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The question whether the Second Amendment confers an individual or collective right to possess and bear arms has been the subject of much scholarly and legal debate. Some scholars view it as a statement of an individual right and others argue that the Amendment was designed only to protect a collective, or state's right.

It is generally acknowledged, however, that at the time of the writing and ratification of the Second Amendment, there was widespread concern about the possibility that the federal government would overstep its constitutional bounds. The Bill of Rights was primarily an expression of the rights that had to be secured if democracy was to exist and if citizens' "inalienable rights" were to be protected. The power of the states was seen as a vital safeguard against potential federal tyranny. In that sense, it is clear that a major goal of the Amendment was to secure the collective power of the states to raise and use arms, should their citizens consider it necessary.

At the same time, Americans took the individual possession of firearms for granted. Many of the legislators who wrote the Second Amendment owned guns, and undoubtedly assumed that their ownership was part of their rights to property and self-defense. Guns were routinely utilized for hunting and to ensure personal and family safety, as well as held in readiness for collective defense.

It is precisely because gun ownership was so widespread that the governmental power to regulate firearms was equally taken for granted*. The right to own and use guns was not considered absolute or viewed as free from governmental regulation since firearms are inherently dangerous instrumentalities and their use, unlike the other activities protected by the Bill of Rights, can inflict serious bodily injury or death.

Firearms are therefore subject to reasonable regulation in the interests of public safety, crime prevention, maintaining the peace, environmental protection, and public health.

Such regulation of firearms and individual gun ownership or use are appropriate, however, only when consistent with civil liberties principles such as privacy, due process, equal protection, and freedom from unlawful searches. Keeping those principles in mind, the ACLU will not oppose governmental regulation of firearms as long as such regulation is reasonably related to a legitimate governmental interest, such as protection of the public health, safety, or welfare. Deference should be given to legislative judgments limiting gun ownership or use so that state and local governments are allowed an opportunity to experiment with solutions to the complex problems involving guns.

[Adopted by the National Board, October 24, 2015]

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*When the Constitution was written, "gun regulations were common...Boston made it illegal to keep a loaded gun in a home...New York, Boston, and all cities in Pennsylvania prohibited the firing of guns within city limits. States imposed curbs on gun ownership. People deemed dangerous were barred from owning weapons...Rhode Island conducted a house-to-house census - an early American form of a gun registry...the misdemeanor of affrighting, dating from medieval times, prohibited carrying a weapon in a way that menaced others." Michael Waldman, The Second Amendment: A Biography (Simon & Schuster, 2014), 32-33. See also Saul Cornell and Nathan De Dino, "A Well Regulated Right: The Early American Origins of Gun Control," 73 Fordham Law Review 487 (2004-2005), at 505-508 ("a variety of gun regulations were on the books when individual states adopted their arms bearing provisions and when the Second Amendment was adopted," p. 502); Saul Cornell, A Well Regulated Militia: The Founding Fathers and the Origins of Gun Control in America (Oxford University Press, 2006); Adam Winkler, "Scrutinizing the Second Amendment," 105 Michigan Law Review 683 (2006-2007).

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Second Amendment | American Civil Liberties Union

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The question whether the Second Amendment confers an individual or collective right to possess and bear arms has been the subject of much scholarly and legal debate. Some scholars view it as a statement of an individual right and others argue that the Amendment was designed only to protect a collective, or state's right.

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Guns, Violence, and The Second Amendment

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Guns, Violence, and The Second Amendment

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The Bill of Rights is a powerful addition to our constitution. The first ten amendments to the Constitution were ratified in 1791 as key Founding Fathers like James Madison and George Mason stated strongly that guarantees of personal rights were missing from a predominantly structural and procedural document. The Bill of Rights, however, was written in a largely general and sometimes vague manner, which required interpretation and elaboration by the Congress and the Supreme Court. One of those rights that has been at the center of the debate over proper definition and implementation is the Second Amendment.

As stated, the Second Amendment reads as follows:
"A well-regulated Militia, being necessary to the securing of a free State, the right of the people to keep and bear Arms, shall not be infringed."
The Second Amendment appears to be organized into four separate sections - the need for a well-regulated Militia, the importance of the Militia securing a free State, the right of the people to keep and bear Arms, and the guarantee that these rights shall not be infringed (to limit or undermine). In modern times the sections on a well-regulated Militia and the importance of securing a free State have been overshadowed by "the right of the people to keep and bear Arms," and the importance of not limiting or undermining this right to bear arms.

Legislative and judicial action on the Second Amendment was not controversial or debated for much of the time after ratification as interpretations of the Amendment concentrated on the importance of a standing army (militia) and the value of the army protecting Americans as members of a free State. It was not until 2007 in a landmark case out of the District of Columbia - District of Columbia v. Heller - that the Supreme Court concentrated on the meaning and application of the "right to bear arms." The issue that brought up the question of citizens having a right to own guns was in response to a law in Washington, D.C. that effectively barred citizens from purchasing and keeping firearms in their homes. But in a 5-4 decision Supreme Court Justice Antonin Scalia writing for the majority concluded that the Second Amendment does provide an individual's right to keep and bear arms for lawful purposes. Later in 2010, the Supreme Court expanded the right to bear arms to the states in a decision out of Illinois - McDonald v. City of Chicago.

With the Heller and McDonald decisions and a later case out of New York (New York State Rifle and Pistol Association, Inc v. Bruen) that disallowed the state from requiring applicants for a gun license to demonstrate a justifiable need, the stage was set for a massive increase in gun purchases in the United States and gun-related deaths. From 2008 to 2022 gun deaths increased from 31,593 to 45,247; gun ownership increased from 304 million in 2008 to 393 million in 2022; mass shootings increased from 253 in 2013 to 647 in 2022; school shooting incidents increased from 13 in 2009 to 51 in 2022, and suicide by guns increased from 18,223 in 2008 to 24,297 in 2020. And more disturbing in 2022 6,000 children died from gun violence.

With the Courts upholding gun rights it became difficult for the federal government, states, and municipalities to pass gun restrictions such as universal background checks, outlawing military-style weapons such as the AR-15, magazine limits and age requirements for gun ownership. Joined with the support of the Courts for the Second Amendment right to bear arms has been the role of the powerful National Rifle Association (NRA), which championed gun rights and refused to make any compromises regarding restrictions on gun ownership. The NRA is well funded by its membership and employees hundreds of lobbyists to convince members of Congress to vote against any legislation that would limit the purchase and ownership of guns. The NRA has been so effective that many members of Congress rely on campaign contributions from the organization, while those that may support restrictions often fear election strategies that urge its members to rally against those who would challenge the limitations on guns. With this kind of lobbying power there has been little effort to reform gun laws, even though a vast majority of Americans support universal background checks, a ban on assault rifles, and restrictions on the number of bullets permitted in a gun.

The gun culture that has permeated America and American society has led to regular and horrific mass shootings. Americans watch the carnage in Sandy Hook, Connecticut; Uvalde, Texas; Buffalo, New York; Atlanta, Georgia; Boulder, Colorado to name just a few of recent mass shootings and begin to feel that we as citizens of this country will have to adjust to the reality of gun deaths, a kind of "normalizing" the impact of the gun culture. But it is important to remember that the United States is unique in the world when it comes to a gun culture and a failure to take action to regulate gun ownership (the United States has 46% of the world's civilian-owned guns). Countries like Japan, Australia, United Kingdom, Germany and Canada all have strict gun laws that require limits on ownership, training with firearms, prohibitions of assault rifles and detailed background checks of potential gun applicants. Not surprisingly, the number of gun-related deaths in these countries is extremely low if non-existent. Moreover, those who live in countries with strict gun laws cannot fathom why the United States permits such lax laws and how the American people and particularly American political leaders accept the tragic loss of life.

While gun rights and protection by the courts of the Second Amendment are currently solidly in place, that does not mean that reform of existing laws or a rejection of the arguments presented in the Heller and subsequent Supreme Court decisions are impossible to achieve. Advocates of changes in gun laws talk about "common sense gun reform" that does not take away a person's right to purchase a gun or gives the government the right to confiscate firearms. Besides the generally accepted view to mandate universal background checks and mental health evaluations of prospective gun purchasers, the emphasis among the proponents of common sense gun reform want to see changes such as the requirement that guns have safety locks with codes that would negate anyone in a household from an unauthorized use of a gun, training of gun owners with mandatory "gun" tests much like those required of new car drivers and personal injury insurance that would require owners pay not only to purchase a gun but to assume financial responsibility for the deadly use of a gun. As advocates of reform often state, such reforms are not unreasonable or invasive of personal freedom, rather they put the onus on the owners to act responsibly and help to save lives.

But unfortunately, until there is a major shift in the political arena and a rejection or at least a modification of the gun culture in our country, these tragic deaths of thousands of Americans will continue. The outlook, sadly, does not look promising for common sense gun reform.

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The Bill of Rights is a powerful addition to our constitution. The first ten amendments to the Constitution were ratified in 1791 as key Founding Fathers like James Madison and George Mason stated strongly that guarantees of personal rights were missing from a predominantly structural and procedural document.

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Guns are deeply ingrained in American society and the nation's political debates.

The Second Amendment to the United States Constitution guarantees the right to bear arms, and about a third of U.S. adults say they personally own a gun. At the same time, in response to concerns such as rising gun death rates and mass shootings, President Joe Biden has proposed gun policy legislation that would expand on the bipartisan gun safety bill Congress passed last year.

Here are some key findings about Americans' views of gun ownership, gun policy and other subjects, drawn primarily from a Pew Research Center survey conducted in June 2023.

About four-in-ten U.S. adults say they live in a household with a gun, including 32% who say they personally own one, according to an August report based on our June survey. These numbers are virtually unchanged since the last time we asked this question in 2021.

There are differences in gun ownership rates by political affiliation, gender, community type and other factors.

Republicans and Republican-leaning independents are more than twice as likely as Democrats and Democratic leaners to say they personally own a gun (45% vs. 20%).

40% of men say they own a gun, compared with 25% of women.

47% of adults living in rural areas report personally owning a firearm, as do smaller shares of those who live in suburbs (30%) or urban areas (20%).

38% of White Americans own a gun, compared with smaller shares of Black (24%), Hispanic (20%) and Asian (10%) Americans.

Personal protection tops the list of reasons gun owners give for owning a firearm. About three-quarters (72%) of gun owners say that protection is a major reason they own a gun. Considerably smaller shares say that a major reason they own a gun is for hunting (32%), for sport shooting (30%), as part of a gun collection (15%) or for their job (7%).

The reasons behind gun ownership have changed only modestly since our 2017 survey of attitudes toward gun ownership and gun policies. At that time, 67% of gun owners cited protection as a major reason they owned a firearm.

Gun owners tend to have much more positive feelings about having a gun in the house than non-owners who live with them. For instance, 71% of gun owners say they enjoy owning a gun - but far fewer non-gun owners in gun-owning households (31%) say they enjoy having one in the home. And while 81% of gun owners say owning a gun makes them feel safer, a narrower majority (57%) of non-owners in gun households say the same about having a firearm at home. Non-owners are also more likely than owners to worry about having a gun in the home (27% vs. 12%, respectively).

Feelings about gun ownership also differ by political affiliation, even among those who personally own firearms. Republican gun owners are more likely than Democratic owners to say owning a gun gives them feelings of safety and enjoyment, while Democratic owners are more likely to say they worry about having a gun in the home.

Non-gun owners are split on whether they see themselves owning a firearm in the future. About half (52%) of Americans who don't own a gun say they could never see themselves owning one, while nearly as many (47%) could imagine themselves as gun owners in the future.

Among those who currently do not own a gun:

56% of men say they could see themselves owning a gun one day; 40% of women say the same.

61% of Republicans and 40% of Democrats who don't own a gun say they would consider owning one in the future.

56% of Black non-owners say they could see themselves owning a gun one day, compared with smaller shares of White (48%), Hispanic (40%) and Asian (38%) non-owners.

Americans are evenly split over whether gun ownership does more to increase or decrease safety. About half (49%) say it does more to increase safety by allowing law-abiding citizens to protect themselves, but an equal share say gun ownership does more to reduce safety by giving too many people access to firearms and increasing misuse.

Republicans and Democrats differ on this question: 79% of Republicans say that gun ownership does more to increase safety, while a nearly identical share of Democrats (78%) say that it does more to reduce safety.

Urban and rural Americans also have starkly different views. Among adults who live in urban areas, 64% say gun ownership reduces safety, while 34% say it does more to increase safety. Among those who live in rural areas, 65% say gun ownership increases safety, compared with 33% who say it does more to reduce safety. Those living in the suburbs are about evenly split.

Americans increasingly say that gun violence is a major problem. Six-in-ten U.S. adults say gun violence is a very big problem in the country today, up 9 percentage points from spring 2022.In the survey conducted this June, 23% say gun violence is a moderately big problem, and about two-in-ten say it is either a small problem (13%) or not a problem at all (4%).

Looking ahead, 62% of Americans say they expect the level of gun violence to increase over the next five years. This is double the share who expect it to stay the same (31%). Just 7% expect the level of gun violence to decrease.

A majority of Americans (61%) say it is too easy to legally obtain a gun in this country. Another 30% say the ease of legally obtaining a gun is about right, and 9% say it is too hard to get a gun. Non-gun owners are nearly twice as likely as gun owners to say it is too easy to legally obtain a gun (73% vs. 38%). Meanwhile, gun owners are more than twice as likely as non-owners to say the ease of obtaining a gun is about right (48% vs. 20%).

Partisan and demographic differences also exist on this question. While 86% of Democrats say it is too easy to obtain a gun legally, 34% of Republicans say the same. Most urban (72%) and suburban (63%) dwellers say it's too easy to legally obtain a gun. Rural residents are more divided: 47% say it is too easy, 41% say it is about right and 11% say it is too hard.

About six-in-ten U.S. adults (58%) favor stricter gun laws. Another 26% say that U.S. gun laws are about right, and 15% favor less strict gun laws. The percentage who say these laws should be stricter has fluctuated a bit in recent years. In 2021, 53% favored stricter gun laws, and in 2019, 60% said laws should be stricter.

About a third (32%) of parents with K-12 students say they are very or extremely worried about a shooting ever happening at their children's school, according to a fall 2022 Center survey of parents with at least one child younger than 18. A similar share of K-12 parents (31%) say they are not too or not at all worried about a shooting ever happening at their children's school, while 37% of parents say they are somewhat worried.

Among all parents with children under 18, including those who are not in school, 63% see improving mental health screening and treatment as a very or extremely effective way to prevent school shootings. This is larger than the shares who say the same about having police officers or armed security in schools (49%), banning assault-style weapons (45%), or having metal detectors in schools (41%). Just 24% of parents say allowing teachers and school administrators to carry guns in school would be a very or extremely effective approach, while half say this would be not too or not at all effective.

There is broad partisan agreement on some gun policy proposals, but most are politically divisive, the June 2023 survey found. Majorities of U.S. adults in both partisan coalitions somewhat or strongly favor two policies that would restrict gun access: preventing those with mental illnesses from purchasing guns (88% of Republicans and 89% of Democrats support this) and increasing the minimum age for buying guns to 21 years old (69% of Republicans, 90% of Democrats). Majorities in both parties also oppose allowing people to carry concealed firearms without a permit (60% of Republicans and 91% of Democrats oppose this).

Republicans and Democrats differ on several other proposals. While 85% of Democrats favor banning both assault-style weapons and high-capacity ammunition magazines that hold more than 10 rounds, majorities of Republicans oppose these proposals (57% and 54%, respectively).

Most Republicans, on the other hand, support allowing teachers and school officials to carry guns in K-12 schools (74%) and allowing people to carry concealed guns in more places (71%). These proposals are supported by just 27% and 19% of Democrats, respectively.

Gun ownership is linked with views on gun policies. Americans who own guns are less likely than non-owners to favor restrictions on gun ownership, with a notable exception. Nearly identical majorities of gun owners (87%) and non-owners (89%) favor preventing mentally ill people from buying guns.

Within both parties, differences between gun owners and non-owners are evident - but they are especially stark among Republicans. For example, majorities of Republicans who do not own guns support banning high-capacity ammunition magazines and assault-style weapons, compared with about three-in-ten Republican gun owners.

Among Democrats, majorities of both gun owners and non-owners favor these two proposals, though support is greater among non-owners.

Note: This is an update of a post originally published on Jan. 5, 2016.

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Six-in-ten U.S. adults say gun violence is a very big problem in the country today, up 9 percentage points from spring 2022.

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Gun Violence: Predictors, Prevention, and Policy

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Gun Violence: Predictors, Prevention, and Policy

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Although this website is dense (text is difficult), it does explore some common misconceptions about the causes of gun violence and provides statistics about the people who perpetrate gun crimes.

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Summary: Conclusions and Recommendations

Gun violence is an urgent, complex, and multifaceted problem. It requires evidence-based, multifaceted solutions. Psychology can make important contributions to policies that prevent gun violence. Toward this end, in February 2013 the American Psychological Association commissioned this report by a panel of experts to convey research-based conclusions and recommendations (and to identify gaps in such knowledge) on how to reduce the incidence of gun violence - whether by homicide, suicide, or mass shootings - nationwide.

Following are chapter-by-chapter highlights and short summaries of conclusions and recommendations of the report's authors. More information and supporting citations can be found within the chapters themselves.

Antecedents to Gun Violence: Developmental Issues

A complex and variable constellation of risk and protective factors makes persons more or less likely to use a firearm against themselves or others. For this reason, there is no single profile that can reliably predict who will use a gun in a violent act. Instead, gun violence is associated with a confluence of individual, family, school, peer, community, and sociocultural risk factors that interact over time during childhood and adolescence. Although many youths desist in aggressive and antisocial behavior during late adolescence, others are disproportionately at risk for becoming involved in or otherwise affected by gun violence. The most consistent and powerful predictor of future violence is a history of violent behavior. Prevention efforts guided by research on developmental risk can reduce the likelihood that firearms will be introduced into community and family conflicts or criminal activity. Prevention efforts can also reduce the relatively rare occasions when severe mental illness contributes to homicide or the more common circumstances when depression or other mental illness contributes to suicide. Reducing incidents of gun violence arising from criminal misconduct or suicide is an important goal of broader primary and secondary prevention and intervention strategies. Such strategies must also attend to redirecting developmental antecedents and larger sociocultural processes that contribute to gun violence and gun-related deaths.

Antecedents to Gun Violence: Gender and Culture

Any account of gun violence in the United States must be able to explain both why males are perpetrators of the vast majority of gun violence and why the vast majority of males never perpetrate gun violence. Preliminary evidence suggests that changing perceptions among males of social norms about behaviors and characteristics associated with masculinity may reduce the prevalence of intimate partner and sexual violence. Such interventions need to be further tested for their potential to reduce gun violence. The skills and knowledge of psychologists are needed to develop and evaluate programs and settings in schools, workplaces, prisons, neighborhoods, clinics, and other relevant contexts that aim to change gendered expectations for males that emphasize self-sufficiency, toughness, and violence, including gun violence.

What Works: Gun Violence Prediction and Prevention at the Individual Level

Although it is important to recognize that most people suffering from a mental illness are not dangerous, for those persons at risk for violence due to mental illness, suicidal thoughts, or feelings of desperation, mental health treatment can often prevent gun violence. Policies and programs that identify and provide treatment for all persons suffering from a mental illness should be a national priority. Urgent attention must be paid to the current level of access to mental health services in the United States; such access is woefully insufficient. Additionally, it should be noted that behavioral threat assessment is becoming a standard of care for preventing violence in schools, colleges, and the workplace and against government and other public officials. Threat assessment teams gather and analyze information to assess if a person poses a threat of violence or self-harm, and if so, take steps to intervene.

What Works: Gun Violence Prevention at the Community Level

Prevention of violence occurs along a continuum that begins in early childhood with programs to help parents raise emotionally healthy children and ends with efforts to identify and intervene with troubled individuals who are threatening violence. The mental health community must take the lead in advocating for community-based collaborative problem-solving models to address the prevention of gun violence. Such models should blend prevention strategies in an effort to overcome the tendency within many community service systems to operate in silos. There has been some success with community-based programs involving police training in crisis intervention and with community members trained in mental health first aid. These programs need further piloting and study so they can be expanded to additional communities as appropriate. In addition, public health messaging campaigns on safe gun storage are needed. The practice of keeping all firearms appropriately stored and locked must become the only socially acceptable norm.

What Works: Policies to Reduce Gun Violence

The use of a gun greatly increases the odds that violence will lead to a fatality: This problem calls for urgent action. Firearm prohibitions for high-risk groups - domestic violence offenders, persons convicted of violent misdemeanor crimes, and individuals with mental illness who have been adjudicated as being a threat to themselves or to others - have been shown to reduce violence. The licensing of handgun purchasers, background check requirements for all gun sales, and close oversight of retail gun sellers can reduce the diversion of guns to criminals. Reducing the incidence of gun violence will require interventions through multiple systems, including legal, public health, public safety, community, and health. Increasing the availability of data and funding will help inform and evaluate policies designed to reduce gun violence.

Gun violence is an important national problem leading to more than 31,000 deaths and 78,000 nonfatal injuries every year. Although the rate of gun homicides in the United States has declined in recent years, U.S. rates remain substantially higher than those of almost every other nation in the world and are at least seven times higher than those of Australia, Canada, France, Germany, India, Italy, Japan, South Korea, Spain, Sweden, the United Kingdom, and many others (see Alpers & Wilson).

Guns are not a necessary or sufficient cause of violence and can be used legally for a variety of sanctioned activities. Still, they are especially lethal weapons that are used in approximately two thirds of the homicides and more than half of all suicides in the United States. Every day in the United States, approximately 30 persons die of homicides and 53 persons die of suicides committed by someone using a gun (Centers for Disease Control and Prevention [CDC], 2013a). Guns also provide individuals with the capacity to carry out multiple-fatality shootings that inflict great trauma and grief on our society, and the public rightly insists on action to make our communities safer.

Gun violence demands special attention. At the federal level, President Barack Obama announced a new "Now Is the Time" plan (White House, 2013) to address firearm violence to better protect children and communities and issued 23 related executive orders to federal agencies. The importance of continued research to address firearm violence is reflected in the 2013 report of the Institute of Medicine (IOM) and the National Research Council (NRC) "Priorities for Research to Reduce the Threat of Firearm-Related Violence." This report calls for a public health approach that emphasizes the importance of accurate information on the number and distribution of guns in the United States, including risk factors and motivations for acquisition and use, the association between exposure to media violence and any subsequent perpetration of gun violence, and how new technology can facilitate prevention. The report also outlines a research agenda to facilitate programs and policies that can reduce the occurrence and impact of firearm-related violence in the United States.

Psychology can make an important contribution to policies that prevent gun violence. Rather than debate whether "people" kill people or "guns" kill people, a reasonable approach to facilitate prevention is that "people with guns kill people." The problem is more complex than simple slogans and requires careful study and analysis of the different psychological factors, behavioral pathways, social circumstances, and cultural factors that lead to gun violence. Whether prevention efforts should focus on guns because they are such a powerful tool for violence, on other factors that might have equal or greater impact, or on some combination of factors should be a scientific question settled by evidence.

