with significant increases in violent crime. Contrary to the argument that firearms are beneficial in crime reduction, this literature indicates that states with more permissive carry laws have witnessed a significant spike in violent crime, including elevated rates of homicide, aggravated assault, and robbery. But despite this new evidence, 25 states have now adopted laws allowing the carrying of guns in public without any permit requirement.

This is partly due to the unintended consequences of making it easier for criminals to carry guns and for guns to be stolen or lost, both of which tend to impose greater burdens on police, leading to lower crime clearance rates. Donohue finds that an increase did not match the extension in gun carrying in protective gun use During 1992 to 2001 and 2007 to 2011, less than 0.9% of victims used a gun defensively when confronted by a criminal despite the substantial adoption of RTC laws over this period. But the attendant more-frequent gun carrying by 16 million permit holders over this period has led to roughly 100,000 additional gun thefts per year. Many of these stolen firearms were later used for criminal purposes.

Greater permissiveness in carrying laws has been accompanied by the adoption of Stand Your Ground (SYG) laws in 26 states, which aim to protect the right to self-defense by negating the “duty to retreat” in the face of a threat. Mirroring RTC laws and their impact on higher rates of violent crime, SYG laws caused an 8% increase in homicides, escalating the number of gun-related fatalities rather than having the intended result of improved personal safety.

Advances in the lethality and power of firearms amplify the effect of permissive gun laws on violent crime. The growing availability of modern assault weapons (AWs) and firearms with large-capacity magazines (LCMs) has elevated the upward trend in mass shooting deaths, with LCMs enabling more rounds to be fired quickly, leading to higher casualty counts.

The combined impact of greater permissiveness in firearm legislation and increasingly lethal firearms has worrying implications for violent crime and victimization rates. While states like California and New York have resisted the move to more permissive gun laws, other states continue to liberalize and the Supreme Court has shown an inclination to accelerate the potential dangers by limiting beneficial state-level restrictions under the Second Amendment.

Donohue’s findings suggest that the federal assault weapons ban restricting certain semi-automatic weapons and LCMs from 1994 to 2004 successfully curtailed the death toll from mass shootings. In the wake of increasingly harmful gun violence, restrictive firearm policies are a tool policymakers can use to improve public safety and health.

Effectiveness of Firearm Restriction, Background Checks, and Licensing Laws in Reducing Gun Violence

April Zeoli, Alex McCourt, and Jennifer Paruk

Gun violence and the high count of firearm deaths continue to be serious public health problems in the United States. Data from 2020 show a significant year-over-year increase in the firearm homicide rate ( 1.6 per 100,000) and a high but stable firearm suicide rate (7.0 per 100,000). One policy option to correct these trends is restricting firearm access for those at risk of harming themselves or others. Zeoli, McCourt, and Paruk provide insight into and evidence of the effectiveness of restrictive firearm laws, which regulate whether high-risk individuals can purchase and possess firearms.

The authors find that these policies can effectively reduce firearm casualties as long as they are well-implemented. However, it is critical to note that most current studies overlook how these firearm policies might have racially disparate effects. Zeoli and colleagues suggest that better and consistent implementation of firearm restriction policies, future studies of their combined effects, and future studies of risk factors and policy effects across different demographic groups are necessary steps for research and policy development in policymaking.

The authors examine risk-based firearm restrictions executed through the civil and criminal court systems. In the civil court system extreme risk protection orders (ERPOs) and domestic violence restraining orders (DVROs) intend to reduce the risk of fatal and nonfatal firearm violence, including firearm suicide, by identifying and reacting to risk factors and patterns that predict violence. Risk factors include a prior history of violence, alcohol or drug abuse, and prior threats of violence against self or others. There is limited evidence at the individual level associating ERPOs and DVROs with decreases in suicides and crime-related fatalities.

Research also finds that DVROs have more protective effects when they include provisions that allow courts to order a newly prohibited individual to relinquish a firearm already in possession. While ERPOs also have potential as an effective mechanism in curbing firearm violence, they are hindered by implementation problems, such as lack of clarity and the potentially complicated and time-consuming process of petitioning for an ERPO. These are problems that clear protocols and education around their use can overcome.