Toward this end, the American Psychological Association (APA) commissioned this report, with three goals. First, this report is intended to focus on gun violence, recognizing that knowledge about gun violence must be related to a broader understanding of violence. Second, the report reviews what is known from the best current science on antecedents to gun violence and effective prevention strategies at the individual, community, and national levels. Finally, the report identifies policy directions, gaps in the literature, and suggestions for continued research that can help address unresolved questions about effective strategies to reduce gun violence. For over a decade, research on gun violence has been stifled by legal restrictions, political pressure applied to agencies not to fund research on certain gun-related topics, and a lack of funding. The authors of this report believe the cost of gun violence to our society is too great to allow these barriers to remain in place.

The Role of Mental Health and Mental Illness

An important focus of this report is the role that mental health and mental illness play in why individuals commit firearm-related violence and how this can inform preventive efforts. This focus undoubtedly brings to mind shootings such as those in Newtown, Conn., Aurora, Colo., and Tucson, Ariz. However, it is important to realize that mass fatality incidents of this type, although highly publicized, are extremely rare, accounting for one tenth of 1 percent of all firearm-related homicides in the United States (CDC, 2013a). Moreover, serious mental illness affects a significant percentage of the U.S. population, with prevalence estimates in the general population as high as 5 percent (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012). This is quite significant, given that the term serious mental illness is typically reserved for the most debilitating kinds of mental disorder, such as schizophrenia, bipolar disorder, and the most severe forms of depression, but can include other mental disorders that result in acute functional impairment.

Although many highly publicized shootings have involved persons with serious mental illness, it must be recognized that persons with serious mental illness commit only a small proportion of firearm-related homicides; the problem of gun violence cannot be resolved simply through efforts focused on serious mental illness (Webster & Vernick, 2013a). Furthermore, the overwhelming majority of people with serious mental illness do not engage in violence toward others and should not be stereotyped as dangerous (Sirotich, 2008).

It also is important to recognize that for the small proportion of individuals whose serious mental illness does predispose them to violence, there are significant societal barriers to treatment. Psychiatric hospitalization can be helpful, but treatment can be expensive, and there may not be appropriate follow-up services in the community. Civil commitment laws, which serve to protect individuals from being unreasonably detained or forced into treatment against their will, can also prevent professionals from treating someone who does not recognize his or her need for treatment.

Other kinds of mental disorders that do not rise to the level of serious mental illness also are associated with gun violence and criminal behavior generally. For example, conduct disorder and antisocial personality disorder are associated with increased risk for violence. (This link is not surprising because violent behavior is counted as one of the symptoms that helps qualify someone for the diagnosis.) Nevertheless, there are well-established, scientifically validated mental health treatment programs for individuals with these disorders, such as multisystemic therapy, that can reduce violent recidivism (Henggeler, 2011). Substance abuse is another form of mental disorder that is a risk factor for violence in the general population and also increases the risk for violence among persons with serious mental illness (Van Dorn, Volavka, & Johnson, 2012).

These observations reflect the complexity of relationships among serious mental illness, mental disorders, and violence. In contrast to homicide, suicide accounts for approximately 61 percent of all firearm fatalities in the United States (CDC, 2013a), and more than 90 percent of persons who commit suicide have some combination of depression, symptoms of other mental disorders, and/or substance abuse (Moscicki, 2001). This suggests that mental health and mental illness are especially relevant to understanding and preventing suicide, the leading type of firearm-related death.

Prediction and Prevention

The prediction of an individual's propensity for violence is a complex and challenging task for mental health professionals, who often are called upon by courts, correctional authorities, schools, and others to assess the risk of an individual's violence. Mental health professionals are expected to take action to protect potential victims when they judge that their patient or client poses a danger to others. However, decades of research have established that there is only a moderate ability to identify individuals likely to commit serious acts of violence. Much depends on the kind of violence and the time frame for prediction. For example, there are specialized instruments for the assessment of violence risk among sex offenders, civilly committed psychiatric patients, and domestic violence offenders. However, the time frame and focus for these predictions often are broadly concerned with long-term predictions that someone will ever be violent with anyone rather than whether a person will commit a particular act of targeted violence.

Research has moved the field beyond the assessment of "dangerousness" as a simple individual characteristic applicable in all cases to recognize that predictive efforts must consider a range of personal, social, and situational factors that can lead to different forms of violent behavior in different circumstances. Moreover, risk assessment has expanded to include concepts of risk management and interventions aimed at reducing risk.

In making predictions about the risk for mass shootings, there is no consistent psychological profile or set of warning signs that can be used reliably to identify such individuals in the general population. A more promising approach is the strategy of behavioral threat assessment, which is concerned with identifying and intervening with individuals who have communicated threats of violence or engaged in behavior that clearly indicates planning or preparation to commit a violent act. A threat assessment approach recognizes that individuals who threaten targeted violence are usually troubled, depressed, and despondent over their circumstances in life. A threat assessment leads to interventions intended to reduce the risk of violence by taking steps to address the problem that underlies the threatening behavior. Such problems can range from workplace conflicts to schoolyard bullying to serious mental illness. One of the most influential threat assessment models was developed by the U.S. Secret Service (Fein et al., 2002; Vossekuil, Fein, Reddy, Borum, & Modzelski, 2002) and has been adapted for use in schools, colleges, business settings, and the U.S. military.

The limited ability to make accurate predictions of violence has led some to question whether prevention is possible. This is a common misconception, because prevention does not require prediction of a specific individual's behavior. For example, public health campaigns have reduced problems ranging from lung cancer to motor vehicle accidents by identifying risk factors and promoting safer behaviors even though it is not possible to predict whether a specific individual will develop lung cancer or have a motor vehicle accident (Mozaffarian, Hemenway, & Ludwig, 2013). A substantial body of scientific evidence identifies important developmental, familial, and social risk factors for violence. In addition, an array of rigorously tested psychological and educational interventions facilitate healthy social development and reduce aggressive behavior by teaching social skills and problem-solving strategies. It is important that policymakers and stakeholders recognize the value of prevention.

Prevention measures also should be distinguished from security measures and crisis response plans. Prevention must begin long before a gunman comes into a school or shopping center. Prevention efforts are often conceptualized as taking place on primary, secondary, and tertiary levels:

Primary prevention (also called universal prevention) consists of efforts to promote healthy development in the general population. An example would be a curriculum to teach all children social skills to resist negative peer influences and resolve conflicts peacefully.

Secondary prevention (also called selective prevention) involves assistance for individuals who are at increased risk for violence. Mentoring programs and conflict-mediation services are examples of such assistance.

Tertiary prevention (also called indicated prevention) consists of intensive services for individuals who have engaged in some degree of aggressive behavior and could benefit from efforts to prevent a recurrence or escalation of aggression. Programs to rehabilitate juvenile offenders are examples.

Throughout this report, we discuss evidence-based prevention programs relevant to the issue of firearm-related violence.

Research can help us understand and prevent gun violence. The psychological research summarized in this report can inform public policy and prevention efforts designed to promote public safety and reduce violence. Gun violence is not a simple, discrete category of crime; it shares characteristics with other forms of violence, and it can be a product of an array of cultural, social, psychological, and situational factors. Nevertheless, there is valuable psychological knowledge that can be used to make our communities safer.

Antecedents to Gun Violence: Developmental Issues

Youth gun violence is often sensationalized and misunderstood by the general public, in part because of increasingly public acts of violence and related media coverage (Snyder & Sickmund, 2006; Williams, Tuthill, & Lio, 2008). In truth, only a small number of juvenile offenders commit the majority of violent juvenile crimes in the United States (Williams et al., 2008). Most juvenile offenders commit "nonperson" offenses, usually in terms of property and technical (parole) violations (Sickmund, Sladky, Kang, & Puzzanchera, 2011). For example, in 2010, the majority of juvenile offenses were nonperson offenses such as property offenses (27.2 percent), drug offenses (8.4 percent), public order offenses (10.7 percent), technical violations (14.4 percent), and status offenses (4.6 percent) - that is, crimes defined by minor (under age 18) status, such as alcohol consumption, truancy, and running away from home (Sickmund et al., 2011). Additionally, young adults between the ages of 18 and 34 are the most likely to commit violent crimes like homicide and to do so using a gun, compared with individuals under 18 (Cooper & Smith, 2011).

A subgroup of youth is particularly vulnerable to violence and victimization. Minority males constitute a disproportionate number of youths arrested and adjudicated, with 60 percent of all arrested youths identifying as part of a racial/ethnic minority group (Sickmund et al., 2011). Males also outnumber females in arrest rates for every area except status offenses and technical violations. Urban African American males are at substantially greater risk for involvement in gun-related homicides as perpetrators and as victims (CDC, 2013a; Spano, Pridemore, & Bolland, 2012). However, the majority of the infrequent but highly publicized shootings with multiple fatalities, such as those at Sandy Hook Elementary School or the Aurora, Colo., movie theater, have been committed by young White males.

This presents a picture of a small number of youths and young adults who are at an increased risk for involvement in gun violence. In the United States, these youths are somewhat more likely to be males of color growing up in urban areas. But it also is important to understand that most young males of all races and ethnicities - and most people in general - are not involved in serious violence and do not carry or use guns inappropriately.

How did this small subset of youths and young adults come to be involved in serious gun violence? Is there a "cradle-to-prison" pipeline, particularly for youths of color living in poverty and in disadvantaged urban areas, that triggers a cascade of events that increase the likelihood of gun violence (Children's Defense Fund, 2009)? A developmental perspective on antecedents to youth gun violence can help us design more effective prevention programs and strategies.

This chapter describes the biological and environmental risk factors that begin early in development and continue into adolescence and young adulthood. Developmental studies that link children's aggressive behavior to more serious involvement in the criminal justice system suggest the accumulation and interaction of many risks in multiple contexts (Dodge, Greenberg, Malone, & Conduct Problems Prevention Research Group, 2008; Dodge & Pettit, 2003). There is no single biological predisposition, individual trait, or life experience that accounts for the development and continuity of violent behavior or the use of guns. Rather, violence is associated with a confluence of individual, family, school, peer, community, and sociocultural risk factors that interact over time during childhood and adolescence (Brennan, Hall, Bor, Najman, & Williams, 2003; Dodge & Pettit, 2003). Risk for gun violence involves similar risk processes, although the complexity and variability of individuals means there is no meaningful profile that allows reliable prediction of who will eventually engage in gun violence. Nevertheless, developmental factors beginning in utero may increase the risk of aggressive behavior and lead to gun violence - especially when guns are readily available and part of an aggressive or delinquent peer culture.

Early-Onset Aggression

Early onset of aggressive behavior significantly increases risk for later antisocial behavior problems. The most consistent and powerful predictor of future violence is a history of violent behavior, and risk increases with earlier and more frequent incidents. Longitudinal work has shown that having a first arrest between 7 and 11 years of age is associated with patterns of long-term adult offending (Loeber, 1982). Children who are highly aggressive throughout childhood and continue to have serious conduct problems during adolescence have been identified as "life-course persistent" (LCP) youths (Moffitt, 1993). Examining longitudinal data from a large birth cohort in New Zealand, Moffitt (1993) created a taxonomy of antisocial behavior that differentiates LCP youths from an "adolescence-limited" subgroup. The latter subgroup characterizes those who engage in antisocial behaviors during adolescence and usually desist by adulthood. By contrast, LCP youths display more severe early aggression in childhood and develop a pattern of chronic violence during adolescence and into adulthood.

Both biological and environmental risks during prenatal development, infancy, and early childhood contribute to the development of early-onset aggression and the LCP developmental trajectory (Brennan et al., 2003; Dodge & Pettit, 2003; Moffitt, 2005). Pre- and postnatal risks associated with early-onset aggression include maternal substance abuse during pregnancy, high levels of prenatal stress, low birth weight, birth complications and injuries (especially those involving anoxia), malnutrition, and exposure to environmental toxins like lead paint (Brennan et al., 2003; Dodge & Pettit, 2003). According to Moffitt (1993), these early developmental risks disrupt neural development and are associated with neuropsychological deficits, particularly in executive functioning and verbal abilities.

Along with neuropsychological deficits, poor behavioral control and a difficult temperament are associated with the development of early-onset aggression (Dodge & Pettit, 2003; Moffitt, 1993). Children with difficult temperaments are typically irritable, difficult to soothe, and highly reactive. These patterns of behavior often trigger negative and ineffective reactions from parents and caregivers that can escalate into early aggressive behavior (Dodge & Pettit, 2003; Wachs, 2006). Family influences, such as familial stress and negative parent-child interactions, can interact with a child's individual characteristics, leading to increased aggressive behavior during childhood.

Family Influences

Highly aggressive children who engage in serious acts of violence during later childhood and adolescence also are exposed to continued environmental risks throughout development (Dodge et al., 2008). The family context has been found to be quite influential in the development and continuity of antisocial behavior. Particularly for early-onset aggressive youths raised in families that are under a high degree of environmental stress, aggressive child behavior and negative parenting practices interact to amplify early-onset aggression. Examples of family risk factors include low parent-child synchrony and warmth, poor or disrupted attachment, harsh or inconsistent discipline (overly strict or permissive), poor parental monitoring, the modeling of antisocial behavior, pro-violent attitudes and criminal justice involvement, and coercive parent-child interaction patterns (Dodge & Pettit, 2003; Farrington, Jolliffe, Loeber, Stouthamer-Loeber, & Kalb, 2001; Hill, Howel, Hawkins, & Battin-Pearson, 1999; Patterson, Forgatch, & DeGarmo, 2010).

Coercive parent-child interactions have been associated with the emergence of aggressive behavior problems in children (Patterson et al., 2010). In these interactions, children learn to use coercive behaviors such as temper tantrums to escape parental discipline. When parents acquiesce to these negative behaviors, they inadvertently reward children for coercive behaviors, reinforcing the idea that aggression or violence is adaptive and can be used instrumentally to achieve goals. These interaction patterns tend to escalate in their severity (e.g., from whining, to temper tantrums, to hitting, etc.) and frequency, leading to increased aggression and noncompliance (Patterson et al., 2010). Such behaviors also generalize across contexts to children's interactions with others outside the home, including with teachers, other adults, and peers. Indeed, prevention research has shown that intervening with at-risk families to improve parenting skills can disrupt the pathway from early-onset aggressive behavior to delinquency in adolescence (Patterson et al., 2010).

Other family risk factors for youths with early predispositions to aggression may be especially relevant to increased risk for gun violence. For instance, research has shown that many families with children own firearms and do not keep them safely stored at home (Johnson, Miller, Vriniotis, Azrael, & Hemenway, 2006). Although keeping firearms at home is not a direct cause of youth gun violence, the rates of suicides, homicides, and unintentional firearm fatalities are higher for 5-14-year-olds who live in states or regions in which rates of gun ownership are more prevalent (Miller, Azrael, & Hemenway, 2002). Poor parental monitoring and supervision, which are more general risk factors for involvement in aggression and violent behaviors (Dodge et al., 2008), may be especially salient in risk for gun violence. For example, impulsive or aggressive children who are often unsupervised and live in a home with access to guns may be at risk.

The family also is an important context for socialization and the development of normative beliefs or perceptions about appropriate social behavior that become increasingly stable during early development and are predictive of later behavior over time (Huesmann & Guerra, 1997). These beliefs shape an individual's social-cognitive understanding about whether and under what circumstances threatened or actual violence is justified. Children who develop beliefs that aggression is a desirable and effective way to interact with others are more likely to use coercion and violence instrumentally to achieve goals or solve problems (Huesmann & Guerra, 1997). Antisocial attitudes and social-cognitive distortions (e.g., problems in generating nonviolent solutions, misperceiving hostile/aggressive intent by others, justifying acts of violence that would be criminal) can also increase risk for violence (Borum & Verhaagen, 2006; Dodge & Pettit, 2003).

Families can play a role in establishing and maintaining normative beliefs about violence and gun usage. For example, pro-violence attitudes and the criminality of parents and siblings during childhood have been found to predict adolescent gang membership and delinquency (Farrington et al., 2001; Hill et al., 1999). Youths from families that encourage the use of guns for solving problems also may be exposed to such attitudes in other contexts (in communities, with peers, and in the media) and may perceive firearms to be an appropriate means to solve problems and protect themselves.

School and Peer Influences

The school setting is another important context for child socialization. Children who enter school with high levels of aggressive behavior, cognitive or neurobiological deficits, and poor emotional regulation may have difficulty adjusting to the school setting and getting along with peers (Dodge et al., 2008; Dodge & Pettit, 2003). Highly aggressive children who have learned to use aggression instrumentally at home will likely use such behavior with teachers, increasing the chances that they will have poor academic experiences and low school engagement (Patterson et al., 2010). Academic failure, low school interest, truancy, and school dropout are all correlated with increased risk for problem behavior and delinquency, including aggression and violence (Dodge & Pettit, 2003). This risk is strongest when poor academic achievement begins in elementary school and contributes to school underachievement and the onset of adolescent problem behaviors, such as substance use and drug trafficking, truancy, unsafe sexual activity, youth violence, and gang involvement (Dodge et al., 2008; Guerra & Bradshaw, 2008).

Involvement in these risk behaviors also is facilitated by affiliation with deviant peers, particularly during adolescence (Dodge et al., 2008). Research has shown that children who are aggressive, victimized, and academically marginalized from the school setting may suffer high levels of peer rejection that amplify preexisting aggressive behaviors (Dodge et al., 2008; Dodge & Pettit, 2003). Longitudinal work indicates that experiences of academic failure, school marginalization, and peer rejection interact to produce affiliations with similarly rejected, deviant, and/or gang-involved peers. Friendships between deviant peers provide youths with "training" in antisocial behaviors that reinforce and exacerbate preexisting aggressive tendencies (Dishion, Véronneau, & Meyers, 2010; Dodge et al., 2008). Peer deviancy training is a primary mechanism in the trajectory from overt, highly aggressive behaviors during childhood to more covert processes during adolescence, such as lying, stealing, substance use, and weapon carrying (Dishion et al., 2010; Patterson et al., 2010).

The larger school context also can interact with youths' experiences of academic failure, peer rejection, and deviant peer affiliations to influence the continuity of antisocial behavior. Poorly funded schools located in low-income neighborhoods have fewer resources to address the behavioral, academic, mental health, and medical needs of their students. In addition, these schools tend to have stricter policies toward discipline, are less clinically informed about problem behaviors, and have stronger zero tolerance policies that result in more expulsions and suspensions (Edelman, 2007). This contextual factor is important, as youths who are attending and engaged in school are less likely to engage in delinquent or violent behavior, whereas marginalized and rejected youths, particularly in impoverished schools, are at increased risk for aggression and violence at school and in their communities. Schools that provide safe environments that protect students from bullying or criminal victimization support student engagement, reduce incidents of student conflict that could result in volatile or violent behavior, and diminish risks that students will bring weapons to school.

Although few homicides (< 2 percent) and suicides occur at school or during transportation to and from school (Roberts, Zhang, & Truman, 2012) and widely publicized mass school shootings are rare, research indicates that a small number of students do carry guns or other weapons. In 2011, 5.1 percent of high school students in Grades 9-12 reported carrying a gun in the 30 days prior to the survey, and 5.4 percent of students had carried a weapon (gun, knife, or club) on school grounds at least once in the 30 days prior to the survey (Eaton et al., 2012). Studies show that youths who carry guns are more likely to report involvement in multiple problem behaviors, to be affiliated with a gang, to overestimate how many of their peers carry guns, and to have a high need for interpersonal safety. For instance, student reports of involvement in and exposure to risk behaviors at school such as physical fighting, being threatened, using substances, or selling drugs on school grounds have been positively correlated with an increased likelihood of carrying weapons to school (Furlong, Bates, & Smith, 2001).

In another study of high school students, 5.5 percent of urban high school students reported that they carried a gun in the year prior to the study, but students estimated that 32.6 percent of peers in their neighborhoods carried guns, a substantial overestimation of the actual gun-carrying rates. Lawful, supervised gun carrying by juveniles is not the concern of this line of research; however, when unsupervised youths carry guns in high-violence neighborhoods, they may be more likely to use guns to protect themselves and resolve altercations. Gun-carrying youths in this study had higher rates of substance use, violence exposure, gang affiliation, and peer victimization (Hemenway, Vriniotis, Johnson, Miller, & Azrael, 2011). Additionally, many gun-carrying youths had lower levels of perceived interpersonal safety (Hemenway et al., 2011). Research has also revealed that deviant peer group affiliations during specific periods of adolescent development may increase the risk for gun violence. For example, research findings have shown that gang membership in early adolescence is significantly associated with increased gun carrying over time. This changes somewhat in late adolescence and young adulthood, when gun carrying is linked more to involvement in drug dealing and having peers who illegally own guns (Lizotte, Krohn, Howell, Tobin, & Howard, 2000).

Communities Matter

The community context is an additional source of risk for the development and continuity of antisocial behavior. Living in extremely disadvantaged, underresourced communities with high levels of crime and violence creates serious obstacles to healthy development. Recent estimates show that currently in the United States, 16.4 million children live in poverty and 7.4 million of those live in extreme poverty (i.e., an annual income of less than half of the federal poverty level; Children's Defense Fund, 2012). One in four children under 5 years of age is poor during the formative years of brain development. In addition, 22 percent of children who have lived in poverty do not graduate from high school, compared with 6 percent of children who have never been poor (Children's Defense Fund, 2012). For families and youths, living in poverty is associated with high levels of familial stress, poor child nutrition, elevated risks of injury, and limited access to adequate health care (Adler & Steward, 2010; Patterson et al., 2010). Ethnic minority youth in the United States are overrepresented in economically struggling communities. These environmental adversities can, in turn, compromise children's health status and functioning in other environments and increase the risk for involvement in violent behaviors, contributing significantly to ethnic and cultural variations in the rates of violence (Borum & Verhaagen, 2006).

In a community context, the degree to which children have access to adequate positive resources (e.g., in terms of health, finances, nutrition, education, peers, and recreation), have prosocial and connected relationships with others, and feel safe in their environment can significantly affect their risk for involvement in violent behaviors. Aggressive children and adolescents who are living in neighborhoods with high levels of community violence, drug and firearm trafficking, gang presence, and inadequate housing may have increased exposure to violence and opportunities for involvement in deviant behavior. Compared with communities that have better resources, disenfranchised and impoverished communities may also lack social, recreational, and vocational opportunities that contribute to positive youth development. Youths with high levels of preexisting aggressive behavior and emerging involvement with deviant or gang-involved peers may be especially at risk for increased violent behavior and subsequent criminal justice involvement when exposed to impoverished and high-crime communities.

Exposure to violence in one's community, a low sense of community safety, unsupervised access to guns, and involvement in risky community behaviors such as drug dealing all contribute to youths' involvement in gun carrying and gun violence. Decreased community perceptions of neighborhood safety and higher levels of social (e.g., loitering, public substance use, street fighting, prostitution, etc.) and physical (e.g., graffiti, gang signs, and discarded needles, cigarettes, and beer bottles) neighborhood disorder have been associated with increased firearm carrying among youths (Molnar, Miller, Azrael, & Buka, 2004). A study of African American youths living in poverty found that those who had been exposed to violence prior to carrying a gun were 2.5 times more likely than nonexposed youths to begin carrying a gun at the next time point, even when controlling for gang involvement (Spano et al., 2012). This study also indicated that after exposure to violence, youths were more likely to start carrying guns in their communities (Spano et al., 2012).

Studies have shown that apart from characteristics like conduct problems and prior delinquency, youths who are involved in gang fighting and selling drugs are also more likely to use a gun to threaten or harm others (e.g., Butters, Sheptycki, Brochu, & Erikson, 2011). Involvement in drug dealing in one's community appears to be particularly risky for gun carrying during later adolescence and early adulthood, possibly due to an increased need for self-protection (Lizotte et al., 2000). Taken together, these studies show that firearm possession may be due to interactions between the need for self-protection in violent communities and increased involvement in delinquent behaviors.

Sociocultural Context: Exposure to Violent Media

Child and adolescent exposure to violent media, a more distal, sociocultural influence on behavior, is also important when considering developmental risks for gun violence. Decades of experimental, cross-sectional, and longitudinal research have documented that exposure to violent media, in movies and television, is associated with increased aggressive behaviors, aggressive thoughts and feelings, increased physiological arousal, and decreased prosocial behaviors (e.g., Anderson et al., 2003; Anderson & Bushman, 2001; Huesmann, 2010; Huesmann, Moise-Titus, Podolski, & Eron, 2003). In light of ongoing advances in technology, research has been expanded to include violent content in video games, music, social media, and the Internet (Anderson et al., 2010; IOM & NRC, 2013).

Findings on associations between violent media exposure and aggressive behavior outcomes have held across differences in culture, gender, age, socioeconomic status, and intellect (e.g., Anderson et al., 2010; Huesmann et al., 2003). Social-cognitive theory on violent media exposure suggests that these images are part of children's socialization experiences, similar to violence exposure in interpersonal and community contexts (Huesmann, 2010). The viewing of violent images can serve to desensitize children to violence and normalize violent behavior, particularly when children have previously developed beliefs that aggression and violence are an acceptable means of achieving goals or resolving conflicts.

It is important to note that the link between violent media exposure and subsequent violent behaviors does not demonstrate a direct causal effect but instead shows how some children may be more susceptible to this risk factor than others. For instance, Huesmann et al. (2003) found that identification with aggressive characters on television and the perception that television violence was real were robust predictors of later aggression over time. Additionally, there is no established link between violent media exposure and firearm usage in particular. However, given the substantial proportion of media that includes interactions around firearms (e.g., in video games, movies, and television shows), the IOM and NRC (2013) recently identified a crucial need to examine specific associations between exposure to violent media and use of firearms. Exposure to violent media, especially for youths with preexisting aggressive tendencies and poor parental monitoring, may be an important contextual factor that amplifies risk for violent behavior and gun use.

Summary and Conclusions

The relatively small number of youths most likely to persist in serious acts of aggression (including increased risk of gun violence) have often experienced the following:

Early childhood onset of persistent rule-breaking and aggression

Socialization into criminal attitudes and behaviors by parents and caretakers who themselves are involved in criminal activities

Exposure in childhood to multiple adverse experiences in their families and communities

Social dislocation and reduced opportunities due to school failure or underachievement

Persisting affiliation with deviant peers or gangs engaged in delinquent/criminal misconduct and with attitudes and beliefs that support possession and use of guns

Broad exposure to sociocultural influences such as mass media violence and depictions of gun violence as an effective means of achieving goals or status

Most youths - even those with chronic and violent delinquent misconduct - desist in aggressive and antisocial behavior during late adolescence, and no single risk factor is sufficient to generate persisting violent behavior. Still, many are disproportionately at risk for becoming perpetrators or victims of gun violence. Homicide remains the second leading cause of death for teens and young adults between the ages of 15 and 24. In 2010, there were 2,711 infant, child, and adolescent victims of firearm deaths. In that year, 84 percent of homicide victims between the ages of 10 and 19 were killed with a firearm, and 40 percent of youths who committed suicide between the ages 15 and 19 did so with a gun (CDC, 2013a). ¹

There is no one developmental trajectory that specifically leads to gun violence. However, prevention efforts guided by research on developmental risk can reduce the likelihood that firearms will be introduced into community and family conflicts or criminal activity. Prevention efforts can also reduce the relatively rare occasions when severe mental illness contributes to homicide or the more common circumstances when depression or other mental illness contributes to suicide.

Reducing incidents of gun violence arising from criminal misconduct or suicide is an important goal of broader primary and secondary prevention and intervention strategies. Such strategies must also attend to redirecting developmental antecedents and larger sociocultural processes that contribute to gun violence and gun-related deaths.

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Antecedents to Gun Violence: Gender and Culture

Any account of gun violence in the United States must consider both why males are the perpetrators of the vast majority of gun violence and why the vast majority of males never perpetrate gun violence. An account that explains both phenomena focuses, in part, on how boys and men learn to demonstrate and achieve manhood through violence, as well as the differences in opportunities to demonstrate manhood among diverse groups of males. Although evidence exists for human biological and social-environmental systems interacting and contributing to aggressive and violent behavior, this review focuses on the sociocultural evidence that explains males' higher rates of gun violence.

Reducing the propensity for some males to engage in violence will involve both social and cultural change. Hence, this section reviews existing research on the relationships between sex, gender (i.e., masculinity), and the perpetration and victimization of gun violence in the United States. The intersection of gender, race/ethnicity, and economic disadvantage is also considered in explaining the rates of gun violence across diverse communities. Finally, the relationships between masculinity, gender socialization, and gun violence are analyzed to identify gender-related risk factors for gun violence that can be targeted for prevention strategies and social policy.

Sex Differences in Gun Violence

Prevalence and Risk
Men represent more than 90 percent of the perpetrators of homicide in the United States and are also the victims of the large majority (78 percent) of that violence (Bureau of Justice Statistics, 2008; Federal Bureau of Investigation [FBI], 2007). Homicide by gun is the leading cause of death among Black youth, the second leading cause of death among all male youth, and the second or third leading cause of death among female youth (depending on the specific age group) (e.g., Miniño, 2010; Webster, Whitehill, Vernick, & Curriero, 2012). In addition, roughly four times as many youths visit hospitals for gun-induced wounds as are killed each year (CDC, 2013a).

Even more common than homicide, suicide is another leading cause of death in the United States, and most suicides are completed with a firearm. Males complete the large majority of suicides; depending on the age group, roughly four to six times as many males as females kill themselves with firearms (CDC, 2013a). Among youth, suicide ranks especially high as a cause of death. It is the third leading cause of death of 15-24-year-olds and the sixth leading cause of death for 5-14-year-olds. However, the rate of suicide and firearm suicide gradually increases over the lifespan. In addition to gender and age differences in prevalence, sizable differences also exist among ethnic groups. Firearm suicide generally is at least twice as high among Whites than among Blacks and other racial groups from 1980 to 2010 (CDC, 2013a), and White males over the age of 65 have rates that far exceed all other major groups.

Perpetrator-Victim Relationship and Location
The prevalence of gun violence strongly depends not only on the sex of the offender but also on the offender's relationship to the victim and the location of the violence (Sorenson, 2006). Both men and women are more likely to be killed with firearms by someone they know than by a stranger. Specifically, men are most likely to be killed in a public place by an acquaintance, whereas women are most likely to be killed in the home by a current or former spouse or dating partner (i.e., "intimate partner"). Women compared with men are especially likely to be killed by a firearm used by an intimate partner.

Women are killed by current or former intimate partners four to five times more often than men (Campbell, Glass, Sharps, Laughon, & Bloom, 2007), including by firearm. These sex differences in victimization do not appear to hold in the limited data available on same-sex intimate partner homicide; it is more common for men to kill their male partners than for women to kill their female partners (Campbell et al., 2007). Notably, these sex differences in gun violence, as a function of the type of perpetrator-victim relationships, are also found in nonfatal gun violence when emergency room visits are examined (Wiebe, 2003).

A disproportionate number of gun homicides occur in urban areas. Conversely, a disproportionate number of firearm suicides occur in rural (compared with urban) areas (Branas, Nance, Elliott, Richmond, & Schwab, 2004). Although they are highly publicized, less than 2 percent of the homicides of children occur in schools (Borum, Cornell, Modzeleski, & Jimerson, 2010; CDC, 2008, 2013b). There are even fewer "random" or "mass" school shootings in which multiple victims are killed at the same time.

Gun Access and Possession
A person must own or obtain a gun to be able to commit gun violence. Research shows that there are sex differences in access to and carrying a gun. Males are roughly two to four times as likely as females to have access to a gun in the home or to possess a gun (Swahn, Hamming, & Ikeda, 2002; Vaughn et al., 2012). In turn, gun carrying is a key risk factor for gun violence perpetration and victimization. For example, gun carrying is associated with dating violence victimization among adolescents, with boys more likely to be victimized than girls (Yan, Howard, Beck, Shattuck, & Hallmark-Kerr, 2010).

Conclusions based on sex differences in access to guns should be drawn with some caution, given that there also appear to be sex differences in the reporting of guns in the home. Men report more guns in the home than do women from the same household (e.g., Ludwig, Cook, & Smith, 1998; Sorenson & Cook, 2008), a sex difference that appears to stem specifically from the substantially higher level of contact with and experience in handling and using guns among boys than girls in the same household (Cook & Sorenson, 2006). Nonetheless, the presence of guns in the home remains predictive of gun violence.

Gender and Gun Violence

Robust sex and race differences in firearm violence have been established. Examined next is how the socialization of men as well as differences in living conditions and opportunities among diverse groups of boys and men help explain why these differences occur.

Making Gender Visible in the Problem of Gun Violence
Gender remains largely invisible in research and media accounts of gun violence. In particular, gender is not used to explain the problem of "school shootings," despite the fact that almost every shooting is perpetrated by a young male. Newspaper headlines and articles describe "school shooters," "violent adolescents," and so forth, but rarely call attention to the fact that nearly all such incidents are perpetrated by boys and young men. Studies of risk factors for school shootings may refer accurately to the perpetrators generally as "boys" but largely fail to analyze gender (e.g., Verlinden, Hersen, & Thomas, 2000).

The large sex differences in gun violence should not be overlooked simply because the vast majority of boys and men do not perpetrate gun violence or excused as "boys will be boys." The size of sex differences in the prevalence of gun violence differs substantially within regions of the United States (Kaplan & Geling, 1998) and across countries (e.g., Ahn, Park, Ha, Choi, & Hong, 2012), which further suggests that gender differences in sociocultural environments are needed to explain sex differences in gun violence.

Masculinity, Power, and Guns
Status as a "man" is achieved by the display of stereotypically masculine characteristics, without which one's manhood is contested. Although the particular characteristics defining manhood and the markers of them can vary across subcultural contexts (Connell, 1995), masculinity has, historically, generally been defined by aggressive and risk-taking behavior, emotional restrictiveness (particularly the vulnerable emotions of fear and sadness, and excepting anger), heterosexuality, and successful competition (Brannon, 1976; Kimmel, 1994; O'Neil, 1981). Such normative characteristics of traditional masculinity are in turn directly related to numerous factors that are associated with gun violence. For example, risk taking is associated with adolescent males' possession of and access to guns (Vittes & Sorenson, 2006).

Social expectations and norms, supported by social and organizational systems and practices, privilege boys who reject or avoid in themselves anything stereotypically feminine, act tough and aggressive, suppress emotions (other than anger), distance themselves emotionally and physically from other men, and strive competitively for power. Men of color, poor men, gay men, and men from other marginalized groups differ substantially in their access to opportunities to fulfill these manhood ideals and expectations in socially accepted ways. For example, men with less formal educational and economic opportunity, who in the United States are disproportionately Black and Latino, cannot fulfill expectations to be successful breadwinners in socially acceptable ways (e.g., paid, legal employment) as easily as White men, and gay men have less ability to demonstrate normative heterosexual masculinity where they cannot legally marry or have children.

At the same time, higher levels of some forms of violence victimization and perpetration (including suicide) are found among these disadvantaged groups. For example, gay youth are more likely than heterosexual males to commit suicide, and African American male youth are disproportionately the victims of gun violence. Such structural discrimination can be seen reflected in implicit cognitive biases against these group members. Virtual simulations of high-threat incidents, such as those used to train police officers, reliably demonstrate a "shooter bias" in which actors are more likely to shoot Black male targets than those from other race-gender groups (i.e., Black women, White men, and White women) (Plant, Goplen, & Kunstman, 2011).

Even to the extent that it is achieved, manhood status is theorized as precarious, needing to be protected and defended through aggression and violence, including gun violence, in order to avoid victimization from (mostly) male peers (Connell, 1995). Paradoxically, as in all competition, the more convincingly manhood is achieved, the more vulnerable it becomes to challenges or threats and thus requires further defending, often with increasing levels and displays of toughness and violence. The dynamic of these expectations of manhood and their enforcement is like a tight box (Kivel, 1998). Boys and men are either trapped inside this box or, in violating the expectations by stepping out of the box, risk being targeted by threats, bullying, and other forms of violence.

Adherence to stereotypic masculinity, in turn, is commonly associated with stress and conflict, poor health, poor coping and relationship quality, and violence (Courtenay 2000; Hong, 2000). Men's gender role stress and conflict are directly associated with various forms of interpersonal aggression and violence, including the perpetration of intimate partner violence and suicide (Feder, Levant, & Dean, 2010; Moore & Stuart, 2005; O'Neil, 2008). Men with more restricted emotionality and more restricted affection with other men are more likely to be aggressive, coercive, or violent (O'Neil, 2008). These dimensions of masculinity also are related to a number of other harmful behaviors that are, in turn, associated directly with gun violence and other forms of aggression (see O'Neil, 2008, for a review). For example, the effect of alcohol consumption on intimate partner violence is greater among men than women (Moore, Elkins, McNulty, Kivisto, & Handsel, 2011), and alcohol consumption may be associated with lethal male-to-male violence at least partly because it is associated with carrying a gun (Phillips, Matusko, & Tomasovic, 2007).

In addition, accumulating research evidence indicates a relationship between gender and many of the factors that are associated with suicide (e.g., substance abuse, unemployment; Payne, Swami, & Stanistreet, 2008). Beliefs in traditional masculinity are related to suicidal thoughts, although differently across age cohorts (Hunt, Sweeting, Keoghan, & Platt, 2006). Men's historic role as economic providers in heterosexual families typically ends with their retirement from the workforce. Suicide rates, including firearm suicide, increase dramatically at precisely this point in the life course (i.e., age 65 and older), whereas they decrease among women this age. The increase in suicide rates among White men at age 65 and older does not occur among Black men, who as a group have much higher levels of unemployment throughout their lives and consequently may not experience the same sense of loss of meaning or entitlement. Male firearm suicide also increases dramatically in adolescence and early adulthood, precisely the years during which young men's sense of manhood is developing.

Beliefs about gender and sexual orientation also help explain sex differences in fatal hate crimes involving guns. Key themes in male gender role expectations are anti-femininity (Brannon, 1976) and homophobia (Kimmel, 1994). Boys are expected to rid themselves of stereotypically feminine characteristics (e.g., "you throw like a girl," "big boys don't cry"). Gun violence against lesbian, gay, bisexual, and transgendered persons can be understood in this context. One explanation of these hate crimes is that they are perpetrated to demonstrate heterosexual masculinity to male peer group members. These homicides, compared with violent crimes in which the victim is (or is perceived to be) heterosexual, often are especially brutal and are more commonly perpetrated by groups of men rather than individual men or women. However, such homicides appear to be perpetrated less often using firearms, which suggests motives beyond a desire to kill - for example, expressing intense hatred or transferring negative affect directly onto the victim (Gruenwald, 2012).

Male role expectations for achievement of success and power, combined with restricted emotionality, may have dangerous consequences, particularly for boys who suffer major losses and need help. A majority of the males who have completed homicides at schools had trouble coping with a recent major loss. Many had also experienced bullying or other harassment (Vossekuil et al., 2002). Such characteristics cannot and should not be used to develop risk profiles of attackers because school shootings are such rare events, and so many men who share these same characteristics never will perpetrate gun violence. However, when male gender and characteristics associated with male gender are highly common among attackers, it is responsible to ask how male gender contributes to school shootings and other forms of gun violence.

In their case studies of male-perpetrated homicide-suicides at schools, Kalish and Kimmel (2010) speculated that a sense of "aggrieved entitlement" may be common among the shooters. In this view, the young men see suicide and revenge as appropriate, even expected, responses for men to perceived or actual victimization. Related findings emerged from a similar analysis of all "random" school shootings (those with multiple, nontargeted victims) from 1982 to 2001 (Kimmel & Mahler, 2003). With a small number of exceptions, the vast majority were committed by White boys (26 of 28) in suburban or rural (not urban) areas (27 of 28). Many of these boys also had experienced homophobic bullying.

Masculinity and Beliefs About Guns
Sex differences in beliefs about guns may begin at an early age as a function of parental socialization and attitudes. Fathers, particularly White fathers, are more permissive than mothers of their children, particularly sons, playing with toy guns (Cheng et al., 2003). Through the socialization of gender, boys and men may come to believe that displaying a gun will enhance their masculine power. Carrying a weapon is, in fact, instrumental in fulfilling male gender role expectations. Estimates of a person's physical size and muscularity are greater when they display a gun (or large knife) than other similarly sized and shaped objects (e.g., drill, saw), even when the person is only described and not visible. This perception persists despite no apparent correlation between actual gun ownership and size or muscularity (Fessler, Holbrook, & Snyder, 2012). Guns symbolically represent some key elements of hegemonic masculinity - power, hardness, force, aggressiveness, coldness (Connell, 1995; Stroud, 2012).

Implications for Prevention and Policy

Sex Differences in Attitudes Toward Gun Policies
Policies and laws addressing the manufacture, purchase, and storage of guns have been advocated in response to the prevalence of gun violence. Perhaps reflecting their differential access to firearms and differential perpetration and victimization rates, men and women hold different attitudes about such gun control policies. Females are generally much more favorable toward gun restriction and control policies (e.g., Vittes, Sorenson, & Gilbert, 2003).

Prevention Programs Addressing Gender
The foregoing analysis of the link between gender and gun violence suggests the potential value of addressing gender in efforts to define the problem of gun violence and develop preventive responses. Preliminary evidence suggests that correcting and changing perceptions among men of social norms regarding beliefs about behaviors and characteristics that are associated with stereotypic masculinity may reduce the prevalence of intimate partner and sexual violence (Fabiano, Perkins, Berkowitz, Linkenbach, & Stark, 2003; Neighbors et al., 2010). However, the effect of such interventions in specifically reducing gun violence remains to be tested. The skills and knowledge of psychologists are needed to develop and evaluate programs and settings in schools, workplaces, prisons, neighborhoods, clinics, and other relevant contexts that aim to change gendered expectations for males that emphasize self-sufficiency, toughness, and violence, including gun violence.

What Works: Gun Violence Prediction and Prevention at the Individual Level

A natural starting point for the prevention of gun violence is to identify individuals who are at risk for violence and in need of assistance. Efforts focused on at-risk individuals are considered secondary prevention because they are distinguished from primary or universal prevention efforts that address the general population. Secondary prevention strategies for gun violence can include such actions as providing prompt mental health treatment for an acutely depressed and suicidal person or conducting a threat assessment of a person who has threatened gun violence against a spouse or work supervisor.

To be effective, strategies to prevent gun violence should be tailored to different kinds of violence. One example is the distinction between acts of impulsive violence (i.e., violence carried out in the heat of the moment, such as an argument that escalates into an assault) and acts of targeted or predatory violence (i.e., acts of violence that are planned in advance of the attack and directed toward an identified target). The incidents of mass casualty gun violence that have garnered worldwide media attention, such as the shootings at Sandy Hook Elementary School in Newtown, Conn., at a movie theater Aurora, Colo., at the Fort Hood military base, and at a political rally in a shopping center in Tucson, Ariz., are all examples of targeted or predatory violence. Distinguishing between impulsive violence, targeted/predatory violence, and other types of violence is important because they are associated with different risk factors and require different prevention strategies.

Predicting and Preventing Impulsive Gun Violence

Research on impulsive violence has enabled scientists to develop moderately accurate predictive models that can identify individuals who are more likely than other persons to engage in this form of violence. These models cannot determine with certainty whether a particular person will engage in violence - just whether a person is at greater likelihood of doing so. This approach is known as a violence risk assessment or clinical assessment of dangerousness. A violence risk assessment is conducted by a licensed mental health professional who has specific training in this area. The process generally involves comparing the person in question with known base rates for those of the same age/gender who have committed impulsive violence and then determining whether the person in question has individual risk factors that would increase that person's likelihood of engaging in impulsive violence. In addition, the process involves examining individual protective factors that would decrease the person's overall likelihood of engaging in impulsive violence. Research that has identified risk and protective factors for impulsive violence is limited in that more research has been conducted on men than women and on incarcerated or institutionalized individuals than on those in the general population. Nevertheless, this approach can be effective for determining someone's relative likelihood of engaging in impulsive violence.

Some risk factors for impulsive violence are static - for example, race and age - and cannot be changed. But those factors that are dynamic - for example, unmet mental health needs for conditions linked with violence to self (such as depression) or others (such as paranoia), lack of mental health care, abuse of alcohol - are more amenable to intervention and treatment that can reduce the risk for gun violence. Secondary prevention strategies to prevent impulsive gun violence can include having a trained psychologist or other mental health professional treat the person's acute mental health needs or substance abuse needs. There must be a vigorous and coordinated response to persons whose histories include acts of violence, threatened or actual use of weapons, and substance abuse, particularly if they have access to a gun. This response should include a violence risk assessment by well-trained professionals and referral for any indicated mental health treatment, counseling and mediation services, or other forms of intervention that can reduce the risk of violence.

Youths and young adults who are experiencing an emerging psychosis should be referred for prompt assessment by mental health professionals with sufficient clinical expertise with psychotic disorders to craft a clinical intervention plan that includes risk management. In some cases, secondary prevention measures may include a court-ordered emergency psychiatric hospitalization where a person can receive a psychiatric evaluation and begin treatment. Criteria for allowing such involuntary evaluations vary by state but typically can occur only when someone is experiencing symptoms of a serious mental illness and, as a result, potentially poses a significant danger to self or others. There is an urgent need to improve the effectiveness of emergency commitment procedures because of concerns that they do not provide sufficient services and follow-up care.