Implementation is also a problem for risk-based firearm restrictions in the criminal court system. As mandated by federal and state law, these policies apply to offenders with felony convictions and to select violence-related non-felony criminal convictions. The effectiveness of criminal court firearm restriction laws varies across studies, suggesting that the mixed results might be affected by inadequate record keeping of criminal offenses, insufficient enforcement, and the absence of tracking or measuring reduced risks after the imposition of firearm restrictions.

Firearm purchasing prohibition policies include background checks and licensing laws. The authors describe purchaser licensing, which requires background checks to be conducted before purchase, as the better option than point-of-sale checks, but few states use this approach. More states should consider adding a licensing step to firearm purchasing because research suggests it provides more time and information to identify individuals with high risk or with a relevant criminal record.

Reducing rates of gun violence and homicide requires a multifaceted approach. Current policies intended to identify and address risk factors predictive of violence can help mitigate part of the problem, but policymakers should push for more specific and transparent implementation. The authors also suggest that we must learn more about the combined effects of firearm restriction and purchasing prohibition policies and their possible disproportionate impact on specific racial communities. Not only does existing research need to be bolstered, but local, state, and federal officials should also make it a priority to collect and report up-to-date data on gun violence and homicide so that lawmakers can respond accordingly.

April M. Zeoli is an associate professor in the School of Public Health and the director of the Policy Core for the Institute for Firearm Injury Prevention at the University of Michigan. Her main field of investigation is the effectiveness of firearm policies that restrict high-risk individuals from purchase and possession of guns and those that facilitate the implementation of firearm restriction policies.

Alexander D. McCourt is an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. His research focuses on the relationships between law and public health, including the effects of firearm policies on population health outcomes.

Jennifer K. Paruk is a PhD candidate in the School of Criminal Justice at Michigan State University. Her research interests include public health and criminal justice policies related to violence prevention.

Research on the Effects of Hospital-Based Violence Intervention Programs: Observations and Recommendations

Daniel Webster, Joseph Richardson, Nicholas Meyerson, Christopher St. Vil, and Rachel Topazian

Perpetrators of gun violence were often once victims themselves. The purpose of hospital-based violence intervention programs (HVIPs) is to arrest the transmission of violence by reducing the likelihood a victim will engage in violence or be its target once again. HVIPs connect victims to counselors, case managers, violence intervention specialists, peer support groups, and community-based programs, and assist with obtaining medical care, employment, housing, mental health services, and treatment for substance abuse. Initial studies on the effectiveness of HVIPs show encouraging results in reducing rates of reinjury, criminal offending, and arrest. Still, due to a lack of substantive research they are far from conclusive. Webster and colleagues surveyed the research, focusing on experimental or otherwise rigorously designed tests of HVIPs, to assess their potential as a mitigator of future crime and morbidity.

In one study, people eligible for but not enrolled in HVIPs were three times more likely to be arrested for violent crimes, four times more likely to be convicted, and seven times more likely to be reinjured than those enrolled in HVIPs. The literature suggests that a substantial portion (nearly a third) of those eligible decline participation, though their reasons for doing so are unclear. At least three other studies support these findings.

Another study found the positive effect of HVIPs persisted after six months, which suggests that the treatment effect is sustained and can lead to lasting shifts in behavior. A study of youth ages 10 to 15 found the positive effect of HVIPs was most evident in those who most closely adhered to the program, suggesting a causal dose-response relationship. The more one stuck to the program, the better one would fare. However, all the studies are vulnerable to selection bias and weakened by insufficient sample sizes and large confidence intervals, making it difficult to establish statistical significance and measure effects with precision. Other studies reached inconclusive results. But the signs point encouragingly at the potential of HVIPs to reduce the risk of re-victimization and impede the spread of violence.

To improve HVIP design, Webster and colleagues recommend that HVIPs deepen partnerships with organizations engaged in street outreach and violence interruption, expand the use of evidence-based methods for positive behavior change, and hire, train, and support more credible messengers, often people with personal experience with violence, to encourage victims to enroll in HVIPs. Building trust and encouraging participation seem to be key mechanisms in program success. Webster and colleagues stress that researchers should collect more high-quality data, increase sample sizes, and design robust experimental studies to estimate the effects of the HVIPs more precisely and generate evidence that can be more convincing to policymakers and funders. They also stress expanding outcomes to measures such as building trust with program participants and incorporating qualitative research approaches.

These methodological improvements are burdensome and expensive, but treating gun violence is even more costly. Gunshot wounds create costs of $100,000, on average. Victims are often uninsured, particularly in communities where gun violence is cyclical and entrenched.Initial research suggests that HVIPs may avert many of the costs – and the suffering – inherent in gun violence, netting savings for healthcare providers and creating a higher quality of life among people vulnerable to participation in gun violence.

Daniel W. Webster is Bloomberg Professor of American Health at the Johns Hopkins Bloomberg School of Public Health, where he is Distinguished Scholar at the Center for Gun Violence Solutions. He has led research and published widely on the effects of policies and programs on gun violence, suicides, and the diversion of guns for use in crime.

Joseph Richardson Jr. is the Joel and Kim Feller Endowed Professor of African-American Studies and Anthropology at the University of Maryland. His research focuses on gun violence; the intersections of structural violence, interpersonal violence, and trauma among Black boys and young men; the intersection of the criminal justice and healthcare systems in lives of young Black men; and parenting strategies for low-income Black male youth. This endowment supports his research on gun violence and trauma among Black boys and young Black men.

Nicholas Meyerson is a PhD student in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. His work has investigated gun violence involvement, health disparities, police-involved violence, and long-term needs of youth involved in the juvenile justice system.

Christopher St. Vil focuses on improving support services for Black males with an emphasis on those living in urban contexts. His research illuminates the disproportionate contextual risks experienced by Black males in the domains of lack of positive role models and the increased likelihood of victimization.

Rachel Topazian is a doctoral student in health and public policy at the Johns Hopkins Bloomberg School of Public Health, where she is a research assistant with the Center for Gun Violence Solutions. Her interests include research ethics and the considerations surrounding informed consent and ethical conduct of research studies.

Prevention Strategies for Policing Gun Violence

Anthony A. Braga, Philip J. Cook, and Stephen Douglas

Recent surges in gun violence account for 79% of the dramatic increase in the national homicide rate. Death-by-bullet disproportionately occurs in Black and Hispanic low-income communities, where relationships with the police are often fraught. Countering arguments to “defund the police” and minimize the presence of local law enforcement within communities, Braga, Cook, and Douglas make a case for the role of effective policing in firearm homicide reduction. They suggest that it is not a matter of simply giving more resources to the police, but of allocating those resources in smart and intentional ways that efficiently address shootings and aim to improve community relations.

Police can accomplish these goals by concentrating efforts on places where shootings are relatively frequent. Research indicates that street gangs and other, less organized but high-risk groups of serious offenders are responsible for most shootings in major cities. These groups’ areas are often crime hot spots with concentrated violence, typically low-income neighborhoods vulnerable to criminal activity. One study the authors reviewed found that such hot spots often feature public housing buildings, gang turfs, drug markets, and other places of conflict that increase the risk of a violent firearm encounter.

By directing attention to specific places and victim demographics and by relying on preventive policing strategies, law enforcement can more effectively curb the rising gun violence rate. Focused deterrence interventions can help facilitate preventative measures by coordinating law enforcement, social service, and community-oriented efforts. The authors suggest that the police should focus sanctions on the people who drive gun violence, take a problem-solving approach to hot spots, and make the threat of arrest for gun violence more credible. Social service providers such as gang outreach workers and other community-based organizations can all contribute to strategies to communicate anti-violence messages to potential shooters and protect potential victims.

Police can also improve their legitimacy through efforts to reduce the opportunity for crime by prioritizing the safety of high-risk groups. The authors strongly emphasize that policing strategies should not bypass procedural justice or cause more harm than necessary to increase the threat of punishment. This balance is critical to improving police-community relations, particularly among Black and Hispanic populations, where gun violence tends to be centralized and relations with the police are often already strained.

Police managers should focus on improving clearance rates for nonfatal gun violence. Homicides have higher clearance rates than nonfatal shootings, many of which are not reported or thoroughly investigated. Even when there are arrests, cases are often hard to make, and suspects are often released despite the risk they pose to their communities. Encouraging more thorough investigations and improving arrest and conviction rates for shootings of all types should be goals for police departments nationwide to prevent future shootings, hold shooters accountable, and preempt retaliation and legal cynicism.