Predicting and Preventing Targeted or Predatory Gun Violence

Acts of targeted or predatory violence directed at multiple victims, including crimes sometimes referred to as rampage shootings and mass shootings, ² occur far less often in the United States than do acts of impulsive violence (although targeted violence garners far more media attention). Acts of targeted violence have not been subject to study that has developed statistical models like those used for estimating a person's likelihood of impulsive violence. Although it seems appealing to develop checklists of warning signs to construct a profile of individuals who commit these kinds of crimes, this effort, sometimes described as psychological profiling, has not been successful. Research has not identified an effective or useful psychological profile of those who would engage in multiple casualty gun violence. Moreover, efforts to use a checklist profile to identify these individuals fail in part because the characteristics used in these profiles are too general to be of practical value; such characteristics are also shared by many nonviolent individuals.

Because of the limitations of a profiling approach, practitioners have developed the behavioral threat assessment model as an alternative means of identifying individuals who are threatening, planning, or preparing to commit targeted violence. Behavioral threat assessment also emphasizes the need for interventions to prevent violence or harm when a threat has been identified, so it represents a more comprehensive approach to violence prevention. The behavioral threat assessment model is an empirically based approach that was developed largely by the U.S. Secret Service to evaluate threats to the president and other public figures and has since been adapted by the U.S. Secret Service and U.S. Department of Education (Fein et al., 2002; Vossekuil et al., 2002) and others (Cornell, Allen, & Fan, 2012) for use in schools, colleges and universities, workplaces, and the U.S. military. Threat assessment teams are typically multidisciplinary teams that are trained to identify potentially threatening persons and situations. They gather and analyze additional information, make an informed assessment of whether the person is on a pathway to violence - that is, determine whether the person poses a threat of interpersonal violence or self-harm - and if so, take steps to intervene, address any underlying problem or treatment need, and reduce the risk for violence.

Behavioral threat assessment is seen as the emerging standard of care for preventing targeted violence in schools, colleges, and workplaces, as well as against government officials and other public figures. The behavioral threat assessment approach is the model currently used by the U.S. Secret Service to prevent violence to the U.S. president and other public officials, by the U.S. Capitol Police to prevent violence to members of Congress, by the U.S. State Department to prevent violence to dignitaries visiting the United States, and by the U.S. Marshals Service to prevent violence to federal judges (see Fein & Vossekuil, 1998). The behavioral threat assessment model also is recommended in two American national standards: one for higher education institutions (which recommends that all colleges and universities operate behavioral threat assessment teams; see ASME-Innovative Technologies Institute, 2010) and one for workplaces (which recommend s similar teams to prevent workplace violence; see ASIS International and Society for Human Resource Management, 2011). In addition, a comprehensive review conducted by a U.S. Department of Defense (2010) task force following the Fort Hood shooting concluded that threat assessment teams or threat management units (i.e., teams trained in behavioral threat assessment and management procedures) are the most effective tool currently available to prevent workplace violence or insider threats like the attack at Fort Hood.

Empirical research on acts of targeted violence has shown that many of those attacks were carried out by individuals motivated by personal problems who were at a point of desperation. In their troubled state of mind, these individuals saw no viable solution to their problems and could envision no future. The behavioral threat assessment model is used not only to determine whether a person is planning a violent attack but also to identify personal or situational problems that could be addressed to alleviate desperation and restore hope. In many cases, this includes referring the person to mental health services and other sources of support. In some of these cases, psychiatric hospitalization may be needed to address despondence and suicidality. Nonpsychiatric resources also can help alleviate the individual's problems or concerns. Resources such as conflict resolution, credit counseling, job placement assistance, academic accommodations, veterans' services, pastoral counseling, and disability services all can help address personal problems and reduce desperation. When the underlying personal problems are alleviated, people who may have posed a threat of violence to others no longer see violence as their best or only option.

Predicting and Preventing Violence by Those With Acute Mental Illness

When treating a person with acute or severe mental illness, mental health professionals may encounter situations in which they need to determine whether their patient (or client) is at risk for violence. Typically, they would conduct a violence risk assessment if the clinician's concern is about risk for impulsive violence, as discussed previously. Clinicians also can conduct - or work with a team to help conduct - a threat assessment if their concern involves targeted violence. The available research suggests that mental health professionals should be concerned when a person with acute mental illness makes an explicit threat to harm someone or is troubled by delusions or hallucinations that encourage violence, but even in these situations, violence is far from certain. Although neither a violence risk assessment nor a threat assessment can yield a precise prediction of someone's likelihood of violence, it can identify high-risk situations and guide efforts to reduce risk. It is important to emphasize that prevention does not require prediction; interventions to reduce risk can be beneficial even if it is not possible to determine who would or would not have committed a violent act.

When their patients (or clients) pose a risk of violence to others, mental health professionals have a legal and ethical obligation to take appropriate action to protect potential victims of violence. This obligation is not easily carried out for several reasons. First, mental health professionals have only a modest ability to predict violence, even when assisted by research-validated instruments. Mental health professionals who are concerned that a patient is at high risk for violence may be unable to convince their patient to accept hospitalization or some other change in treatment. They can seek involuntary hospitalization or treatment, but civil commitment laws (that vary from state to state) generally require convincing evidence that a person is imminently dangerous to self or others. There is considerable debate about the need to reform civil commitment laws in a manner that both protects individual liberties and provides necessary protection for society.

There is no guarantee that voluntary or involuntary treatment of a potentially dangerous individual will be effective in reducing violence risk, especially when the risk for violence does not arise from a mental illness but instead from intense desperation resulting from highly emotionally distressing circumstances or from antisocial orientation and proclivities for criminal misconduct. When individuals with prior histories of violence are released from treatment facilities, they typically need continued treatment and monitoring for potential violence until they stabilize in community settings. Jurisdictions vary widely in the resources available to achieve stability in the community and in the legal ability to impose monitoring or clinical care on persons who decline voluntary services.

Furthermore, if unable to obtain civil commitment to a protective setting, mental health professionals must consider other protective actions permitted in their jurisdictions, which may include warning potential victims that they are in danger or alerting local law enforcement, family members, employers, or others. Whether their particular jurisdiction mandates a response to "warn or protect" potential victims or leaves this decision to the discretion of the clinician, mental health professionals are often reluctant to take such actions because they are concerned that doing so might damage the therapeutic relationship with their patient and drive patients from treatment or otherwise render effective treatment impossible.

Another post-hospitalization strategy is to prohibit persons with mental illness from acquiring a firearm. The Gun Control Act of 1968 prohibited persons from purchasing a firearm if they had been involuntarily committed to a psychiatric inpatient unit. The Brady Handgun Violence Act (1994), known as the Brady Law, began the process of background checks to identify individuals who might attempt to purchase a firearm despite prohibitions. There is some evidence that rates of gun violence are reduced when these procedures are adequately implemented, but research, consistent implementation, and refinement of these procedures are needed (Webster & Vernick, 2013a).

Predicting and Preventing Gun-Based Suicide

Suicide accounts for approximately 61 percent of all firearm fatalities in the United States - 19,393 of the 31,672 firearm deaths reported by the CDC for 2010 (Murphy, Xu, & Kochanek, 2013). When there is concern that a person may be suicidal, mental health professionals can conduct suicide screenings and should rely on structured assessment tools to assess that person's risk to self. Behavioral threat assessment also may be indicated in such situations if the potentially suicidal individual may also pose a threat to others.

More than half of suicides are accomplished by firearms and most commonly with a firearm from the household (Miller, Azrael, Hepburn, Hemenway, & Lippmann, 2006). More than 90 percent of persons who commit suicide had some combination of symptoms of depression, symptoms of other mental disorders, and/or substance abuse (Moscicki, 2001). Ironically, although depression is the condition most closely associated with attempted or completed suicide, it is also less likely than schizophrenia or other disorders to prompt an involuntary civil commitment or other legal triggers that can prevent some persons with mental illness from possessing firearms. As in behavioral threat assessment, suicide risk may be reduced through identifying and providing support in solving the problems that are driving a person to consider suicide. In many cases the person may need a combination of psychological treatment and psychiatric medication.

Tragic shootings like the ones at Sandy Hook Elementary School and the movie theater in Aurora, Colo., spark intense debate as to whether specific gun control policies would significantly diminish the number of mass shooting incidents. This debate includes whether or how to restrict access to firearms, especially with regard to persons with some mental illnesses. Another line of debate concerns whether to limit access to certain types of firearms (e.g., reducing access to high-capacity magazines). Empirical evidence documents the efficacy of some firearms restrictions, but because the restrictions often are not well implemented and have serious limitations, it is difficult to conduct the kind of rigorous research needed to fairly evaluate their potential for reducing gun violence.

The often-debated Brady Law (1994) does not consistently prevent persons with mental illness from acquiring a firearm. The prohibition applies only to persons with involuntary commitments and omits both persons with voluntary admissions and those with no history of inpatient hospitalization. The law does not prevent a person with a history of involuntary commitment from obtaining a previously owned firearm or one possessed by a friend or relative. Additional problems with implementing the Brady Law include incomplete records of involuntary commitments, background checks limited to purchases from licensed gun dealers, and exceptions from background checks for firearms purchased during gun shows.

Despite these limitations and gaps, there is some scientific evidence that background checks reduce the rate of violent gun crimes by persons whose mental health records disqualify them from legally obtaining a firearm. A study of one state (Connecticut) found that the risk of violent criminal offending among persons with a history of involuntary psychiatric commitment declined significantly after the state began reporting these individuals to the National Instant Criminal Background Check System (Swanson et al., 2013). This study supports the value of additional research to investigate strategies for limiting access to firearms by persons with serious mental illness.

In contrast, access to appropriate mental health treatment can work to reduce violence at the individual level. For example, one major finding of the MacArthur Risk Assessment study (Monahan et al., 2001) was that getting continued mental health treatment in the community after release from a psychiatric hospitalization reduced the number of violent acts by those who had been hospitalized. In other studies, outpatient mental health services, including mandated services, have been effective in preventing or reducing violent and harmful behavior (e.g., New York State Office of Mental Health, 2005; N.Y. Mental Hygiene Law [Kendra's Law], 1999; O'Keefe, Potenza, & Mueser, 1997; Swanson et al., 2000).

There is abundant scientific research demonstrating the effectiveness of treatment for persons with severe mental illness such as schizophrenia and bipolar disorder. However, there are social, economic, and legal barriers to treatment. First, there is a persistent social stigma associated with mental illness that deters individuals from seeking treatment for themselves or for family members. Public education to increase understanding of and support for persons with serious mental illness and to encourage access to treatment is needed.

Second, mental health treatment, especially inpatient hospitalization, is expensive, and persons with mental illness often cannot access this level of care or afford it. Commercial insurers often have limitations on hospital care or do not cover intensive services that are alternatives to inpatient admission. Public sector facilities such as community mental health centers and state-operated psychiatric hospitals have experienced many years of shrinking government support; demand for their services exceeds their capacity. Many mental health providers limit their services to the most acute cases and cannot extend services after the immediate crisis has resolved.

Third, there are complex legal barriers to the provision of mental health services when an individual does not desire treatment or does not believe he or she is in need of treatment. A severe mental illness can impair an individual's understanding of his or her condition and need for treatment, but a person with mental illness may make a rational decision to refuse treatment that he or she understandably regards as ineffective, aversive, or undesirable for some reason (e.g., psychiatric medications can produce unpleasant side effects and hospitalization can be a stressful experience).

When an individual refuses to seek treatment, it may be difficult to determine whether this decision is rational or irrational. To protect individual liberties, laws throughout the United States permit involuntary treatment only under stringent conditions, such as when an individual is determined to be imminently dangerous to self or others due to a mental illness. People who refuse treatment but are not judged to be imminently dangerous (a difficult and ambiguous standard) fall into a "gray zone" (Evans, 2013). Some individuals with serious mental illness pose a danger to self or others that is not imminent, and often it is not possible to monitor them adequately or determine precisely when they become dangerous and should be hospitalized on an involuntary basis. In other situations, the primary risk posed by the individual does not arise from mental illness but from his or her willingness to engage in criminal misconduct for personal gain.

Furthermore, when a person is committed to a psychiatric hospital on an involuntary basis, treatment is limited in scope. Once the person is no longer regarded as imminently dangerous (the criteria differ across states), he or she must be released from treatment even if not fully recovered; that person may be vulnerable to relapse into a dangerous state. In some cases of mass shootings, persons who committed the shooting were known to have a serious mental illness, but authorities could not require treatment when it was needed. In other cases, authorities were not aware of an individual's mental illness before the attempted or actual mass shooting incident.

A related problem is that the onset or recurrence of serious mental illness can be difficult to detect. Symptoms of mental illness may emerge slowly, often in late adolescence or early adulthood, and may not be readily apparent to family members and friends. A person hearing voices or experiencing paranoid delusions may hide these symptoms and simply seem preoccupied or distressed but not seriously ill. A person who has been treated successfully for a serious mental illness may experience a relapse that is not immediately recognized. There is a great need for public education about the onset of serious mental illness, recognition of the symptoms of mental illness, and increased emphasis on the importance of seeking prompt treatment.

Understanding School Shootings

Thirteen years before the shooting at Sandy Hook Elementary School, the Columbine High School shootings (in April 1999) shocked the American public and galvanized attention on school shootings. The intensified focus led to landmark federal research jointly conducted by the U.S. Secret Service and the U.S. Department of Education (Fein et al., 2002; Vossekuil et al., 2002) that examined 37 incidents of school attacks or targeted school shootings and included interviews with school shooters. Known as the Safe School Initiative, the findings from this research shed new light on ways to prevent school shootings, showing that school attacks are typically planned in advance, the school shooters often tell peers about their plans beforehand and are frequently despondent or suicidal prior to their attacks (with some expecting to be killed during their attacks), and most shooters had generated concerns with at least three adults before their shootings (Vossekuil et al., 2002). This research and subsequent investigations indicate that school attacks - although rare events - are most likely perpetrated by students currently enrolled (or recently suspended or expelled) or adults with an employment or another relationship to the school. The heterogeneity of school attackers makes the development of an accurate profile impossible. Instead, research supports a behavioral threat assessment approach that attends to features such as:

threats, including behaviors or statements reflecting thoughts or plans for a school attack (often these are confided to peers);

ready access to a firearm or other lethal weapon and unusual preparation or practice for use; and

mental health symptoms, including depression with accompanying feelings of desperation and despondency.

These findings led to the development of the U.S. Secret Service/U.S. Department of Education school threat assessment model (Vossekuil et al., 2002) and similar models (see, for example, the "Virginia Student Threat Assessment Guidelines"; Cornell et al., 2012). After the shooting at Sandy Hook Elementary School in 2012, Virginia passed a law requiring threat assessment teams in Virginia K-12 public schools. Threat assessment teams were already required by law for Virginia's public colleges and universities following the Virginia Tech shootings in 2007. Other states have passed or are debating similar measures for their institutions of higher education and/or K-12 schools. Threat assessment teams are recommended by the new federal guides on high-quality emergency plans for schools and for colleges and universities (U.S. Department of Education, 2013).

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What Works: Gun Violence Prevention at the Community Level

Prevention of violence occurs along a continuum that begins in early childhood with programs to help parents raise healthy children and ends with efforts to identify and intervene with troubled individuals who threaten violence. A comprehensive community approach recognizes that no single program is sufficient and there are many opportunities for effective prevention. Discussion of effective prevention from a community perspective should include identification of the community being examined. Within the larger community, many stakeholders are affected by gun violence that results in a homicide, suicide, or mass shooting.

Such stakeholders include community and public safety officials, schools, workplaces, neighborhoods, mental health and public health systems, and faith-based groups. When it comes to perpetrating gun violence, however, a common thread that exists across community groups is the recognition that someone, or possibly several people, may have heard something about an individual's thoughts and/or plans to use a gun. Where do they go with that information? How do they report it so that innocent people are not targeted or labeled unfairly - and how can their information initiate a comprehensive and effective crisis response that prevents harm to the individual of concern and the community?

To date, there is little research to help frame a comprehensive and effective prevention strategy for gun violence at the community level. One of the most authoritative reviews of the body of gun violence research comes from the National Research Council of the National Academy of Sciences (see Wellford, Pepper, & Petrie, 2004). In reviewing a range of criminal justice initiatives designed to reduce gun violence, such as gun courts, enhanced sentencing, and problem-based policing, Wellford et al. concluded that problem-oriented policing, also known as place-based initiatives or target policing, holds promise, particularly when applied to "hot spots" - areas in the community that have high crime rates. They included studies on programs such as the Boston Gun Project (see Kennedy, Braga, & Piehl, 2001), more commonly known as Operation Ceasefire, in their review and concluded that although many of these programs may have reduced youth homicides, there is only modest evidence to suggest that they effectively lowered rates of crime and violence, given the confounding factors that influence those rates and are difficult to control. In other words, the variability in the roles of police, prosecutors, and the community creates complex interactions that can confound the levels of intervention and affect sustainability.

Wellford et al.'s (2004) conclusions were supported by the findings of the 2011 Firearms and Violence Research Working Group (National Institute of Justice, 2011), which also questioned whether rigorous evaluations are possible given the reliability and validity of the data. Wellford et al. advocated for continued research and development of models that include collaboration between police and community partners and for examination of different evaluation methodologies.

There are varied prevention models that address community issues. When it comes to exploring models that specifically address preventing the recent episodes of gun violence that have captured the nation's attention, however, the inevitable conclusion is that there is a need to develop a new model that would bring community stakeholders together in a collaborative, problem-solving mode, with a goal of preventing individuals from engaging in gun violence, whether directed at others or self-inflicted. This model would go beyond a single activity and would blend several strategies as building blocks to form a workable systemic approach. It would require that community service systems break their tendencies to operate in silos and take advantage of the different skill sets already available in the community - for example:

Police are trained in crisis intervention skills with a primary focus on responding to special populations such as those with mental illness.

Community members are trained in skilled interventions such as Emotional CPR and Mental Health First Aid - consumer-based initiatives that use neighbor-to-neighbor approaches that direct people in need of care to appropriate mental health treatment.

School resource officers are trained to show a proactive presence in schools.

Each group may provide a solution to a piece of the problem, but there is nothing connecting the broad range of activities to the type of collaborative system needed to implement a comprehensive, community-based strategy to prevent gun violence. From a policy and practice perspective, no one skill set or one agency can provide the complete answer when it comes to developing a prevention methodology. However, some models developed through the community policing reform movement may be relevant because they are generally acknowledged to have been useful in reducing violence against women and domestic violence and in responding to children exposed to violence. These community policing models involve collaborative problem solving as a way to safeguard the community as opposed to relying only on arrest procedures. Moreover, they engage the community in organized joint efforts to produce public safety (Peak, 2013).

Another initiative, Project Safe Neighborhoods ( PSN), is also relevant. PSN, a nationwide program that began in 2001 and was designed specifically to reduce gun violence, has some similarity to the community policing model. PSN involved the 94 U.S. attorneys in cities across the country in a prominent leadership role, ensured flexibility across jurisdictions, and required cross-agency buy-in, though there seems to have been less formalized involvement with mental health services. Nevertheless, it used a problem-solving approach that was aimed at getting guns off the streets, and the results of varied outcome assessments demonstrate that it was successful in reducing gun violence, particularly when the initiatives were tailored to the gun violence needs of specific communities (McGarrell et al., 2009).

A common approach used by PSN involved engaging the community to establish appropriate stakeholder partnerships, formulating strategic planning on the basis of identification and measurement of the community problem, training those involved in PSN, providing outreach through nationwide public service announcements, and ensuring accountability through various reporting mechanisms. The PSN problem-solving steps, with some adaptations, could provide a useful strategy for initiating collaborative problem solving with relevant community stakeholders in the interest of reducing gun violence and victimization through prevention.

The models discussed here illustrate how community engagement and collaboration helped break new ground in response to identified criminal justice problems, but they could be strengthened considerably by incorporating the involvement of professional psychology. The need for collaboration was again highlighted at a Critical Issues in Policing meeting (Police Executive Research Forum, 2012) as part of a discussion on connecting agency silos by building bridges across systems. Because police and mental health workers often respond to the same people, there is a need for collaboration on the best way to do this without compromising their roles. This emphasis takes the discussion beyond the student/school focus and expands it to include the use of crisis intervention teams (CIT) and community advocacy groups as additional resources for achieving the goal of preventing violence in the community.

The CIT model was another result of community policing reform that brought police and mental health services together to provide a more effective response to the needs of special populations, particularly mental health-related cases. Developed in Memphis in 1988 but now deployed in many communities across the country, the CIT model trains CIT officers to deescalate situations involving people in crises and to use jail diversion options, if available, rather than arrests. Although research on the effectiveness of CITs is generally limited to outcome studies in select cities, the model continues to gain prominence. In fact, the National Alliance on Mental Illness ( NAMI) has established a NAMI CIT Center and is promoting the expansion of CIT nationwide. Studies by Borum (2000), Steadman, Deane, Borum, and Morrissey (2000), and Teller, Munetz, Gil, and Ritter (2006) have illustrated that high-risk encounters between individuals with mental illness and police can be substantially improved through CIT training, particularly when there are options such as drop-off centers, use of diversion techniques, and collaborations between law enforcement, mental health, and family members. Each plays a significant role in ensuring that city or county jails do not become de facto institutions for those in mental health crises.

Crisis intervention teams were also a major focus of a 2010 policy summit (International Association of Chiefs of Police [IACP], 2012). The summit, hosted by SAMHSA, the Bureau of Justice Assistance, and IACP, produced a 23-item action agenda. Although the summit focused on decriminalizing the response to persons with mental illness and was not directed specifically at dealing with people who perpetrate gun violence, some of their recommendations did apply. The central theme of the agenda encouraged law enforcement and mental health service systems to engage in mutually respectful working relationships, collaborate across partner agencies, and establish local multidisciplinary advisory groups. These partnerships would develop policy, protocols, and guidelines for informing law enforcement encounters with persons with mental illness who are in crisis, including a protocol that would enable agencies to share essential information about those individuals and whether the nature of the crisis could provoke violent behavior. They further recommended that these types of protocols be established and maintained by the multidisciplinary advisory group and that training be provided in the community to sensitize community members to signs of potential danger and how to intervene in a systematic way.

A Police Foundation (2013) roundtable on gun violence and mental health reported that some police departments have reached out to communities and offered safe storage of firearms when community members have concern about a family member's access to firearms in the home. As a service to the community, the police would offer to keep guns secured in accessible community locations until the threat has subsided and the community member requests the return. The police would also confer with mental health practitioners regarding a designated family or community member on an as-needed basis. This strategy is consistent with a community threat assessment approach in which law enforcement authorities engage proactively with the community to reduce the risk of violence when an individual poses a risk.

Gun Violence in Schools

Gun violence in schools has been a national concern for more than two decades. Although school shootings are highly traumatic events and have brought school safety to the forefront of public attention, schools are very safe environments compared with other community settings (Borum et al., 2010). Less than 2 percent of homicides of school-aged children occur in schools. Over a 20-year period, there have been approximately 16 shooting deaths in U.S. schools each year (Fox & Burstein, 2010), compared with approximately 32,000 shooting deaths annually in the nation as a whole (Hoyert & Xu, 2012).