Effective policing is an essential component of neighborhood safety that can rapidly affect gun violence rates at the community level. We should allocate resources and time to focus on areas where violence is concentrated. The authors stress that focused deterrence, problem-solving at hot spots, and better clearance rates can lead to a virtuous cycle of better community-police relations, better cooperation with police investigations, and better shooting and homicide rates. Enforcement strategies that are proactive and informed by evidence are a way to achieve both lower crime rates and better relationships with the communities police agencies serve.

Anthony A. Braga is the Jerry Lee Professor of Criminology and director of the Crime and Justice Policy Lab at the University of Pennsylvania.

Philip J. Cook is the ITT/Sanford Professor Emeritus of Public Policy and professor emeritus of economics at Duke University.

Stephen Douglas is a research associate in the Crime and Justice Policy Lab at the University of Pennsylvania and a doctoral candidate in the School of Criminology and Criminal Justice at Northeastern University.

Mass Shootings in the United States: Prevalence, Policy, and a Way Forward

Jaclyn Schildkraut and Lisa B. Geller

Despite the increasing lethality and frequency of mass shootings in the U.S., limited policy action has been taken in preventing and alleviating damage. Schildkraut and Geller examine existing policies on two levels – prevention and harm mitigation – and suggest that a multifaceted, proactive approach is needed to address the continuing problem of mass shootings appropriately. They identify challenges, including strong public support for policies that have failed to translate into enacted legislation, gaps in existing federal firearm policies, lack of a standardized definition of a mass shooting, and loopholes in both federal and state law. They also identify several factors and “warning behaviors” of potential perpetrators that may help to avert such tragedies.

In their study of preventative policies, the authors analyze universal background checks, firearm purchaser licensing laws (“permit-to-purchase”), Extreme Risk Protection Orders (ERPOs), Domestic Violence Protection Orders (DVPOs), and threat assessment. They find universal background checks to be most effective in reducing the incidence of mass shootings and casualties when combined with firearm purchaser licensing laws. Protection orders, including ERPOs and DVPOs, are useful in dealing with shooters who are suicidal or are likely to commit domestic violence, respectively. Emerging research also finds that ERPOs have been used in efforts to prevent mass shootings. Noting the importance of early and efficient threat identification before violent events, the authors advocate for better and more widely advertised mechanisms for reporting and communicating potential threats of mass shootings to relevant stakeholders.

Harm mitigation policies examined by the authors include “target hardening,” surveillance, bans on assault weapons and large-capacity magazines (LCMs), and response practices. They provide evidence for the effectiveness of limiting the number of rounds in a magazine, specifically for LCMs, associated with fewer mass shooting incidents and fatalities. They pay special attention to lockdown drills carried out in schools. Lockdown and active shooter protocols generally increase the chance of survival in a mass shooting, though because these events are relatively rare, the evidence is mixed.

Schildkraut and Geller indicate that a varied, multilayered policy approach is necessary for predicting, preventing, and minimizing damage. No one policy solution alone will curb this crisis. Rather, more research is necessary around the rare but increasingly frequent phenomenon of mass shootings, and policymakers should consider all contributing factors when planning preventative and harm-mitigation policies.

Jaclyn Schildkraut is the executive director of the Regional Gun Violence Research Consortium at the Rockefeller Institute of Government. Her research focuses on school and mass shootings, school safety, homicide and gun violence trends, and mediatization effects. Dr. Schildkraut’s work has been published in more than fifty books and journals.

Lisa B. Geller is a researcher at the Johns Hopkins Center for Gun Violence Solutions at the Bloomberg School of Public Health. Her work focuses on research, advocacy, and implementation of evidence-based gun violence prevention policies, including extreme risk protection orders and domestic violence protective orders.

Understanding Risk and Implementing Data-Driven Solutions for Firearm Suicide

Michael D. Anestis, Allison E. Bond, and Shelby L. Bandel

Firearms are used in less than 5% of all suicide attempts in the United States. Still, they are disproportionally responsible for a total of 52.8% suicide deaths. More people die each year from self-inflicted gunshots than do from firearm homicide. Noting the increase in the firearm suicide rate and overall suicide rates over the past twenty years, Anestis, Bond, and Bandel examine and reflect upon past research to highlight the need to appropriately address firearm suicide risk and further develop firearm suicide prevention measures. They find that monitoring firearm accessibility and encouraging safe and secure storage of weapons are both crucial and promising mechanisms to consider as part of efforts to reduce firearm mortality rates.