The Gun-Free Schools Act of 1994 made federal education funding contingent upon states requiring schools to expel for at least one year any student found with a firearm at school. This mandate strengthened the emerging philosophy of zero tolerance as a school disciplinary policy. According to the APA Zero Tolerance Task Force (2008), this policy was predicated on faulty assumptions that removing disobedient students would motivate them to improve their behavior, deter misbehavior by other students, and generate safer school conditions. The task force found no scientific evidence to support these assumptions and, on the contrary, concluded that the practice of school suspension had negative effects on students and a disproportionately negative impact on students of color and students with disabilities.

After the 1999 shooting at Columbine High School, both the FBI (O'Toole, 2000) and the U.S. Secret Service (Vossekuil et al., 2002) conducted studies of school shootings and concluded that schools should not rely on student profiling or checklists of warning signs to identify potentially violent students. They cautioned that school shootings were statistically too rare to predict with accuracy and that the characteristics associated with student shooters lacked specificity, which means that numerous nonviolent students would be misidentified as dangerous. Both law enforcement agencies recommended that schools adopt a behavioral threat assessment approach, which, as noted earlier, involves assessment of students who threaten violence or engage in threatening behavior and then individualized interventions to resolve any problem or conflict that underlies the threat. One of the promising features of threat assessment is that it provides schools with a policy alternative to zero tolerance. Many schools across the nation have adopted threat assessment practices. Controlled studies of the "Virginia Student Threat Assessment Guidelines" have shown that school-based threat assessment teams are able to resolve student threats safely and efficiently and to reduce school suspension rates (Cornell et al., 2012; Cornell, Gregory, & Fan, 2011; Cornell, Sheras, Gregory, & Fan, 2009).

The Role of Health and Mental Health Providers in Gun Violence Prevention

The health care system is an important point of contact for families regarding the issue of gun safety. Physicians' counseling of individuals and families about firearm safety has in some cases proven to be an effective prevention measure and is consistent with other health counseling about safety. According to the 2012 policy statement of the American Academy of Pediatrics (AAP):

The AAP supports the education of physicians and other professionals interested in understanding the effects of firearms and how to reduce the morbidity and mortality associated with their use. HHS should establish a program to support gun safety training and counseling programs among physicians and other medical professionals. The program should also provide medical and community resources for families exposed to violence.

The AAP's Bright Futures practice guide urges pediatricians to counsel parents who possess guns that storing guns safely and preventing access to guns reduce injury by as much as 70 percent and that the presence of a gun in the home increases the risk for suicide among adolescents. A randomized controlled trial indicates that health care provider counseling, when linked with the distribution of cable locks, has been demonstrated to increase safer home storage of firearms (Barkin et al., 2008). The removal of guns or the restriction of access should be reinforced for children and adolescents with mood disorders, substance abuse (including alcohol), or a history of suicide attempts (Grossman et al., 2005). Research is needed to identify the best ways to avoid unintended consequences while achieving intended outcomes.

In recent years, legal and legislative challenges have emerged that test the ability of physicians and other medical professionals to provide guidance on firearms. For example, in 2011 the state of Florida enacted the Firearm Owners' Privacy Act, which prevented physicians from providing such counsel under threat of financial penalty and potential loss of licensure. The law has been permanently blocked from implementation by a U.S. district court. Similar policies have been introduced in six other states: Alabama, Minnesota, North Carolina, Oklahoma, Tennessee, and West Virginia. The fundamental right of all health and mental health care providers to provide counseling to individuals and families must be protected to mitigate risk of injury to people where they live, work, and play.

It is apparent that long before the events at Sandy Hook Elementary School, many public health and public safety practitioners were seeking strategies to improve responses to violence in their communities and have experienced some success through problem-solving projects such as PSN and CIT. Yet there is still a need to rigorously evaluate and improve these efforts. In the meantime, basic safety precautions must be emphasized to parents by professionals in health, education, and mental health.

Public health messaging campaigns around safe storage of firearms are needed. The practice of keeping firearms stored and locked must be encouraged, and the habit of keeping loaded, unlocked weapons available should be recognized as dangerous and rendered socially unacceptable. To keep children and families safe, good safety habits have to become the only socially acceptable norm.

What Works: Policies to Reduce Gun Violence

The use of a gun greatly increases the odds that violence will result in a fatality. In 2010, the most recent year for which data are available, an estimated 17.1 percent of the interpersonal assaults with a gunshot wound resulted in a homicide, and 80.7 percent of the suicide attempts in which a gun was used resulted in death (CDC, 2013a). By contrast, the most common methods of assault (hands, fists, and feet) and suicide attempt (ingesting pills) in 2010 resulted in death in only 0.009 percent and 2.5 percent of the incidents, respectively (CDC, 2013a). ³

As shown in Figure 1, in the past 30 years, the percentage of deaths caused by gunfire has stabilized to about 68 percent for homicides and, as drug overdoses have increased, dropped to 50 percent for suicide. There are more gun suicides than gun homicides in the United States. In 2010, 61.2 percent (19,392) of the 31,672 gun deaths in the United States were suicides (CDC, 2013a).

Figure 1. Deaths Attributed to Firearms, 1981-2010

Note: Data are from the Web-Based Injury Statistics Query and Reporting System (WISQARS™), Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2013. Retrieved from http://www.cdc.gov/injury/wisqars/fatal.html.

Much of the public concern about guns and gun violence focuses on interpersonal violence, and public policy mirrors this emphasis. Although there is no standard way to enumerate each discrete gun law, most U.S. gun laws focus on the user of the gun. Relatively few focus on the design, manufacture, distribution, advertising, or sale of firearms (Teret & Wintemute, 1993). Fewer yet address ammunition.

The focus herein is on the lifespan of guns - from design and manufacture to use - and the policies that could address the misuse of guns. It is critical to understand how policies create conditions that affect access to and use of guns. Because they constitute the largest portion of guns used in homicides (FBI, 2012a), handguns are the focus of most laws. Despite the substantial human and economic costs of gun violence in the United States and the ongoing debate about the effectiveness of gun regulations, scientifically rigorous evaluations are not available for many of these policies (Wellford et al., 2004). The dearth of such research on gun policies is due, in part, to the lack of government funding on this topic because of the political influences of the gun lobby (e.g., Kellermann & Rivara, 2013).

Design and Manufacture

The type of handguns manufactured in the United States has changed. Pistols overtook revolvers in manufacturing in the mid-1980s. In addition, the most widely sold pistol went from a .22 caliber in 1985 to a 9 mm or larger (e.g., .45 caliber pistols) by 1994 (Wintemute, 1996), with smaller, more concealable pistols favored by permit holders as well as criminals. This shift has been described as increasing the lethality of handguns, although, according to our review, no research has examined whether the change in weapon design has led to an increased risk of death. Such research may not be feasible given that the aforementioned weapons - that is, small, concealable pistols - still likely constitute a small portion of the estimated 283 million guns in civilian hands in the United States (Hepburn, Miller, Azrael, & Hemenway, 2007). The disproportionate appearance of such pistols among guns that were traced by law enforcement following their use in a crime has been attributed to the ease with which smaller guns can be concealed and their low price point (Koper, 2007; Wright, Wintemute, & Webster, 2010).

Ammunition, by contrast, is directly related to lethality. Hollow-point bullets are used by hunters because, in part, they are considered a more humane way to kill. The physics of hollow-point bullets are such that, upon impact, they will tumble inside the animal and take it down. Some bullets have been designed to be frangible, that is, to break apart upon impact and thus cause substantial internal damage. By contrast, the physics of full metal jacket bullets are such that, unless they hit a bone, they are likely to continue on a straight trajectory and pass through the animal, leaving it wounded and wandering. Hollow-point bullets are used by law enforcement to reduce over-penetration (i.e., when a bullet passes through its intended target and, thus, risks striking others).

Some design features would substantially reduce gun violence. One of the most promising ideas is that of "smart guns" that can be fired only by an authorized user. For example, young people, who are prohibited due to their age from legally purchasing a firearm, typically use a gun from their own home to commit suicide (Johnson, Barber, Azrael, Clark, & Hemenway, 2010; Wright, Wintemute, & Claire, 2008) and to carry out a school shooting (CDC, 2003). If personalized to an authorized adult in the home, the gun could not be operated by the adolescent or others in the home, thus rendering it of little use to the potential suicide victim or school shooter. During the Clinton administration, the federal government made a modest investment in the research and development of personalized firearms. There also was considerable private investment in technologies that would prevent unauthorized users from being able to fire weapons. Efforts to create these "smart guns" have resulted in multiple patent applications. Armatix GmbH, a German company, has designed and produced a personalized pistol that is being sold in several Western European nations and has been approved for importation to the United States. Although the cost of this new personalized gun is very high, it is believed that personalized guns can be produced at a cost that would be affordable by many (Teret & Merritt, 2013).

The assault weapons ban (the Violent Crime Control and Law Enforcement Act), enacted for a 10-year period beginning in 1994, provided a good opportunity to assess the effectiveness of restricting the manufacturing, sale, and possession of a certain class of weapons. "Assault weapons," however, are difficult to conceal and are used rarely in most street crime or domestic violence. Assault weapons are commonly used in mass shootings in which ammunition capacity can determine the number of victims killed or wounded. Because multiple bullets are not an issue in suicide, one would not expect changes in such deaths either. Perhaps not surprisingly, an effect of the ban could not be detected on total gun-related homicides (Koper, 2013; Koper & Roth, 2001).

Unfortunately, prior research on the effects of the federal assault weapons ban did not focus on the law's effects on mass shootings or the number of persons shot in such shootings. Assault weapons or guns with large-capacity ammunition feeding devices account for half of the weapons used in mass shootings such as at Sandy Hook Elementary School (see Follman & Aronson, 2013). Mass shootings with these types of weapons result in about 1.5 times as many fatalities as those committed with other types of firearms (Roth & Koper, 1997).

Distribution

The distribution of guns is largely the responsibility of a network of middlemen between gun manufacturers and gun dealers. When a gun is recovered following its use (or suspected use) in a crime, law enforcement routinely requests that the gun be traced - that is, the serial number is reported to the manufacturer, who then contacts the distributor and/or dealer who, in turn, reviews records to determine the original purchaser of a specific weapon. The number of gun traces is such that the manufacturers get many calls about their guns each day. One researcher estimated that Smith and Wesson, with about 10 percent of market share, received a call every seven to eight minutes about one of their guns (Kairys, 2008). Thus, one could reasonably expect that manufacturers would have some knowledge of which distributors sell guns that are disproportionately used in crime, and distributors would, in turn, know which retailers disproportionately sell guns used in crime.

Following in the footsteps of cities and states that had successfully sued the tobacco industry under state consumer protection and antitrust laws for costs the public incurred in caring for smokers, beginning in the late 1990s cities and states began to file claims against firearm manufacturers in an attempt to recover the costs of gun violence they incurred. In response, in 2005, Congress enacted and President George W. Bush signed the Protection of Lawful Commerce in Arms Act, which prohibits civil liability lawsuits against "manufacturers, distributors, dealers, or importers of firearms or ammunition for damages, injunctive or other relief resulting from the misuse of their products by others" ( 15 U.S.C. §§ 7901-7903). Thus, the option of using litigation, a long-standing and sometimes controversial tool by which to address entrenched public health problems (e.g., Lytton, 2004), was severely restricted.

Advertising

Advertisements for guns have largely disappeared from classified ads in newspapers. By contrast, advertising in magazines, specifically gun magazines, is strong (Saylor, Vittes, & Sorenson, 2004). Such advertising is subject to the same Federal Trade Commission (FTC) regulations as other consumer products. In 1996, several organizations filed a complaint with the FTC after documenting multiple cases of what they asserted to be false and misleading claims about home protection (for specific examples, see Vernick, Teret, & Webster, 1997). As of November 1, 2013, the FTC had not ruled on the complaint. However, the firearm industry changed its practices such that by 2002, self-protection was an infrequent theme in advertisements for guns (Saylor et al., 2004). To our knowledge, current advertising has not been studied. New issues relevant to the advertising of guns include online advertisements by private sellers who are not obligated to verify that purchasers have passed a background check, online ads from prohibited purchasers seeking to buy firearms, the marketing of military-style weapons to civilians, and the marketing of firearms to underage youth (for examples and more information, see Kessler & Trumble, 2013; Mayors Against Illegal Guns, 2013; McIntire, 2013; Violence Policy Center, 2011).

Sales and Purchases

Gun sales have been increasing in the United States. The FBI reported a substantial jump in background checks (a proxy for gun sales) in the days following the Sandy Hook Elementary School shootings. In fact, of the 10 days with the most requests for background checks since the FBI started monitoring such information, 7 of them were within 8 days of Sandy Hook (FBI, 2013). Guns can be purchased from federally licensed firearm dealers or private, unlicensed sellers in a variety of settings, including gun shows, flea markets, and the Internet.

Responsible sales practices (for examples, see Mayors Against Illegal Guns, n.d.) rely heavily on the integrity of the seller. And usually that responsibility is well placed: Over half (57 percent) of the guns traced (i.e., submitted by law enforcement, usually in association with a crime, to determine the original purchaser of the weapon) were originally sold by only 1.2 percent of federally licensed firearm dealers (Bureau of Alcohol, Tobacco and Firearms [ATF], 2000). However, there are problems. Sometimes a person who is prohibited from purchasing a gun engages someone else, who is not so prohibited, to purchase a gun for him or her. The person doing the buying is called a "straw purchaser." Straw purchase attempts are not uncommon; in a random sample of 1,601 licensed dealers and pawnbrokers in 43 states, two thirds reported experiencing straw purchase attempts (Wintemute, 2013b).

Two studies tested the integrity of licensed firearm dealers by calling the dealers and asking whether they could purchase a handgun on behalf of someone else (in the studies, a boyfriend or girlfriend), a straw purchase transaction that is illegal. In the study of a sample of gun dealers listed in telephone directories of the 20 largest U.S. cities, the majority of gun dealers indicated a willingness to sell a handgun under the illegal straw purchase scenario (Sorenson & Vittes, 2003). In a similar study of licensed gun dealers in California, a state with relatively strong regulation and oversight of licensed gun dealers, one in five dealers expressed a willingness to make the illegal sale (Wintemute, 2010). Programs such as the ATF and National Sports Shooting Council's "Don't Lie for the Other Guy," which provides posters and educational materials to display in gun stores as well as tips for gun dealers on how to identify and respond to straw purchase attempts, have not been evaluated.

It is important to be able to identify high-risk dealers because, in 2012, the ATF had insufficient resources to monitor federally licensed gun dealers (Horwitz, 2012); there were 134,997 unlicensed gun dealers in April 2013 (ATF, 2013). Some states have recognized the limited capacity of the ATF and the weaknesses of federal laws regulating gun dealers and enacted their own laws requiring the licensing, regulation, and oversight of gun dealers (Vernick, Webster, & Bulzacchelli, 2006) and, when enforced, these laws appear to reduce the diversion of guns to criminals shortly after a retail sale (Webster, Vernick, & Bulzacchelli, 2009). Undercover stings and lawsuits against gun dealers who facilitate illegal straw sales have also been shown to reduce the diversion of guns to criminals (Webster, Bulzacchelli, Zeoli, & Vernick, 2006; Webster & Vernick, 2013b).

To help ensure that guns are not sold to those who are prohibited from purchasing them, the National Instant Criminal Background Check System ([NICS], part of the Brady Law) was developed so that the status of a potential purchaser could be checked immediately by a federally licensed firearm dealer. Prohibited purchasers include, but are not limited to, convicted felons, persons dishonorably discharged from the military, those under a domestic violence restraining order, and, in the language of the federal law, persons who have been adjudicated as mentally defective or have been committed to any mental institution (see 18 U.S.C. § 922(g) (1)-(9) and (n)). About 0.6% of sales have been denied on the basis of these criteria since NICS was established in 1998 (FBI, 2012b).

A substantial portion of firearm sales and transfers, however, is not required to go through a federally licensed dealer or a background check requirement; this includes, in most U.S. states, private party sales including those that are advertised on the Internet and those that take place at gun shows where licensed gun dealers who could process background checks are steps away. Some evidence suggests that state policies regulating private handgun sales reduce the diversion of guns to criminals (Vittes, Vernick, & Webster, 2013; Webster et al., 2009; Webster, Vernick, McGinty, & Alcorn, 2013).

The ability to check the background of a potential purchaser nearly instantly means that in many states, someone who is not a prohibited purchaser can purchase a gun within a matter of minutes. Ten states and the District of Columbia have a waiting period (sometimes referred to as a "cooling-off" period) for handguns ranging from 3 (Florida and Iowa) to 14 (Hawaii) days (Law Center to Prevent Gun Violence, 2012). The efficacy of waiting periods has received little direct research attention.

With the exception of misdemeanor domestic violence assault, federal law and laws in most states prohibit firearm possession of those convicted of a crime only if the convictions are for felony offenses in adult courts. Research has shown that misdemeanants who were legally able to purchase handguns committed crimes involving violence following those purchases at a rate 2-10 times higher than that of handgun purchasers with no prior convictions (Wintemute, Drake, Beaumont, & Wright, 1998). Wintemute and colleagues (Wintemute, Wright, Drake, & Beaumont, 2001) examined the impact of a California law that expanded firearm prohibitions to include persons convicted of misdemeanor crimes of violence. In their study of legal handgun purchasers with criminal histories of misdemeanor violence before and after the law, denial of handgun purchases due to a prior misdemeanor conviction was associated with a significantly lower rate of subsequent violent offending.

Persons who are legally determined to be a danger to others or to themselves as a result of mental illness are prohibited by federal law from purchasing and possessing firearms. A significant impediment to successful implementation of this law is that the firearm disqualifications due to mental illness often are not reported to the FBI's background check system. As mentioned earlier, in 2007 Connecticut began reporting these disqualifications to the background check system. In a ground-breaking study, Swanson and colleagues (2013) studied the effects of this policy change on individuals who would most likely be affected - that is, those who were legally prohibited from possessing firearms due solely to the danger posed by their mental illnesses. They found that the rate of violent crime offending was about half as high among those whose mental illness disqualification was reported to the background system compared with those whose mental illness disqualification was not reported.

Federal law allows an individual to buy several guns, even hundreds, at once; the only requirement is that a multiple-purchase form be completed (18 U.S.C. § 923(g)(3)(A)(2009)). Large bulk purchases have been linked to gun trafficking (Koper, 2005). Policies such as one-handgun-a-month have rarely been enacted. Evaluations of these laws document mixed findings (Webster et al., 2009, 2013;Weil & Knox, 1996).

The United States was one of the signers of the Geneva Convention, which prohibits the use of hollow-point bullets in war (the goal being to wound but not kill wartime enemies), but hollow-point bullets are available to civilians in the United States. A hunting license is not a prerequisite for the purchase of hollow-point bullets in the United States. California passed a law requiring a thumbprint for ammunition purchases; the law was ruled "unconstitutionally vague" by a Superior Court judge in 2011, but some municipalities (e.g., Los Angeles, Sacramento) have similar local ordinances in effect.

Owner

In 2004, a national survey found that 20 percent of the U.S. adult population reported they own one or more long-guns (shotguns or rifles), and 16 percent reported they own a handgun (Hepburn et al., 2007). Self-protection was the primary reason for owning a gun. Most people who have a gun have multiple guns, and half of gun owners reported owning four or more guns. In fact, 4 percent of the population is estimated to own 65 percent of the guns in the nation.

Nationally representative studies suggest that the mental health of gun owners is similar to that of individuals who do not own guns (Miller, Barber, Azrael, Hemenway, & Molnar, 2009; Sorenson & Vittes, 2008). However, gun owners are more likely to binge drink and drink and drive (Wintemute, 2011).

In perhaps the methodologically strongest study to date to examine handgun ownership and mortality, Wintemute and colleagues found a strong association between the purchase of a handgun and suicide: "In the first year after the purchase of a handgun, suicide was the leading cause of death among handgun purchasers, accounting for 24.5 percent of all deaths" (Wintemute, Parham, Beaumont, Wright, & Drake, 1999). The risk of suicide remained elevated (nearly twofold and sevenfold, respectively, for male and female handgun purchasers) at the end of the 6-year study period. Men's handgun purchase was associated with a reduced risk of becoming a homicide victim (0.69); women's handgun purchase, by contrast, was associated with a 55 percent increase in risk of becoming a homicide victim. A waiting period may reduce immediate risk but appears not to eliminate short- or long-term risk for suicide.

Risk can extend to others in the home. Efforts to educate children about guns (largely to stay away from them), when tested with field experiments, indicate they are generally ineffective (e.g., Hardy, 2002). Child Access Prevention (CAP) laws focus on the responsibilities of adults; adults are held criminally liable for unsafe storage of firearms around children. CAP laws have been associated with modest decreases in unintentional shootings of children and the suicides of adolescents (Webster & Starnes, 2000; Webster, Vernick, Zeoli, & Manganello, 2004).

User

Most gun-related laws focus on the user of the gun (e.g., increased penalties for using a gun in the commission of a crime). Some research suggests that having been threatened with a gun, as well as the perpetrator's having access to a gun and using a gun during the fatal incident, is associated with increased risk of women becoming victims of intimate partner homicide (Campbell et al., 2003). Regarding sales, note that persons with a domestic violence misdemeanor or under a domestic violence restraining order are prohibited by federal law from purchasing and possessing a firearm and ammunition. Research to date indicates that firearm restrictions for persons subject to such laws have reduced intimate partner homicides by 6 percent to 19 percent (Vigdor & Mercy, 2006; Zeoli & Webster, 2010).

As with initial discussions about motor vehicle safety, which focused on what was then referred to as the "nut behind the wheel," current discussions about gun users sometimes involve terms such as "good guys" and "bad guys." Although intuitively appealing, such categories seem to assume a static label and do not take into account the fact that "good guys" can become "bad guys" and "bad guys" can become "good guys." One way an armed "good guy" can become a "bad guy" is to use a gun in a moment of temporary despondence or rage (Bandeira, 2013; Wintemute, 2013a).

Research on near-miss suicide attempts among young adults indicates that impulsivity is of concern. About one fourth of those whose suicide attempt was so severe they most likely would have died reported first thinking about suicide five minutes before attempting it (Simon et al., 2001). Although an estimated 90 percent of those who attempt suicide go on to die of something else (i.e., they do not subsequently kill themselves; for a review, see Bostwick & Pankratz, 2000), for those who use a gun, as noted in opening paragraph of this chapter, there generally is not a second chance.

Conclusion

Given the complexity of the issue, a multifaceted approach will be needed to reduce firearm-related violence (see, for example, Chapman & Alpers, 2013). Not all ideas that on the surface seem to be useful actually are. For example, gun buyback programs may raise awareness of guns and gun violence in a community but have not been shown to reduce mortality (Makarios & Pratt, 2012). Such data can inform policy. President Obama's January 2013 executive orders about gun violence include directing the CDC to research the causes and prevention of gun violence. The federal government has since announced several funding opportunities for research related to gun violence. And the recent Institute of Medicine and National Research Council (2013) report called for lifting access restrictions on gun-related administrative data (e.g., data related to dealers' compliance with firearm sales laws, gun trace data) that could be used to identify potential intervention and prevention points and strategies. So perhaps more data will be available to inform and evaluate policies designed to reduce gun violence.