Access to a firearm does not encourage suicide. Instead, , access to firearms for an individual experiencing a suicidal crisis can far more easilyact upon their thoughts of self-harm. Even after accounting for variables such as urbanization, socioeconomic status, unemployment, prior suicide attempts, and psychopathology, this threat remains significant, as suicidal individuals factor the ease of access to firearms into their decision on how to end their lives. Firearm suicide is especially prevalent among law enforcement and military service members, who have regular access to firearms.

Making firearms less accessible can reduce the practicality of selecting a firearm as a method for suicide.

The authors conclude that some legislation, including laws that require gun owners to obtain a license and participate in firearm safety and storage education, can help prevent firearm suicide. Some existing policy solutions include preventing at-risk individuals from obtaining firearms, monitoring the storage of privately owned firearms, and temporarily withdrawing firearm access in cases of imminent risk to self or others.

Other policies that do not require changes include safe firearm storage maps, lethal means counseling, and community intervention programs. Facilitating discussions about firearm safety and its role in suicide prevention is particularly important in increasing firearm owners’ willingness to store their firearms more securely. The authors suggest that we should do more to educate communities about the hazards of unsafe firearm storage and to alleviate firearm owners’ concerns through effective messaging.

The authors find that individuals who undergo an initial failed attempt at suicide rarely try again. However, given that firearm suicide attempts have a fatality rate of 85-90%, those who select a firearm as their method of choice are unlikely to survive their first attempt. The number of suicidal individuals who indicate a preference for methods of suicide with high rates of mortality has increased, which is worrying given the upward trend in firearm ownership.

Despite several existing policies that can combat firearm suicide rates, the research on firearm access restrictions is scant. Data on suicide deaths are also limited, inaccessible, and inaccurate. This shortcoming presents a significant problem since stakeholders require up-to-date and timely information on firearm suicides to develop effective solutions. While better implementation and more meticulous testing of existing mechanisms may help, the authors suggest that launching new ways to collect data on firearm suicide and suicide risk nationally are necessary. Policymakers should treat suicide prevention efforts as one approach among many to minimize the harm that could be caused by the nationwidesurge in personally owned firearms.

Michael D. Anestis is the executive director of the New Jersey Gun Violence Research Center and an associate professor in the Department of Urban-Global Public Health at Rutgers. His research interests include firearm suicide prevention within both military and civilian populations.

Allison E. Bond is a clinical psychology PhD student at Rutgers University and is a graduate research assistant at the New Jersey Gun Violence Research Center. Her research interests include firearm suicide prevention, with a particular focus on effective messaging to promote secure firearm storage.

Shelby L. Bandel is a clinical psychology PhD student at Rutgers University and is a graduate research assistant at the New Jersey Gun Violence Research Center. Her research interests include firearm suicide prevention as well as societal and demographic factors associated with secure firearm storage.

Social and Structural Determinants of Community Firearm Violence and Community Trauma

Shani Buggs, Nicole Kravitz-Wirtz, and Julia Lund

Decades of disinvestment through discriminatory practices and policies have left structurally marginalized communities – and particularly those with majority Black or Brown populations – disproportionately vulnerable to gun violence. Inadequate infrastructure and resources, including income and housing insecurity, lack of early childhood care, underfunded schools, limited food access, and environmental pollution – all problems present in communities experiencing disinvestment – are associated with increased risks of exposure to gun violence.

Children and adolescents in these communities are particularly vulnerable. Firearm homicide is the second leading cause of death for Black girls and the leading cause of death for Black boys. In 2020, Black boys accounted for nearly one in five firearm homicides despite constituting less than 1% of the U.S. population. Nationally, an estimated 13% of youth ages 14-17 report hearing gunshots or seeing someone shot over their lifetime; in communities impacted by persistent disinvestment, youth (12-15 years of age) are more than four times as likely to be exposed to gun violence in the past year. Black youth are nine times more likely than White youth to live or attend school in neighborhoods with a recent firearm homicide.