The focus of this section has largely been on mortality. The scope of the problem is far greater, however. For every person who dies of a gunshot wound, there are an estimated 2.25 people who are hospitalized or receive emergency medical treatment for a nonfatal gunshot wound (Gotsch, Annest, Mercy, & Ryan, 2001). And guns are used in the street and in the home to intimidate and coerce (e.g., Sorenson & Wiebe, 2004; Truman, 2011).

Single policies implemented by themselves have been shown to reduce certain forms of gun violence in the United States. Adequate implementation and enforcement as well as addressing multiple intervention points simultaneously may improve the efficacy of these laws even more. After motor vehicle safety efforts expanded to include the vehicle, roadways, and other intervention points (vs. a focus on individual behavior), motor vehicle deaths dropped precipitously and continue to decline (CDC, 1999, 2013a). A multifaceted approach to reducing gun violence will serve the nation well.

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³ The 2010 data used to calculate current rates shown here are available at http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html and http://www.cdc.gov/injury/wisqars/nonfatal.html.

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APA Experts, Reviewers and Staff

APA Panel of Experts

Dewey Cornell, PhD
Clinical Psychologist and Professor of Education
Curry School of Education
University of Virginia

Arthur C. Evans Jr., PhD
Commissioner
Department of Behavioral Health and Intellectual disAbility Services
Philadelphia, Pa.

Nancy G. Guerra, EdD (Coordinating Editor)
Professor of Psychology
Associate Provost for International Programs
Director, Institute for Global Studies
University of Delaware

Robert Kinscherff, PhD, JD
Associate Vice President for Community Engagement
Massachusetts School of Professional Psychology
Senior Associate
National Center for Mental Health and Juvenile Justice

Eric Mankowski, PhD
Professor of Psychology
Department of Psychology
Portland State University

Marisa R. Randazzo, PhD
Managing Partner
SIGMA Threat Management Associates
Alexandria, Va.

Ellen Scrivner, PhD, ABPP
Executive Fellow
Police Foundation
Washington, D.C.

Susan B. Sorenson, PhD
Professor of Social Policy / Health & Societies
Senior Fellow in Public Health
University of Pennsylvania

W. Douglas Tynan, PhD, ABPP
Professor of Pediatrics
Jefferson Medical College
Thomas Jefferson University

Daniel W. Webster, ScD, MPH
Professor and Director
Center for Gun Policy and Research
Johns Hopkins Bloomberg School of Public Health

Reviewers

We are grateful to the following individuals for their thoughtful reviews and comments on drafts of this report:

Louise A. Douce, PhD
Special Assistant, Office of Student Life
Adjunct Faculty, Department of Psychology
The Ohio State University

Joel A. Dvoskin, PhD, ABPP
Department of Psychiatry
University of Arizona

Ellen G. Garrison, PhD
Senior Policy Advisor
American Psychological Association

Melissa Strompolis, MA
Doctoral Candidate
University of North Carolina at Charlotte

Mathilde Pelaprat, PsyD, provided writing and research assistance on Chapter 2.

APA Staff

Rhea Farberman, APR
Executive Director
Public and Member Communications
American Psychological Association

Editorial and Design Services
Deborah C. Farrell, Editor │ Elizabeth F. Woodcock, Designer

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relationship of mental health and mental illness

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Gun violence: Prediction, prevention, and policy

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This report reviews research-based evidence on the causes of gun violence, including homicide, suicide or school shooting. How do mental health and mental illness affect prediction of gun violence? What can be done at the individual and community level to prevent gun violence?

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Does the 2nd Amendment actually give you the right to own a gun? (VIDEO)

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Does the 2nd Amendment actually give you the right to own a gun? (VIDEO)

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Video digs into the history of the Second Amendment and gun ownership.

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Does the 2nd Amendment actually give you the right to own a gun?

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While today, we might think the 2nd Amendment protects our personal right to own guns, a lot of experts would tell you that wasn't the case for most of U.S. history... at least, not until 2008.

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In July 2012, in the aftermath of the movie theater massacre in Aurora, Colorado, Mother Jones created a first-of-its-kind open-source database documenting mass shootings in the United States. Our research focused on indiscriminate rampages in public places resulting in four or more victims killed by the attacker. We exclude shootings stemming from more conventionally motivated crimes such as armed robbery or gang violence. (Or in which the perpetrators have not been identified.) Other news outlets and researchers have since published larger tallies that include a wide range of gun crimes in which four or more people have been either wounded or killed. While those larger datasets of multiple-victim shootings are useful for studying the broader problem of gun violence, our investigation provides an in-depth look at a distinct phenomenon-from the firearms used and mental health factors to the growing copycat problem. Tracking mass shootings is complex; we believe ours is the most useful approach for studying this specific phenomenon.

Since we began, our interactive map below and the downloadable database behind it have been expanded with 56 additional cases from 2013-2020. Dating back to at least 2005, the FBI and leading criminologists essentially defined a mass shooting as a single attack in a public place in which four or more victims were killed. We adopted that baseline for fatalities when we gathered data in 2012 on three decades worth of cases. (It is important to note that there have been many similar indiscriminate gun rampages in public places-but resulting in fewer fatalities- that would otherwise be included in our dataset. In that regard, ours is a conservative measure of the problem.) In January 2013, a mandate for federal investigation of mass shootings authorized by President Barack Obama lowered that baseline to three or more victims killed. Accordingly, we include attacks dating from January 2013 in which three or more victims were killed. (Any analysis of the frequency of mass shootings using our database should account for this.) Our original analysis, which covers cases from 1982-2012 with four or more victims killed, follows below. The cases we've documented since then using the revised federal baseline reaffirm our major analytical findings.

It is perhaps too easy to forget how many times this has happened. The gun massacre at a movie theater in Aurora, Colorado, in July 2012, another at a Sikh temple in Wisconsin that August, another at a manufacturer in Minneapolis that September-and then the unthinkable nightmare at a Connecticut elementary school that December-were some of the latest in an epidemic of such gun violence over the last three-plus decades. Since 1982, there have been at least 118 public mass shootings across the country, with the killings unfolding in 35 states, from Massachusetts to Hawaii. They are occurring more often: An analysis of this database by researchers at Harvard University, further corroborated by a different study from the FBI, determined that mass shootings have tripled in frequency in recent years.

We've gathered detailed data on nearly four decades worth of cases, including information on the attackers' profiles, the types of weapons they used, and the number of victims they injured and killed. [Editor's note: The following analysis covers our original dataset comprised of 62 cases from 1982-2012.]

Weapons: Of the 143 guns possessed by the killers, more than three quarters were obtained legally. They included dozens of assault weapons and semi-automatic handguns with high-capacity magazines. (See charts below.) Just as a perpetrator used a .40-caliber Glock to slaughter students in Red Lake, Minnesota, in 2005, so too did the one in Aurora, along with an AR-15 assault rifle, when blasting away at his victims in a darkened movie theater. In Newtown, Connecticut, the attacker wielded a .223 Bushmaster semi-automatic assault rifle as he massacred 20 school children and six adults.

The perpetrators: More than half of the cases involved school or workplace shootings (12 and 20, respectively); the other 30 cases took place in locations including shopping malls, restaurants, and religious and government buildings. Forty-four of the killers were white males. Only one was a woman. (See Goleta, Calif., in 2006.) The average age of the killers was 35, though the youngest among them was a mere 11 years old. (See Jonesboro, Ark., in 1998.) A majority were mentally troubled- and many displayed signs of mental health problems before setting out to kill. Explore the above map and database for further details-we do not consider it to be all-inclusive, but based on the criteria we used, we believe that we have produced the most comprehensive rundown available on this particular type of violence. (Mass shootings represent a small fraction of America's overall gun violence.) For the stories of the 151 shooting rampage victims of 2012, click here, and for our groundbreaking investigation into the economic costs of the nation's gun violence, including mass shootings, click here.

Here is a description of the criteria we use:

The perpetrator took the lives of at least four people. A 2008 FBI report identifies an individual as a mass murderer-versus a spree killer or a serial killer-if he kills four or more people in a single incident (not including himself), typically in a single location. (*In 2013, the US government's fatality baseline was revised down to three; our database reflects this change beginning from Jan. 2013, as detailed above.)

The killings were carried out by a lone shooter. (Except in the case of the Columbine massacre and the Westside Middle School killings, which involved two shooters.)

The shootings occurred in a public place. (Except in the case of a party on private property in Crandon, Wisconsin, and another in Seattle, where crowds of strangers had gathered, essentially constituting a public crowd.) Crimes primarily related to gang activity or armed robbery are not included, nor are mass killings that took place in private homes (often stemming from domestic violence).

Perpetrators who died or were wounded during the attack are not included in the victim tallies.

We included a handful of cases also known as "spree killings"-cases in which the killings occurred in more than one location, but still over a short period of time, that otherwise fit the above criteria.

For more on the thinking behind our criteria, see these two explanatory pieces. Plus: more on the mental health factor and on state laws rolling back gun restrictions across the US. And: Explore the full data set behind our investigation.

Here are two charts detailing the killers' weapons:

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Mother Jones was founded as a nonprofit in 1976 because we knew corporations and the wealthy wouldn't fund the type of hard-hitting journalism we set out to do.

Today, reader support makes up about two-thirds of our budget, allows us to dig deep on stories that matter, and lets us keep our reporting free for everyone. If you value what you get from Mother Jones, please join us with a tax-deductible donation today so we can keep on doing the type of journalism 2020 demands.
Donate

FACT:

Mother Jones was founded as a nonprofit in 1976 because we knew corporations and the wealthy wouldn't fund the type of hard-hitting journalism we set out to do.

Today, reader support makes up about two-thirds of our budget, allows us to dig deep on stories that matter, and lets us keep our reporting free for everyone. If you value what you get from Mother Jones, please join us with a tax-deductible donation today so we can keep on doing the type of journalism 2020 demands.
Donate

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In July 2012, in the aftermath of the movie theater massacre in Aurora, Colorado, Mother Jones created a first-of-its-kind open-source database documenting mass shootings in the United States. Our research focused on indiscriminate rampages in public places resulting in four or more victims killed by the attacker.

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Johns Hopkins School of Public Health Survey on Gun Policy

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Johns Hopkins School of Public Health Survey on Gun Policy

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Includes numbers, statistics, and charts.

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Johns Hopkins Bloomberg School of Public Health

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A 2023 nationally representative public opinion survey from researchers at the Johns Hopkins Center for Gun Violence Solutions found broad agreement among Americans for gun violence prevention policies-regardless of their political affiliation or whether or not they own guns.

The Johns Hopkins National Survey of Gun Policy has tracked Americans' support of gun policies every two years since 2013. Despite portrayals by politicians, lobbyists, and the media of gun policy as controversial and starkly divided, survey results show that a majority of Americans support gun policies that have proven effective at or show promise for reducing gun violence.

Support for this policy increased by more than two percentage points overall since 2021.

Domestic violence protection orders (DVPOs) -sometimes referred to as domestic violence restraining orders-are civil court orders to protect victims and survivors of domestic abuse, including dating partners. Federal law prohibits anyone subject to a DVPO from purchasing or possessing firearms.

Gun owners and non-gun owners alike largely support prohibiting firearm access in these situations, at 79.2% and 81.7%, respectively.

Over the past 10 years, support among American adults for restricting people under DVPOs from owning a gun has remained near or above 80%.

Research shows that the stronger the DVPO protections, the clearer the life-saving benefits. DVPOs that require firearm removal are associated with a 12% reduction in intimate partner homicide.

An extreme risk protection order (ERPO) is a civil order with due process protections issued by a court when someone is at risk of violence (including suicide and assault).

Law enforcement-and family or household members, depending on a state's ERPO law-may petition the court to temporarily restrict a person's access to firearms when they are believed to be at elevated risk of harming themselves or others.

"ERPOs and DVPOs are two examples of how we are using evidence to inform intervention and implementation strategies to improve the lives of families and communities throughout the country," says Shannon Frattaroli, PhD `99, MPH `94, professor of Health Policy and Management.

A vast majority of Democrats (89.7%) support this policy, as do most Republicans (68.5%).

Gun owners (72.3%) and non-gun owners (78.4%) also largely support this policy.

ERPOs can also be used to address threats of mass shootings. A 2022 study that analyzed nearly 6,800 ERPO cases from six states (CA, CO, CT, FL, MD, WA) found that 10% involved the threat of killing at least three people.

Permit-to-Purchase laws, or firearm purchaser licensing, require an individual to apply for and obtain a license before purchasing a firearm. In most states with this policy, the process includes submitting an application to state or local police, getting fingerprinted, undergoing a comprehensive background check, and often involves safety training requirements.

"Requiring a license or permit to purchase a handgun reduces firearm homicides and suicides, as well as trafficking and shootings of law enforcement officers. It is one of the most effective policies we have to reduce gun violence," says Cassandra Crifasi, PhD `14, MPH, co-director of the Center for Gun Violence Solutions.

Among gun owners and Republicans, more than half support this policy.

States with strong handgun purchaser licensing laws were associated with 56% lower rates of fatal mass shooting incidents and 67% fewer mass shooting victims.

"The most quintessential safe and secure storage is a gun being unloaded, locked in a gun safe or lockbox, and the ammunition is stored separately," says Crifasi.

Research has demonstrated decreased risk for suicide among adolescents when guns are stored safely. States with child access prevention laws that require guns to be stored in a safe and secure manner have lower rates of adolescent suicide. Safe and secure firearm storage practices can also help to prevent unintentional gun injuries, homicides, and mass shootings.

Behavioral interventions-including educational campaigns, and policy interventions, like child access prevention laws-can promote safe and secure storage practices and save lives.

More than half of gun owners (58.0%) and a large majority of non-gun owners (78.9%) support requiring gun owners to keep firearms locked when not in use.

Several types of community violence intervention program models have been used to reduce gun violence through outreach by credible messengers to individuals at highest risk, mediation of disputes that could potentially lead to shootings, promotion of nonviolent responses to conflicts, assistance with social services, and life coaching.

"Despite the deep challenges faced by communities that have experienced high rates of gun violence, research has shown that investments in targeted and well-implemented public health solutions can save lives and reduce trauma from gun violence," says Daniel Webster, ScD '91, MPH, Bloomberg Professor of American Health in the Department of Health Policy and Management.

A majority of gun owners (61.8%) and Republicans (54.4%) support funding for programs that can reduce violence through conflict mediation and other social supports.

In Oakland, California, a community violence intervention program was associated with a citywide 32% reduction in shootings through 2017 that was concentrated in the areas and groups that were engaged by the program.

Concealed carry laws regulate who can carry a loaded, concealed handgun in public spaces. Permissive open and concealed carry laws are promoted as making it easier for individuals to defend themselves against crime, but these laws have been shown to increase gun violence.

"In general, violent crime increased after states loosened concealed carry permitting requirements," says Mitchell Doucette, PhD '18, assistant scientist in the Department of Health Policy and Management and director of research methods at the Center for Gun Violence Solutions. "Allowing more individuals to carry concealed guns in public-including some who would have previously been denied carry permits due to prior arrests or restraining orders-can increase inappropriate use of firearms in response to interpersonal conflicts, disputes, or other situations."

Less than a quarter of Americans supported this policy in survey data collected in 2021 and 2019 as well.

Here's how you can help push for evidence-based solutions to gun violence

Learn more about solutions to gun violence that focus on prevention strategies that, if implemented broadly, would significantly reduce gun-related death and injury.

Contact your elected representatives-at the local, state, and federal levels-to share the results of our public opinion polling on effective solutions to gun violence.

Share our social media posts about this survey to help inform your family and friends.

Stay up-to-date with the Johns Hopkins Center for Gun Violence Solutions About the Survey
The 2023 Johns Hopkins National Survey of Gun Policy was fielded from January 4 to February 6, 2023, by NORC with funding from the Robert Wood Johnson Foundation.

The Johns Hopkins National Survey of Gun Policy has tracked Americans' support of gun policies every two years since 2013. The 2023 survey included 3,096 respondents including 1,002 gun owners and 2,094 non-gun owners. The breakdown by political party affiliation of survey respondents was 730 Republicans, 1,199 Democrats, and 1,163 Independents.

Results from each of the previous year's surveys can be found at the following links:
This page was originally published on June 2, 2023, and revised on July 21, 2023.

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Americans Agree on Effective Gun Policy More than We're Led to Believe | Johns Hopkins Bloomberg School of Public Health

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Americans broadly agree on numerous gun violence prevention policies-regardless of their political affiliation or whether or not they own guns-according to a new national public opinion survey from researchers at the Johns Hopkins Center for Gun Violence Solutions.

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No article, just interactive graphs.

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Violence is a significant problem in the United States. From infants to the elderly, it affects people in all stages of life. In 1992, CDC established the National Center for Injury Prevention and Control (NCIPC) as the lead federal organization for violence prevention. CDC is committed to stopping violence before it begins.

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Includes several helpful charts, graphs, and statistics.

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Home > Topics > Gun Violence: The Impact on Public Health

Infographics

Published on: July 12, 2022. Updated on: July 12, 2022.

326 mass shootings

within the first 189 days of 2022

These interactive panels allow users to explore how gun violence has grown across the United States and become the leading cause of death for children and adolescents.

The number of firearm deaths grew by nearly 43% between 2010 and 2020 - reaching 45,222 deaths by the end of the decade. Suicide by firearms have also continued to rise alarmingly.

Between 2018 and 2021, there was a yearly average of around 513 mass shooting events. While mass shootings are often the most publicized events, they are not the primary source of gun violence.

Prior to 2020, motor vehicle accidents were consistently the leading cause of death for children and adolescents in the US. In 2021, 6.1 deaths per 100,000 people under the age of 19 years old were related to firearms.

In response to the number of deaths and injuries caused by motor vehicle accidents, numerous legislative steps have been taken to improve car and motor vehicle safety over time. Until recently, there had not been any widespread federal legislation in response to gun violence since 1994, an act that expired in 2004.

Guns are the leading cause of death for American children and adolescents: Jason E Goldstick, PhD et al., New England Journal of Medicine, "Current Causes of Death in Children and Adolescents in the United States", May 2022

Children and adolescents are defined as persons 1 to 19 years old.

For the first time, guns surpassed motor vehicle accidents as cause of death: Daniel J Flannery and Ruth W Begun, "Guns surpass motor vehicles as top cause of death for U.S. children: What parents should know", Case Western Reserve University, Jack, Joseph, and Morton Mandel School of Applied Social Sciences

Firearm vs. motor vehicle deaths: Dan Keating, The Washington Post, "Guns killed more young people than cars did for the first time in 2020", May 2022

Data in the above article is from the Centers for Disease Control and Prevention'sWeb-based Injury Statistics Query and Reporting System (WISQARS).

In 2019, one child or teen was killed with a firearm every 2 hours and 36 minutes: The Children's Defense Fund, The State of America;s Children 2021 Gun Violence, 2022

Firearm homicide rates: Scott R Kegler, PhD et al., Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, " Vital Signs: Changes in Firearm Homicide and Suicide Rates - United States, 2019-2020"

Overall, incidents of gunfire on school grounds have been on the rise since 2013. Across the US, Georgia has the highest number of gunfire occurrences on school grounds in this timeframe, resulting in 10 deaths and 38 injuries.

Mental illness is often stigmatized as being the cause of gun violence. However, only a minority of mass shooters have experienced serious mental illness. It is estimated that 96% of the common violence that occurs would continue even if the elevated risk of violence among people with mental illness was eliminated.

On June 25, 2022, President Biden signed the bipartisan gun safety bill. This new legislation aims to improve mental health support and school safety, restrict firearm access for domestic violence offenders, enable states to put in place laws that will allow authorities to take weapons from those deemed "dangerous", and toughen background checks for young gun buyers.

This infographic was reviewed by Paul Helmke, professor of practice at Indiana University's O'Neill School of Public and Environmental Affairs and founding director of the Civic Leaders Living-Learning Center.

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Gun Violence: The Impact on Public Health

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Home > Topics > Gun Violence: The Impact on Public Health Infographics Published on: July 12, 2022. Updated on: July 12, 2022. 326 mass shootings within the first 189 days of 2022 These interactive panels allow users to explore how gun violence has grown across the United States and become the leading cause of death for children and adolescents.

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Includes lots of helpful numbers, statistics, and graphs, as well as explanation of the data.

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What the data says about gun deaths in the U.S.

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More Americans died of gun-related injuries in 2021 than in any other year on record, according to the latest available statistics from the CDC.

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No article, just interactive graphs.

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Firearm homicide rates are at record high levels. Firearm homicides have a devastating impact on the safety and well-being of Americans. These deaths are preventable. CDC has released a series of prevention resources to help communities prevent violence using the best available evidence.

The figures below show the firearm homicide rates and average daily numbers of firearm homicides by month and year. The figures include provisional and final data. Provisional data are preliminary data that may not yet be complete. These data are subject to change as information continues to be collected and analyzed - as such, they are estimates that may differ from the final count. Provisional data are not final and must always be used with the understanding that numbers and information may change as the data becomes more complete. Final (annual) data are released only after CDC has received all death records from the states and has fully reviewed the data for completeness and quality.

Firearm Homicide Rates by Month, 2019-2023*

Average Daily Number of Firearm Homicides by Month, 2019-2023*

This page is updated monthly as new provisional data are released. It represents the most up-to-date data available from CDC's National Vital Statistics System (NVSS). The graphs and tables present final and provisional rates and the average daily number of firearm homicides.

National provisional counts include deaths happening within the 50 states and the District of Columbia that have been received and classified by CDC's National Center for Health Statistics. The counts may not include all deaths during a given period. Rates might also shift slightly as revised at-risk population estimates are incorporated.

Provisional firearm death data might initially be displayed after an eight-month lag to ensure a high level of completeness. For example, provisional data for January of a given year would be initially displayed in September of that same year. Provisional data are periodically updated until marked as final. Partial data refers to provisional death data that are not complete for an entire calendar year.

More information on provisional data is available through CDC WONDER.

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Violence is a significant problem in the United States. From infants to the elderly, it affects people in all stages of life. In 1992, CDC established the National Center for Injury Prevention and Control (NCIPC) as the lead federal organization for violence prevention. CDC is committed to stopping violence before it begins.

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Curbing Gun Violence: Applying Public Health Approach

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Curbing Gun Violence: Applying Public Health Approach

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New research challenges assumptions about the impact of gentrification on community safety, with findings indicating the social upheaval it can cause likely contributes to an initial uptick in gun violence.

An analysis published this week in JAMA Surgery found the incidence rate for firearm injuries in gentrifying neighborhoods was 62% higher between 2014 and 2019 than in nongentrifying neighborhoods with similar socioeconomic characteristics.

The study encompassed nearly 60,000 urban census tracts in the U.S. between 2010 and 2019, with researchers also examining firearm injury data for 2014 to 2019. A gentrifying neighborhood was defined as one located in a central part of a city where for at least two consecutive years the median housing price appreciated over the median household value for the region and median household income was at or below the 40th percentile of the median regional value. The study identified more than 14,000 census tracts as gentrifying, affecting roughly 57 million residents annually.

Researchers compared changes in firearm injury rates in gentrifying neighborhoods with those in both low-income and high-income nongentrifying neighborhoods, and found "a sharp increase in the rate of firearm injury concurrent with the gentrification process," according to the study - one not found in either of the other types of neighborhoods.

"For example, between 1 and 5 years after gentrification, firearm injury incidence increased more than 6-fold," the study says.

Active gentrification also was tied to an additional 26% increase in the incidence of firearm injuries above a baseline increase seen in nongentrifying neighborhoods.

"In the very beginning years of gentrification there's an increase in firearm violence that's associated," says study co-author Dr. Sarabeth Spitzer, a general surgery resident at Brigham and Women's Hospital in Boston and an injury prevention fellow at Brigham and Women's Gillian Reny Stepping Strong Center for Trauma Innovation. "I think this is an important finding because it allows us to potentially target high-risk neighborhoods that might be at risk of having a spike in firearm violence."

The study notes that database limitations prevented researchers from examining intent tied to firearm injuries, but indicates that the incidence of such injuries in gentrifying neighborhoods after a while began to decrease and stabilize.

"For us, this (study) is an indicator that communities are really important and communities are a part of the solution for preventing gun violence," says study co-author Molly Jarman, director of the Injury Prevention Program at the Stepping Strong Center. "People build relationships, and they settle into a rhythm with the people they see every day in their neighborhoods. If you start shifting around who lives where and who interacts with whom, then tensions that may have been managed well suddenly spill over."

Gentrification has been a controversial issue in many U.S. cities for decades. While it can have a positive impact when examining issues like poverty rate, home values and crime rates, the new study says it "may result in social disruption and alterations of social norms that can destabilize the previous social structure as prior residents experience rising costs, increasingly limited housing, and the stress associated with possible displacement into new communities."

"Together, these studies paint a nuanced picture of gentrification's association with firearm injuries, with an initial increase as prior residents are displaced and eventual stabilization and decrease in firearm injury incidence when higher-income residents predominate and firearm injuries are displaced into surrounding (low-income nongentrifying) communities," the new study says.

Spitzer and Jarman say policies that focus on increasing affordable housing and reducing the impact of resident displacement - as well as interventions that seek to rebuild cohesion within communities that have been disrupted through gentrification - could help mitigate the risk of increased gun violence.

"Gentrification, or neighborhood change, has always occurred over time, but we need to be aware of that process, recognize it when it's happening, and make sure people don't get trampled in the process," Jarman says.

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Study Points to Gentrification as Trigger for Gun Violence

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Disruption and displacement may fuel increased firearm injuries in neighborhoods experiencing gentrification, according to a new analysis.

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6 Real Ways to We Can Reduce Gun Violence in America

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America is the only developed country with such high rates of gun violence. Here are six steps we can take to reduce those numbers.

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Gun Control Works: The Science to Prove it

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Gun Control Works: The Science to Prove it

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AP

There are more than 38,000 gun deaths in the US every year, and approximately 85,000 non-fatal injuries.

Despite some restrictions on gun research, scientists have sought to evaluate how certain policies affect gun deaths.

Policies that seem to reduce rates of gun violence include stricter background checks, limiting access to dangerous weapons, and prohibiting domestic abusers from owning weapons.

On Sunday, a gunman opened fire at a Madden NFL video game tournament in Jacksonville, Florida. The shooter killed at least two victims and himself, and shot at least nine others.

As the country tries to figure out what - if anything - can be done in the wake of yet another mass shooting, it's worth taking a look at the evidence we have on the effects of gun regulations.

There are close to as many guns in the US as there are people. There may be more, or there may be fewer, depending on which study you look at - there's no exact count, since there isn't a national database of gun purchases or firearm owners, and federal law does not require a prospective gun owner to get a license or permit.

That's one of the many obstacles researchers come up against when trying to evaluate why so many people die from guns in the US.

But what they do know is that the number of gun deaths in the US is incredibly high. Most of these deaths are not from mass shootings, but from firearm suicides and murders. According to the American Public Health Association, guns kill more than 38,000 people per year and cause approximately 85,000 non-fatal injuries.

There's still a lot we don't know about this recent recent shooting, including whether the shooter purchased his weapon legally or if any common policy recommendations would have stopped him from obtaining a weapon.

Yet we do have evidence on effective policies that could have helped prevent some incidents. Despite some congressional limitations on gun research, scientists have sought to evaluate the effects of gun-control legislation in the US and in other places around the world.

Here's what the data shows.

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David Gray/Reuters

Scott Barbour/Getty Images

Features Gun Control Parkland

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Gun control really works - here's the science to prove it

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There are more than 38,000 gun deaths in the US every year, and approximately 85,000 non-fatal injuries. Despite some restrictions on gun research, scientists have sought to evaluate how certain policies affect gun deaths. Policies that seem to reduce rates of gun violence include stricter background checks, limiting access to dangerous weapons, and prohibiting domestic abusers from owning weapons.

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Four Countries with Gun Control - What American Can Learn from Them

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Four Countries with Gun Control - What American Can Learn from Them

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Thirty people will be shot dead in America today. On average. It could be more. If it's less, then more will die tomorrow. Or the next day.

The United States's gun homicide rate is 25 times higher than other high-income countries, according to a recent study.

Americans are divided on whether the country's gun deaths could be reduced through tougher laws on gun ownership. Liberals argue that legal restrictions on gun ownership could save lives. Conservatives say that tougher gun laws would do nothing to change the behaviour of violent criminals.

Even the 2012 Sandy Hook school shooting that left 20 first-graders dead was not enough to convince American lawmakers to pass new gun control laws, with many people seeing the ownership of guns as a crucial check on government tyranny. The country's highest court has ruled that outright bans on civilian ownership of handguns are unconstitutional.

After similar mass shootings, other countries have taken more dramatic steps to regulate gun ownership. A look at four countries show that tougher gun laws have been central to these efforts, but that enforcement and culture may also play important roles in preventing violence.

UK

From the moment 43-year-old Thomas Hamilton unloaded his legally held arsenal of handguns on children and staff at Dunblane primary school on 13 March 1996, gun control was on the cards.

Nothing like Dunblane - a massacre of 16 five- and six-year-olds, along with the teacher who tried to protect them - had taken place before in Britain. The shock and collective grief of the whole nation resonated from the northernmost point of Scotland to the tip of Cornwall. This was not the United States, where by 1996, classroom shootings had occurred in many places including Nashville, San Diego and South Carolina.

Gwen Mayor died with 16 of her young pupils at the school in Dunblane, Scotland. Photograph: PNR/PA

As grief turned to a national anger, public debate focused on how someone like Hamilton, a former Scout leader who had been ostracised because of his suspicious behaviour with young boys, had been allowed to own such lethal weapons.

Public petitions, most notably by the Snowdrop Campaign, founded by friends of the bereaved families, called for a total ban on the private ownership and use of handguns in the UK. Signed by 750,000 people it was symbolic of the weight of public opinion.

Nine years before Dunblane, there had been Hungerford, where Michael Ryan went on a rampage through the Berkshire town, killing 16 people in a series of random shootings before turning the gun on himself. He had been carrying a handgun and two semi automatic rifles, for which he had firearms certificates.

The aftermath of Hungerford brought to an end the right to own semi-automatic firearms in Britain; they were banned along with pump action weapons, and registration became mandatory for shotgun owners.

With Dunblane the focus turned to handguns - held by tens of thousands who took part in pistol shooting across the country. The Conservative then prime minister, John Major, passed the Firearms (Amendment) Act 1997 after the Cullen inquiry into the massacre. It banned all cartridge ammunition handguns, except 22 calibre single-shot weapons.

But with the landslide election of Labour and Tony Blair the same year, the law was tightened further, and the remaining .22 cartridge handguns were also banned. The decision, supported by a majority of the public, all but wiped out target shooting as a sport in the UK.

Dave Thompson, chief constable of the West Midlands, and the lead on gun crime for the National Association of Chief Constables, said: "The legislation coincided very well with a culture."

Overnight, however, about 200,000 owners of handguns, most of whom kept them for pistol shooting, found their weapon banned and their pastime wiped out. All small-bore pistols and rifles used by target shooters were included in the ban. Penalties for anyone in possession of an illegal firearm were tough - from heavy fines to prison terms of 10 years.

The hostility of those involved in the sport to what they term the draconian legislation is still strong, 20 years after Dunblane. Mike Wells, secretary of the Sportsman's Association of Great Britain and Northern Ireland, set up in 1996 to counter public pressure for a ban on handguns, said politicians had been driven by a need to show they were doing something but their actions did nothing to stop the criminal use of guns. "It never, never has any effect. The criminal underworld in England, the drug dealers ... have all got guns, but they are illegal guns," he said.

Mark Mastaglio, an expert on firearms who worked for the Forensic Science Service for 20 years, said there was no evidence that the ban on handguns after Dunblane had done anything to cut the criminal use of firearms. "It was very rare that there was ever leakage from the licensed gun owners to the criminal fraternity. Most guns used by criminal are either illegally imported or converted weapons. And that remains the case today," said Mastaglio.

Crime statistics in the years after the ban was introduced appear to support the theory that it had little impact. Gun crime rose sharply, to peak at 24,094 offences in 2003/4. After that the number of crimes in which a firearm was involved fell consistently, to 4,779 offences in 2013. In the year ending September 2015 there was a small rise of 4% to 4,994 offences.

Thompson said the legislation was only part of it: law enforcement agencies had to prove they would carry through on the tough penalties and there was also poor policing of gang areas, and poor ballistics records and analysis. Both were addressed in the early 2000s, when there was a huge decline in gun crime, he said.

But there has been only one mass shooting in the UK - in Whitehaven, Cumbria, in 2010, during which Derrick Bird killed 12 people - since Dunblane.

Mastaglio said: "Dunblane was certainly a turning point. It was a huge piece of legislation, and had a huge impact on registered gun owners in the UK. We now have one of the most stringent set of firearms legislation in the world - only Japan has tougher laws."

Japan

Japan has what may be the closest any country comes to "zero-tolerance" of gun ownership - a policy that experts say contribute its enviously low rates of gun crime. As of 2011, legal gun ownership stood at 271,000, according to police records, in a country of 127 million people.

There were six reported gun deaths in Japan in 2014, according to the National Police Agency. In 2006 just two people were killed in gun attacks; when the number rose to 22 in 2007 it prompted a bout of national soul-searching.
In his seminal 1993 paper for the Asia Pacific Law Review, whose conclusions still hold true more than 20 years later, David Kopel described Japanese gun control laws as "the most stringent in the democratic world".

The 1958 law on the possession of swords and firearms states: "No one shall possess a firearm or firearms or a sword or swords." Among the few exceptions are shotguns, but here too, the restrictions would cause outrage among American gun owners.

Before they can even lay hands on a shotgun for hunting and sport shooting, prospective owners must attend classes and pass written and practical exams. They must then undergo psychological assessments to determine they are fit to own a firearm. Police background checks are exhaustive and even extend to the gun owners' relatives.

The aim, according to Kopel, is to make possession of a shotgun so complex and drawn out that few people believe it worthwhile applying for one.

Civilian ownership of handguns is banned. The few violations reported in the media usually involve members of the country's many crime syndicates who have managed to smuggle them in from abroad.

But Japan was not always a low-crime, gun-intolerant nation. Guns quickly became the weapon of choice for feuding warlords after Portuguese traders introduced them to the country's south-west in the early 1500s. Over time, Japan improved the design and performance of firearms and began mass producing them.

The beginning of the end of widespread gun ownership came when the feudal warlord Toyotomi Hideyoshi (1537-1598) unified Japan, then disarmed the peasant population by banning civilians from owning swords and firearms in 1588.

Seized plastic handguns which were created using 3D printing technology are displayed by police in Yokohama, south of Tokyo. Photograph: Kyodo/Reuters

"The shogunate banned them because they were fearful of the consequences of having guns in hands of an angry populace," said Robert Whiting, author of Tokyo Underworld. The quid pro quo, Whiting added, was that the general population's safety would be assured provided they paid their taxes.

The notion that gun ownership should be limited to the authorities survived Japanese militarism and carried through to the postwar period. Japanese police officers did not begin carrying pistols until 1946, with the permission of the US-led occupation authorities.

Despite sporadic outbreaks of gun violence, Japan's yakuza crime syndicates are reluctant to build up caches of firearms. Threatening a rival with a gun is often seen as an "unmanly" departure from the yakuza's traditional code of honour, to which even modern-day mobsters try to adhere, according to Whiting.

Kopel says Japan's gun laws do not necessarily prevent criminals - especially the yakuza - from acquiring guns. But, he added, even gangsters "see themselves as within the social system, in a broad sense. Even when breaking the law, they still play by certain rules of society."

Australia

Eerily, Australia's moment of truth also occurred almost exactly 20 years ago, when a shooting spree in a gift shop in Port Arthur, Tasmania, resulted in 35 people dying in about half an hour. It was the worst mass shooting by one person in Australia's history. The killer, Martin Bryant, received a sentence of 35 terms of life imprisonment.

Less than two weeks later, Australia's then prime minister, John Howard, announced a sweeping package of gun reforms in a country where guns had long been considered an essential prop in the national mythology of life in the bush.

"Port Arthur we acted on," said Tim Fischer, then Howard's deputy prime minister. "The USA is not prepared to act on their tragedies."

Before Port Arthur, most states had a weak licensing system and no requirement to register guns. Howard proposed each state and territory should introduce and enforce a firearm licensing and registration system which required people to have a "genuine reason" for having a firearm, such as sport or target shooting, recreational hunting or being a farmer.

Howard also introduced a national gun buyback policy for all weapons that did not comply, which led to the buying and melting down of more than 650,000 firearms at a cost of A$350m (now £185m). One study said the buyback cut the rate of firearm suicides by 74% in the first 10 years.

There have been no mass shootings in the 20 years since Port Arthur; in the 20 years before the massacre there had been 13.

However, since the 1996 National Firearms Agreement, four states have moved to wind back the mandatory 28 days "cooling off" period between applying for and buying a gun, a trend Howard has described as disturbing.

One of those states was Tasmania.

Germany

Germany's relationship with firearms is intriguing: while there are a lot of guns in the country, they don't seem to kill a lot of people.

Germany has one of the highest weapons-per-head rates in the world. In 2014, 5.5m legal weapons were registered as being in the hands of 1.45 million private individuals. The country's police union estimates the number of illegal weapons in the country to be considerably higher, around 20m. According to GunPolicy.org, this puts Germany at 15th place out of 175 nations in terms of guns per capita.

Gun ownership is more widespread in the west of the country than in the former East Germany, where private gun ownership was illegal before the fall of the Berlin Wall. Recent reports suggest that gun ownership is rapidly increasing still: between November 2015 and February 2016 alone, 20,000 applications were filed for new gun licences.

Yet in Germany gun homicide rate is one of the lowest in Europe: a death rate of 0.05 per 1,000 people, compared with 3.34 in the US. In fact, incidents of gun crime, including both weapons being fired and used to threaten people, have declined by almost a quarter since 2010 (pdf).

Experts put this trend down to a number of tweaks to gun law in the wake of high-profile shootings.

In 2002, a 19-year-old student in the Thuringian state capital, Erfurt, shot dead 16 people at the school that had recently expelled him, using weapons he had obtained from his gun club.

Within a year, the law regulating access to guns had been changed: Germany is the only country in the world where anyone under the age of 25 who applies for their first firearms licence must undergo a psychiatric evaluation with a trained counsellor, involving personality and anger management tests.

Experienced hunters or sports shooters over the age of 25 may be called in for psychiatric tests if they display certain kinds of behaviour, such as being caught drink-driving.

A further tweak to the gun law in 2008 means that inherited guns have to be fitted with a state-of-the-art blocking mechanism, making them unusable.

A tribute to the victim of the school shooting in Winnenden, near Stuttgart, by 17-year-old Tim Kretschmer. Photograph: Alex Grimm/Getty Images

There were calls for even more stringent laws after 17-year-old Tim Kretschmer shot dead 15 at a school in Winnenden near Stuttgart in March 2009. Kretschmer had obtained his weapons from an arsenal of 15 guns kept by his father, who was a member of a shooting club.

Under the newly amended weapons act, it is now harder for individuals to own multiple weapons. A national gun register was established for the first time in 2013 - previously, records of gun ownership were kept only at regional level.

Police officers can now also visit registered gun owners' home for spot checks without warning. Guns in private possessions have to be locked away in a safe, with the security code or location of the key known only to the owner of the gun.

A number of politicians went even further in the wake of the Winnenden massacre, calling for a complete ban on the storage of firearms in private homes. Even hunters or sportsmen, they argued, should have to deposit their arms at centralised depots.

The proposal was rejected after protests from hunters, who argued that they frequently need access to weapons at short notice, such as when wildlife was involved in traffic accidents.

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Four countries with gun control - and what America could learn from them

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The UK, Australia, Japan and Germany have all taken measures to reduce gun homicides. Can the US learn anything from them?

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Columbia University Department of Psychiatry

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There have already been more than 300 mass shootings in the United States this year-the latest at a 4th of July parade in the Highland Park suburb of Chicago that left seven people dead and dozens injured. As the nation reckons with these increasingly common public massacres, many blame mental illness as the fundamental cause.

The reality is that people with mental illness account for a very small proportion of perpetrators of mass shootings in the U.S., says Ragy Girgis, MD, associate professor of clinical psychiatry in the Columbia University Department of Psychiatry and the New York State Psychiatric Institute.

In 2021, Dr. Girgis, an expert in severe mental illness, and colleagues from Columbia's Center of Prevention and Evaluation authored the first report on mass shootings using the Columbia Mass Murder Database (CMMD), which examined the relationship between serious mental illness and mass shootings.

Columbia Psychiatry News spoke with Dr. Girgis about the role of mental illness in mass shootings, the motivations behind mass murder, why the perpetrators of mass violence use guns, and more.

Are people with mental health disorders more likely to commit mass shootings or mass murder?

The public tends to link serious mental illnesses, like schizophrenia or psychotic disorders, with violence and mass shootings. But serious mental illness-specifically psychosis-is not a key factor in most mass shootings or other types of mass murder. Approximately 5% of mass shootings are related to severe mental illness. And although a much larger number of mass shootings (about 25%) are associated with non-psychotic psychiatric or neurological illnesses, including depression, and an estimated 23% with substance use, in most cases these conditions are incidental.

Additionally, as we demonstrated in our paper, the contribution of mental illness to mass shootings has decreased over time. The data suggest that while it is critical that we continue to identify those individuals with mental illness and substance use disorders at high risk for violence and prevent the perpetration of violence, other risk factors, such as a history of legal problems, challenges coping with severe and acute life stressors, and the epidemic of the combination of nihilism, emptiness, anger, and a desire for notoriety among young men, seem a more useful focus for prevention and policy than an emphasis on serious mental illness, which leads to public fear and stigmatization.

Columbia Mass Murder Database

Findings from the Columbia database help dispel the myth that having a severe psychiatric illness is predictive of who will perpetrate mass murder

Why does the public erroneously link mental illness with mass shootings and with violence in general?

A lot of people who aren't experts in mental illness tend to equate bad behavior, and often immorality, with mental illness. These are a false equivalence. I think it's incumbent on us, especially when we're talking about something as horrible as mass shootings, to make sure other people understand that all bad behavior, and certainly not evil and pure psychopathy, is not the same as mental illness.

What is the Columbia Mass Murder Database?

The Columbia database, compiled by researchers at the New York State Psychiatric Institute and the Columbia University Irving Medical Center, is the largest catalog of mass shootings and mass murder in the world. We have approximately 1,800 entries, including any mass shooting or murder reported between 1900 and 2019 worldwide that resulted in at least three deaths (not including the perpetrator).

The major findings from our database are that the vast majority of mass shootings and mass murder are committed by people without mental illness, and certainly not psychotic illness, and when a person with severe mental illness commits a mass murder, they're much less likely to use firearms than other methods, such as arson or knives.

How is CMMD different from other databases tracking this topic?

The CMMD is different because we examined mass murder before the modern period until the present to assess changes over time, included mass murder committed by means other than firearms so we could examine what is specific about mass shootings, and collected information on mass shootings and mass murder committed worldwide. We were comprehensive by collating names and events reported in all types of databases, including popular databases, but we made sure that our data were robust by only keeping names and events, and information on these events, included in reputable news sources, as well as court and police records.

Why do people use guns when they commit mass murder?

There's solid evidence that nearly half of all mass shootings are associated with suicide by perpetrator, or what they call "suicide by cop." Guns are the most successful method of killing oneself.So, one main reason people choose guns is they want to die. In about 30% of mass shootings, perpetrators kill themselves with their own gun; about 10% are suicide by cop. However, while guns are the most effective method of suicide, they're not as effective at killing a large number of other people. Mass murder committed with means other than firearms, such as bombing, arson, vehicles, even stabbings, is about two and a half times more deadly than mass murder committed with firearms.

Another reason people use firearms to carry out mass shootings (aside from availability) is our cultural romanticization of violence. As a result, the movie, television, music, and video game industries will have to play a role in any efforts to decrease gun assaults.

What tends to be the motivations behind mass shootings?

First, understand that mental illness as the primary cause of any mass murder, especially mass shooting, is uncommon. Half of all mass shootings are associated with no red flags-no diagnosed mental illness, no substance use, no history of criminality, nothing. They're generally committed by middle-aged men who are responding to a severe and acute stressor, so they're not planned, which makes them very difficult to prevent. So, we must look much further upstream.

This is why it is important to consider ways to manage gun availability, for example. The yearly prevalence of the incidence of mass murder was stable at about 7 per billion people, or seven mass shootings for every billion people, between 1900 and about 1970. Then between about 1970 and 2019, the incidence increased by four times, so now mass shootings occur about 28 times per billion people around the world. One might say that this is because of the availability of guns in general, and automatic weapons, in particular, especially in the U.S. where these weapons became more available to the general population during this time period. Mass murder committed with means other than firearms also grew, but at a slightly slower rate. The other thing that one must consider is that most mass shootings are committed with non-automatic weapons, making them the weapons of choice, and supporting the notion that gun availability is a primary contributor to method of mass murder.

You have said that the media's publishing personal details about the perpetrators encourages violent behavior and is harmful. Please explain.

If we're talking about the mass shooters that we hear the most about, such as school shooters and other individuals who commit such public crimes, we have examined a number of these cases and are seeing a pattern. As opposed to most mass shooters, these perpetrators tend to be younger males who are often nihilistic, empty, angry, feel rejected by society, blame society for their rejection, and harbor a strong desire for notoriety. They want to make their mark on the world that will elevate them to the status they believe they are entitled to and deserve.

Sensationalized headlines, photographs, and breaking personal information about the shooters, victims, and acts themselves provide the notoriety perpetrators of mass shootings crave and can spark others to carry out similar acts. Refraining from publishing any personal information about mass shooters may be one of the easiest, quickest, and most effective interventions for decreasing mass shootings, especially school and other public shootings, which comprise about 10% of all mass shootings.