Youth in communities most heavily impacted by gun violence must often navigate strategically through public spaces to create and maintain physical and emotional safety. Ethnographic research suggests youth in these communities frequently alter their schedules and transportation routes to avoid violence. Trauma from gun violence is palpable not only at the individual level but also at the community level. Gun violence’s secondary effects alter individual lives and leave indelible marks on the collective consciousness of entire communities.

This manifests in frequent police stops, business disruptions, heavy school security, and sidewalks marked with memorials where people have died from violence. Early exposure to gun violence is negatively associated with cognitive functioning, attention, and impulse control, and conflict resolution capacities. It is also associated with various PTSD symptoms, such as depression, anxiety, aggression, substance misuse, and school problems. Quasi-experimental studies in New York and Chicago found that children who had witnessed a homicide near their home had significantly lower standardized test scores than children who had not.

Buggs, Kravitz-Wirtz, and Lund argue that the most effective strategies to prevent gun violence in these communities are to expand supportive programming to interrupt violence and treat root causes. For instance, despite perennial underfunding, community-based violence intervention (CVI) programs have shown promise in reducing community violence. Cities could make CVI funding a permanent line item in their budgets.The authors stress that progress must be made by empowering community members, whose perspectives and experiences have long been marginalized, to build capacity to discourage violence through community development and informal means rather than through policing.

To that end, the authors suggest participatory budgeting whereby community members have input in how their local government allocates funds. They also discuss the effect of investments in the physical environment on violent crime, which includes vacant lot remediation, dilapidated building demolition, home facade renovation, installing streetlights, and planting trees. Income support policies are also associated with violence reduction. Subsidies such as the Earned Income Tax Credit and the Low-Income Tax Credit Program are also associated with reductions in gun violence, which suggest that even marginal increases in wealth and income can have significant impacts on violence prevention.

Shani A. L. Buggs is a public health and policy researcher with the Violence Prevention Research Program and the California Firearm Violence Research Center at the University of California, Davis. Through her research on community-driven safety, she strives to inform policies that facilitate health equity and well-being for all families and communities.

Nicole D. Kravitz-Wirtz is a population health sociologist with the Violence Prevention Research Program and the California Firearm Violence Research Center at UC Davis. Her research aims to understand the social ecology of places to foster equitable, community-centered policies and practices for improving the health of people and communities impacted by violence.

Julia J. Lund is a research data analyst with the Violence Prevention Research Program and the California Firearm Violence Research Center at UC Davis. She utilizes interdisciplinary and mixed methods to understand the structural drivers of violence and support community-driven approaches to safety and wellness.

How Multi-disciplinary Research Centers and Networks Can Advance the Science of Firearm Injury Prevention

Carissa Schmidt, Leigh Rauk, Rebecca Cunningham, Marc A. Zimmerman, and Patrick Carter

Firearms are second only to drug overdose and poisoning deaths as a leading cause of injury-related deaths in the United States, and a leading cause of death for children and high schoolers. Responsible for over 45,000 fatalities and an estimated 70,000 non-fatal injuries, firearm injury poses a critical public health problem.

Still, firearm injury prevention research is severely underfunded, which has led to Due to injury-prevention science’s failure to achieve the same level of progress in reducing firearm injury and deaths as in other areas (e.g., motor vehicle crash). This lack of federal funding has led to limited high-quality research studies, deficits in the data infrastructure needed to answer critical scientific questions, and no mechanism to train new and developing researchers.

The relative lack of research was primarily driven by the Dickey Amendment and related funding policies that reallocated funds for firearm injury prevention research to other areas. Although firearm deaths surpassed motor vehicle crash deaths in 2017, investment in research on preventing motor vehicle crashes is still 39 times larger than the budget allocation to preventative research on gun injuries. The disparity in research funding for firearm injury prevention is reflected in scholarly output. In nine years (2008-2017) over 2,000 academic studies were published on preventing motor vehicle crashes. In comparison, over 19 years (2000-2019) only 812 firearm-related research articles appeared in health science journals. For every article on firearm injury, there are five about motor vehicle crashes.

The body of research is meager, as is the number of researchers. In 2013, the field of firearm injury had fewer than 12 senior investigators. For over at least three decades, the pipeline of firearm investigators has been steadily collapsing as funding incentives are diverted to other areas of study.

Although significant political obstacles must be overcome to regain federal funding for research on firearm injury, Schmidt and colleagues highlight university centers and institutes’ growing importance and unique role. They posit that university research centers/institutes may be an ideal mechanism for combining multi-disciplinary research with a solid data infrastructure to understand the magnitude of the individual, interpersonal, and broader social costs of firearm injuries in the United States. These centers and institutes can develop a pipeline of researchers that move in innovative directions, retain institutional memory, and are relatively independent from federal policy. They could also engage community partnerships in ongoing research efforts, thus overcoming the knowledge deficits that have accrued from a lost generation of researchers.

Carissa J. Schmidt is an assistant research scientist at the University of Michigan’s Institute for Firearm Injury Prevention. She has published a well-cited scoping review on risk and protective factors for youth firearm violence as well as other publications in the fields of youth violence and community psychology.

Leigh Rauk is a postdoctoral fellow at the University of Michigan, where she studies firearm injury prevention among adolescents and teens with the FACTS consortium. Specific areas of study include firearm-related behaviors and events within schools and factors that contribute to the well-being of youth across all ecological levels.

Rebecca M. Cunningham is the William G. Barsan Professor of Emergency Medicine (Medical School) and a professor of health behavior and health education (School of Public Health) at the University of Michigan. In addition to her work developing and testing behavioral interventions for youth violence, she is the principal investigator (PI) of the Firearm Safety among Children and Teens Consortium.

Marc A. Zimmerman is the Marshall H. Becker Professor of Public Health at the University of Michigan (UM), co-director of the UM Institute for Firearm Injury Prevention, and PI of the CDC-funded Michigan Youth Violence Prevention Center. His work focuses on community-based approaches to positive youth development.

Jessica S. Roche is the managing director for the University of Michigan Institute for Firearm Injury Prevention. Her work focuses on developing, evaluating, and translating evidence-based programs into practice.

Patrick M. Carter is an associate professor of emergency medicine (Medical School) and health behavior and health education (School of Public Health) at the University of Michigan, co-director of the UM Institute for Firearm Injury Prevention, and director of the CDC-funded Injury Prevention Center. His work focuses on healthcare-based approaches to reducing risky firearm behaviors and firearm violence outcomes.

Social Media Data for Firearms Research: Promise and Perils

Lisa Singh and Carole Greene

Recent years have witnessed substantial improvements in existing data sources to support gun violence research, though limitations remain. Social media data represent a relatively new and potentially valuable source of information for firearms data. While social media data have many strengths, important considerations must be addressed when using these data.

About70% of Americans participate in a social media platform. Of those users, many report daily or near-daily engagement. This high intensity of use has created a large magnitude of social media data. But social media data have other strengths beyond the sheer volume of data available. For example, such data can provide access to continuous, automated, and near-real-time monitoring and are obtained in a naturalistic setting.

Researchers have used social media in public health contexts, such as the COVID-19 pandemic, and social movements, like Black Lives Matter. Singh and Gresenz suggest that social media plays a critical role in informing the public about emergency health and safety responses during times of crisis and in mobilizing community members to address health and safety- related threats. Social media platforms also provide insight into users’ emotions, perspectives, attitudes, and personal beliefs. Already, studies have used social media to analyze sentiment, emotion, and public discourse around shooting events, for example.

However, as an emerging and non-traditional data source, social media presents its own analytical and ethical challenges. Measures used across social media platforms and interfaces are not standardized. Even when reproduced perfectly, the same study may yield different results. Since researchers collect information only from platform users, their samples do not often represent the target populations, particularly on platforms that appeal to youth or other population subgroups. Incomplete and inadequate information on user demographics exists, rendering statistically sound inferences difficult to make. Further, users’ regular exposure to false information is a unique threat researchers face.

Extracting data from social media platforms also raises questions about using personal and sensitive information for research without explicit consent. Unique ethical issues, including the vulnerability of human belief and opinion formation to algorithmic bias, must be approached transparently.

Social media data represent a promising source of additional information for informing gun violence research, either in conjunction with or as a supplement to traditional data sources. Singh and Gresenz suggest the importance of understanding how to use this data responsibly and accurately. The benefits and potential of social media for informing gun violence research must be considered, alongside the analytical and ethical challenges of using such data.

Lisa Singh is a professor in the department of computer science and the director of the Massive Data Institute at Georgetown University. She has authored or coauthored over ninety peer-reviewed publications and book chapters related to data-centric computing, for example, data mining, data privacy, and data science.

Carole Roan Gresenz is an economist and professor at Georgetown University in the McCourt School of Public Policy and School of Health. She is a coauthor on the first and second editions of The Science of Gun Policy: A Critical Synthesis of Research Evidence on the Effects of Gun Policies in the United States (RAND Corporation 2018).

Balancing Rights and Responsibilities: The Role of Government and Citizens in Combatting Gun Violence

Michael R. Ulrich

Any effort to pass firearm safety measures, such as tracking and checking firearm misuse, is inevitably evaluated within constitutional restrictions. The Supreme Court has declared that the Second Amendment grants the right for individuals to keep and bear arms. Given the Court’s recent decision in New York State Rifle & Pistol Association v. Bruen, which limits the government’s inherent duty to protect public safety, Ulrich suggests that effective solutions for gun violence reduction will require establishing a balance between the right to own a firearm and the authority of the government to limit that right when necessary. Anachronistic approaches to firearm policymaking that are biased by history and tradition fail to respect the liberties of both gun owners and those affected by gun violence.

In Bruen, the Supreme Court grounds the Second Amendment right in reasons of self-defense and deterrence. This justification assumes the role of the citizen in their personal protection and the notion that motivated offenders with guns can be stopped effectively through the proliferation of guns in the hands of law-abiding members of the public. Ulrich finds that evidence for both is lacking. Most people who commit firearm-related crimes carry guns for self-protection and do not have the explicit intention to harm when they are carrying a weapon. Violent crime, in comparison to property crime, is rare. Even in high-risk situations, victims are unlikely to use a gun successfully to fend off their attackers and, in some cases, may even increase their chances of being shot.

The “law-abiding” archetype is too vague and unsupported to be a foundation for future gun violence prevention policies. It also overemphasizes an individual’s risk perceptions, which are intrinsically susceptible to bias. Research indicates that Black men are disproportionately perceived to be prone to violence compared to people of other races and genders. This social perception is rooted in overt racial discrimination throughout American history. Its modern consequence is that Black men are less able to legitimately defend themselves and are more frequently targeted for suspicion and unwarranted violence. Given this circumstance, it is unlikely that Bruen will serve the public safety interests of the groups and communities with the most to lose from gun violence.

The state’s role in promoting public safety and its fundamental duty to protect the public should be central to debates over expressions of Second Amendment rights. Firearms are inherently dangerous, and gun owners must accept that Second Amendment rights are limited for this reason, especially in improper use. When the presence of a gun becomes a threat to public or individual safety, appropriate government action should be taken to limit Second Amendment rights. This includes evaluating how well different methods of statutory firearm control prevent or reduce gun violence and the extent to which they are needed.

Gun policies and laws can operate at many levels to improve the rates of gun crimes. Targeting individuals and areas at greater risk of violent crime with appropriate law enforcement can effectively curb immediate gun violence. Community-oriented policing programs that aim to improve police-community relations, can facilitate cooperation with investigations and crime prevention within at-risk neighborhoods and create lower-crime equilibriums. Evidence-based gun policies, such as firearm acquisition restrictions, can help reduce gun-related crime among a more significant portion of the population and may reduce the supply of guns used in crimes. Government investments to mitigate risk factors, such as income inequality, unemployment, mental health disorders, and inadequate, unaffordable housing, will likely have an even longer-lasting impact on protecting public health.

If the growing problem of gun violence in the U.S. is to be tackled effectively, both the rights protected by the Second Amendment and the obligation of the government to protect public safety and health must be considered. Ulrich suggests that legislation and policy can serve both sides without burdening either gun owners or the victims of gun crimes.

Michael R. Ulrich is an assistant professor of health law, ethics, and human rights at Boston University’s School of Public Health and School of Law; and Solomon Center Distinguished Visiting Scholar at Yale Law School. His scholarship focuses on the intersection of public health, constitutional law, and bioethics, emphasizing social justice through examining the law’s impact on health outcomes of marginalized and underserved populations.