Is there a difference in violence committed by women vs. violence committed by men?

Mental illness makes more of a difference when we're talking about violence committed by women, who are responsible for about 5% to 8% of mass murder. This is because the mechanism by which mental illness and substances of abuse, when they are causative, contribute to violence is by impairing impulse control. Research has shown that the lack of impulse control caused by mental illness and substances has a greater effect on women than on men, likely because men, especially younger men, tend to already be quite impulsive. It is also important to note that when women perpetrate mass murder, they are much less likely to use firearms than other methods, consistent with our thesis that mental illness is minimally responsible for mass shootings.
Ragy Girgis, MD, MS, is an associate professor of clinical psychiatry at the Columbia University Department of Psychiatry and New York State Psychiatric Institute. He is an expert in severe mental illness, and in particular schizophrenia, with a focus on brain imaging as well as the development of experimental treatments in individuals with early psychosis.

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Is There a Link Between Mental Health and Mass Shootings?

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Findings from the Columbia database help dispel the myth that having a severe psychiatric illness is predictive of who will perpetrate mass murder.

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Ban on Assault Weapons - Why did it expire?

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Ban on Assault Weapons - Why did it expire?

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On the presidential campaign trail in Iowa and on the op-ed page of The New York Times, former Vice President Joe Biden has made the case for going back to a nationwide ban on assault weapons and making it "even stronger."

Some have reacted with quizzical expressions: "Back?" "Stronger?"

Yes. Twenty five years ago, when Biden was chairman of the Senate Judiciary Committee, Congress passed the Public Safety and Recreational Firearms Use Protection Act - commonly called the assault weapons ban.

It prohibited the manufacture or sale for civilian use of certain semi-automatic weapons. The act also banned magazines that could accommodate 10 rounds or more.

"Assault weapons - military-style firearms designed to fire rapidly - are a threat to our national security, and we should treat them as such," Biden wrote in his weekend op-ed. "Anyone who pretends there's nothing we can do is lying - and holding that view should be disqualifying for anyone seeking to lead our country."

The earlier ban was enacted as a subsection of the Violent Crime Control and Law Enforcement Act of 1994, an election-year package meant to show that Democrats were "tough on crime."

Times were different then. More Americans said they worried about violent crime and the threat associated with criminals armed with powerful weapons.

So among other things, Biden and Democrats got behind stricter sentencing guidelines and expanding the category of federal crimes punishable with the death penalty.

At the time, Biden defended the legislation against charges of weakness by saying: "We do everything but hang people for jaywalking in this bill."

Eagerness to tackle crime rates made at least some Democrats in 1994 also willing to address the role of guns - particularly those perceived as more dangerous and which had been turned on innocent citizens.

In his Times op-ed, Biden salutes the senator often credited as the architect of the 1994 ban, Dianne Feinstein of California. Then, in just her second year as a senator, Feinstein took over as chief sponsor of a bill originally offered by Ohio Democrat Howard Metzenbaum in 1989 after a mass shooting on a schoolyard in Stockton, Calif.

That shooting took the lives of five children and injured 28 others and a teacher.

Feinstein's resolve to carry this legislation forward was bolstered when eight more people were killed and six injured in another California horror, this time at a law firm in San Francisco.

"It was the 1993 mass shooting at 101 California Street," she later said. "That was the tipping point for me. That's what really motivated me to push for a ban on assault weapons."

But to secure the votes for passage, the ban's sponsors agreed to allow those who already had these guns to keep them. Biden now says he would initiate a buyback program instead, although it isn't clear how that might work or how effective it might be.

Sponsors also accepted a "sunset provision" by which the 1994 ban would automatically expire after 10 years unless renewed by a vote of Congress. Even so, the ban only got 52 votes in the Senate on its way to inclusion in the overall crime bill, which was signed into law by President Bill Clinton.
The world turns
By the time those 10 years had passed, however, the political climate had changed.

Republicans by then had held the House throughout the period and the Senate for all but 18 months. The GOP had just increased its numbers in both chambers in the midterm elections of 2002, a political season dominated by anxiety after the terror attacks of Sept. 11, 2001.

Feinstein and others made numerous efforts to restore the ban that year and over the next several years. When Barack Obama was elected president in 2008 he made renewing the ban part of his agenda. Efforts were mounted again after the Sandy Hook Elementary School shooting in December 2012, but none bore fruit.

The attempt to reinstate the ban after Sandy Hook attracted 12 fewer votes in the Senate than Feinstein had mustered in an attempt to renew the ban in 2004.
Legacy
Biden has come to rue much about the 1994 legislation.

It led to a surge in prison populations that has since been reviled as "mass incarceration" that proved disproportionately injurious to African Americans. Biden has been upbraided for it by his rivals since this year's Democratic presidential contest began.

But in 1994, the most immediate consequence of the crime bill was a backlash against the assault weapons ban among gun advocates.

The midterm elections that fall were already difficult for the Democrats, who had to defend the new North American Free Trade Agreement, some higher taxes and a scandal in the House banking system.

Adding in the blowback over the assault weapons ban - particularly intense in the rural South and West - turned the midterm into a debacle for Democrats. They lost control of both the Senate and House, the latter for the first time in 40 years.

Among those defeated that fall was 42-year veteran Jack Brooks, a Texas Democrat who had been chairman of the House Judiciary Committee when the crime bill passed.

Brooks had tried to have the assault weapons ban removed from the bill and was himself a longtime member of the National Rifle Association. But it was not enough to save him in rural Texas that fall.

The sense that gun control cost Democrats votes intensified after the presidential election of 2000. That year's Democratic nominee, Vice President Al Gore of Tennessee, could not carry his home state or other swing states won by the Clinton-Gore ticket in the 1990s.

Gore surely paid a price for his stances on coal and other issues as well, but much of the blame for his narrow Electoral College loss fell on voters' response to his positions on guns.

In 2004, when the Republican Congress refused to renew the assault weapons ban, the Democrats' presidential nominee was Massachusetts Sen. John Kerry, who sought to style himself as a hunter and gun owner but nonetheless supported the ban and its renewal.

The Electoral College that year looked a lot like 2000, and Kerry could have won had he carried Ohio. But in that state, as elsewhere, a poor showing in rural counties doomed the Democratic nominee.
What effect did the ban have?
Today we can look back at the 10 years of the ban and at 15 years since its expiration.

Critics of the ban have argued that it violated Second Amendment rights while accomplishing little, and evidence suggests it did not do much to reduce the incidence of gun violence overall.

What it did, its defenders reply, was reduce the number of people killed in mass shootings.

Both sides of the debate claim vindication in subsequent research. Comparing the various studies is difficult because they use different definitions of "assault weapon" and mass shooting.

One thing is clear: Assault weapons like those once restricted by the ban were used in the most memorable events that have defined the current era of random massacre, including at Sandy Hook in 2012, Marjory Stoneman Douglas High School in Parkland, Fla., in 2018 - and this month in Texas and Ohio.

They are the emblem of the nation's soul sickness over these tragedies.

So today Democratic candidates stand by the assault weapons ban, despite its political costs in the past and potential costs in the future.

President Trump now calls for having "strong background checks" for gun purchases but does not call for new restrictions on assault weapons.

"There's no political appetite for it," he says.

But many surveys show the opposite.

A survey done this month by Morning Consult and Politico found 7 in 10 voters, including 54% of Republicans, supported "a ban on assault-style weapons." Even higher percentages supported a ban on high-capacity magazines and a purchase age of at least 21 for any gun. The survey, done Aug. 5-7, included 1,960 interviews and had a margin of error of two percentage points.

Given that similar percents supported a ban after the shootings of the early 1990s and after the Sandy Hook and Parkland tragedies, there would seem to be a long-term pattern.

Whether that can be translated into legislative action by the current political establishment is - as always - another question.

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The U.S. Once Had A Ban On Assault Weapons - Why Did It Expire?

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On the presidential campaign trail in Iowa and on the op-ed page of The New York Times , former Vice President Joe Biden has made the case for going back to a nationwide ban on assault weapons and making it "even stronger." Some have reacted with quizzical expressions: "Back?" "Stronger?"

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TED Talk: A Solution to gun violence found in US history (VIDEO)

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TED Talk: A Solution to gun violence found in US history (VIDEO)

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Gun safety advocate reviews the history of guns in America and proposes a solution.

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David Farrell: A solution to gun violence found in US history | TED Talk

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Guns weren’t always the contentious issue they are today in the US. Forty years ago, guns were primarily used for sport and recreation, and mass shootings were a rarity. Much has changed since then, and while there’s a lot of debate around how to put an end to gun violence, there has yet to be a sol…

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The Long History of Failed Gun Control Legislation

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The Long History of Failed Gun Control Legislation

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It has come to this: Volodymyr Zelensky, Ukraine's heroic president, who is in the midst of a brutal and deadly war, sends his condolences to America. "Deeply saddened by the news of the murder of innocent children in Texas," Zelensky tweeted after what is already known as the Texas School Massacre.

Tuesday's murders of 19 children and 2 teachers in a Uvalde, Tex., elementary school by a teenager wielding an assault rifle has reignited the gun control debate-just days after it was supposedly reignited by the racist killings of 10 African American customers at a supermarket in Buffalo, N.Y., also by a teenager wielding an assault rifle.

As of Wednesday morning, according to the nonprofit Gun Violence Archive, 17,198 people had been killed by guns in America so far in 2022, more than half by suicide, and there had been 213 mass shootings.

Such tragedies might prompt some countries to change, to pass new gun control laws in an effort to avoid future massacres. But America has a long history of failed attempts at such legislation, despite approaching it from various angles-domestic violence, 3D home printed guns, the rapid fire of semiautomatic weapons, longer background checks, keeping guns away from terrorists.

Opposition from Second Amendment hard-liners and the deep-pocketed National Rifle Association (NRA) has kept gun controllegislation from passing since the 1994 assault weapons ban-which "sunsetted" in 2004 and was not renewed. Not one major gun-control bill has passed Congress since the 2012 Sandy Hook massacre (states, however, have been more successful in passing laws to both tighten or loosen regulations).

"Being reasonably close to people who are out in the field working on gun violence prevention and people who are survivors of gun violence themselves, I am thinking especially about what it's like for them to see these incredibly painful traumatic events," says Jonathan Jay, a Boston University School of Public Health assistant professor of community health sciences, who studies the causes of gun violence in cities and racial disparities in gun violence exposure. "These are retraumatizing-and reminders of the ways in which our public policy has not put community safety above some other roles."

He emphasizes that gun violence costs thousands of lives per year beyond mass shootings, and that the easy availability of guns has ripple effects, spreading trauma across communities of all demographics.

"Because guns are so widely available, it is pretty easy for people to bring a gun to a situation, for a gun to be involved at a moment when someone is at their worst," Jay says. "Whether that's a teenager who has been bullied or a person who is contemplating suicide or an argument in a neighborhood that gets out of hand, those momentary states of mind can become lethal with a gun. Disputes that might not have ended in a fistfight or any physical violence at all can become lethal or life-changing with a gun.

"The case for these measures is much, much wider than these really traumatic mass shooting events," he says.

After the Uvalde massacre, Senator Chuck Schumer (D-N.Y.), Senate majority leader, said he's going to bring background checks up for a vote again. But there is little chance it will pass. Meanwhile, Texas Republican Governor Greg Abbott, Senator Ted Cruz (R-Tex.), and former President Donald Trump are set to speak at a NRA gun-rights conference in Houston on Friday.

Here are some of the most notable failures of gun control legislation over the last decade (and one or two very small successes):

Post Sandy Hook regulations

After 20 first-graders and 6 others were murdered at Sandy Hook Elementary School in December 2012, President Barack Obama and Democrats attempted to tighten regulations on assault weapons, limit the capacity of magazines, and tighten background checks. All their bills failed in the Senate in April 2013, on what Obama called "a pretty shameful day. "

Domestic gun violence prevention bills

In 2014, Senate Republicans defeated a bill that would have funded states' efforts to keep guns out of the hands of domestic abusers and a law that would have banned those under temporary restraining orders from buying or possessing guns.

Home-printed gun scrutiny

That same year, 2014, the Republican-controlled House stopped a proposal that would have required serial numbers on homemade guns, such as those made with 3D printers; the bill never even got out of committee.

Keeping guns away from terrorists

In 2015, the Republican-led Senate defeated a bill that would have banned people on a federal terrorism watch list from buying firearms. Opponents of the "no fly, no buy" bill noted the many errors and inconsistencies on the watch list.

Gun trafficking as a federal crime

In 2015 and 2021, Democrats proposed making gun trafficking a federal crime and increased penalties for those who buy guns for felons and others prohibited from owning them, known as "straw buyers." None of the proposals passed.

Expanding background checks

In 2015 and 2016, after mass shootings in San Bernardino, Calif., and at the Pulse Nightclub in Orlando, Fla, Democrats proposed applying background checks to gun shows and private sales, where many gun transactions happen without scrutiny. All failed, as did weaker measures proposed by Republicans. A similar bill on gun shows also failed in 2017, and several subsequent proposals have gone nowhere against NRA opposition.

Record reporting improvements

After a shooter killed 26 at a church in Sutherland Springs, Texas, in 2017, with guns he was able to buy in spite of a domestic violence conviction, even the NRA backed a set of minor improvements to the reporting of criminal and mental health records to the background check system. The changes passed Congress as part of a larger spending bill signed into law by President Trump.

"Smart gun" requirements

A bill introduced by Democrats in 2017, after the mass shooting at a country music festival in Las Vegas, would have required gun manufacturers to equip their product with available technologies ensuring that only the proper owner could fire the gun. This would keep children and other family members from firing them as well as render them useless if stolen. It failed.

Bumpstock ban

The Las Vegas shooter used devices known as bump stocks that allow semiautomatic weapons to fire essentially as fast as fully automatic ones. He killed 60 people with semiautomatic rifles equipped with bump stocks. The legislation never passed, but the Trump administration banned the devices through regulation.

Extending background check time limit

Multiple attempts have been made to extend the three-day maximum on federal background checks, after which sales are allowed to proceed. The gunman who killed nine members of a Bible study group at a Black church in Charleston, S.C., in 2015 was able to purchase his handgun thanks to this loophole. None of the bills have passed.

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The Long, Failed History of Gun Control Legislation

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Terrorism, domestic violence, school shootings, 3D printed guns-none of them have been enough to win the support of Republicans resistant to gun control reforms

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Parkland Survivor on Why This Generation Needs Gun Control

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Parkland Survivor on Why This Generation Needs Gun Control

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In an exclusive op-ed for Teen Vogue's gun control issue, Parkland survivor and activist X González shares why young people are stepping up for gun control.

On Wednesday, February 14, 17 students and faculty at Marjory Stoneman Douglas High School in Parkland, Florida, were gunned down on the campus where I also attend school. Their names were Alyssa Alhadeff, Scott Beigel, Martin Duque, Nicholas Dworet, Aaron Feis, Jaime Guttenberg, Chris Hixon, Luke Hoyer, Cara Loughran, Gina Montalto, Joaquin Oliver, Alaina Petty, Meadow Pollack, Helena Ramsay, Carmen Schentrup, Alex Schachter, and Peter Wang. Our lives and our community are forever changed due to this senseless tragedy - one we know could have been prevented.

Since that day, many fellow survivors and I have not kept quiet. We have taken the media by storm through appearances and interviews, met with state and federal lawmakers to beg them to enact much stricter gun control laws, and been joined in protest by students around the nation and the world who've held school walkouts and demonstrations that exhibit the energy and power of young people in full force.

In just a few weeks' time, we, the youth of the United States, have built a new movement to denounce gun violence and call for safety in all of our communities.

And this is only the beginning.

A Generation Raised on Violence

I was born in 1999, just a few months after 13 people were left dead after a shooting at Columbine High School in Colorado. From 1966 to the Valentine's Day that my school proved to be less than bulletproof, nearly 1,100 people have been killed in mass public shootings in the U.S.. From the deaths of 26 at Sandy Hook Elementary in Newtown, Connecticut, in 2012, to the 2016 massacre of mostly Latinx people at Pulse nightclub in Orlando, to the loss of 58 lives at an outdoor concert in Las Vegas last year, we've seen mass shootings play out again and again and again.

Gun violence has torn up many communities across the country, mainly due to negligence on behalf of local and national government to properly regulate access to guns, ignorance to their constituents' varying situations, and willingness to take money from organizations that very clearly do not have the best intentions for the future of the United States.

The problem of gun violence goes beyond the countless demographic differences between people. Any way you cut it, one of the biggest threats to life as a teen in the U.S. today is being shot. People have been shot to death en masse in grocery stores, movie theaters, nightclubs, and libraries, on school campuses and front porches, and at concerts - anywhere and everywhere, regardless of socioeconomic background, skin color, age, ethnicity, religion, gender, geographical location.

Young people in this country have experienced gun violence for their entire lives, only to be faced with a number of representatives and officials who have been seduced by the gun lobby or have generally failed to make effective change. The pro-gun propaganda peddled by the National Rifle Association feeds myths about gun ownership, and these myths arguably perpetuate the suffering of thousands of Americans each year.

After all of this pain and all of this death caused by gun violence, it seems as if the kids are the only ones who still have the energy to make change.

What Do We Mean When We Say "Change"?

Parkland youth are working to end gun violence through actions like the March for Our Lives event in Washington, D.C., on March 24 and the ongoing #NeverAgain movement. I'm one of them. Fed up with the apathy pervading this country, we realized that we don't need to wait around to have our voices heard or for someone else to make change - we have to be the change we need to see.

The mass walkouts held around the country on March 14, which marked the one-month anniversary of the mass shooting at our school, weren't even organized by March for Our Lives. They were efforts led by students around the world who were speaking in the most influential way they knew how: civil disobedience, marching in the streets with signs and chanting truth to power. Efforts to mobilize young voters are widespread, and many are being conducted by first-time organizers.

Students around the country have already shown commitment to doing their part. Now it's on the adults to join us.

Many companies have broken ties with the National Rifle Association, and the House of Representatives passed a bill to fund more security measures in schools. That's great, but it's not enough.

We need to digitize gun-sales records, mandate universal background checks, close gun-show loopholes and straw-man purchases, ban high-capacity magazines, and push for a comprehensive assault weapons ban with an extensive buyback system.

It would also benefit us to redefine what assault weapons are so that when we call for a ban against them, it's clear that we aren't trying to ban all guns. No one needs to use an assault weapon to protect themselves while walking home at night. No one should be allowed to use an AR-15 to strategically hunt people, which, in case anyone forgot, is what made us speak out in the first place.

Rather than engage with this logic, many are suggesting that a possible solution to increasing school safety would be arming teachers. This doesn't make any rational or logical sense. For those who don't agree, I have questions:

How would arming teachers work, logistically?

Would they have to buy their own guns, or would there be armories in schools? Would students be able to break into armories?

While teaching, would a teacher keep their weapon on their person or in a lockbox?

If it was in a lockbox on the other side of the room when a threatening person walked in, would the teacher be able to get to their gun in time?

If the threat and the teacher were in close proximity, would the threat not be able to disarm the teacher and turn the pistol on them and in turn the students?

Why would a student shooter even need to worry about metal detectors or getting patted down if they already know they can overpower the teacher and take that gun for their own use?

If the teacher wasn't in close proximity, what would stop the teacher's bullets from hitting other students who might be in the way and obscured by gunsmoke?

And since there was a resource or police officer on campus to help protect students and teachers, why didn't that stop 17 people from getting killed and 15 from getting injured on February 14?

At Stoneman Douglas, the entire shooting lasted roughly six minutes. In that time, the shooter - a former student who conducted this violence in a three-story building known as the freshman building - fired at least 100 shots, which hit walls, windows, classrooms, and 32 people. Seventeen people's lives ended far, far too soon, and each of them had ties and connections to countless other individuals, and all of those people have to grapple with the fact that these students and faculty - our friends, our teachers, our coaches, our family - are gone.

This is the reality we face as young people in America today: the constant fear of being gunned down in the places we should feel the most secure. We have grown up in this country and watched violence unfold to no resolution. We have watched people with the power and authority to make changes fail to do so.

And that's why we are stepping up. Some of us are new to this fight, but across America there are people, young and old, who have been fighting for gun safety and an end to gun violence of all kinds.

This month, Teen Vogue is dedicating its digital cover to rising voices in the gun control movement, young people who are working on the issue in different ways, all of them impacted by gun violence.

There is 21-year-old Howard University student Clifton Kinnie, who, in 2014, mobilized teenagers to organize against gun violence and register to vote after 18-year-old Mike Brown was killed by a police officer in Ferguson, Missouri. Natalie Barden, a 16-year-old sophomore at Newtown High School in Connecticut, was a preteen when she lost her younger brother, Daniel, in 2012, during the Sandy Hook shooting. She's been asking for change for more than five years as part of a family that has become vocal anti-gun-violence organizers, and she is now courageously stepping up to mobilize her peers.

Jazmine Wildcat, a 14-year-old member of the Northern Arapaho Tribe, is part of a gun-owning family in Riverton, Wyoming, and she started writing letters to her lawmakers after the students were killed in Parkland. In her community, where gun ownership is considered a fact of life and a point of pride, she's bravely taking a stand as one of the few voices advocating for change in her area. Kenidra Woods, a 17-year-old junior from St. Louis, was already advocating for more discussion of self-harm and mental health among teens before Parkland, after which she sprang into action to help conduct a walkout at her school in February in solidarity. She and her classmates faced resistance from administrators after students were barred from returning to class, and she's since become one of the most vocal young activists in this nationwide movement.

Nza-Ari Khepra of Chicago founded Project Orange Tree after a friend, 15-year-old Hadiya Pendleton, was shot and killed in 2013. She's now 21 and a student at Columbia, continuing her efforts to end gun violence; her smart work was the inspiration for the nationwide "Wear Orange" campaign.

Then there are those of us representing Parkland: Fellow Stoneman Douglas student Nick Joseph lost one of his best friends, Joaquin Oliver, on February 14, and is speaking out in his name by organizing and marching, rising to a challenge no 16-year-old in mourning should have to face. Sarah Chadwick, 16, has been organizing the March for Our Lives event set for March 24, and she is loudly denouncing critics like the NRA's Dana Loesch on Twitter. Jaclyn Corin, 17, who lost her friend Jaimie Guttenberg on February 14, planned a trip to meet lawmakers at the very start of the movement and has been a crucial member of #NeverAgain.

We Stoneman Douglas students may have woken up only recently from our sheltered lives to fight this fight, but we stand in solidarity with those who have struggled before us, and we will fight alongside them moving forward to enact change and make life survivable for all young people. People who have been fighting for this for too long, others who were never comfortable enough to openly talk about their experiences with gun violence, or still others who were never listened to when opening up about their experiences with gun violence or were afraid to speak out - these are the people we are fighting with and for.

The media afforded a group of high school students the opportunity to wedge our foot in the door, but we aren't going through this alone. As a group, and as a movement, it's vital that we acknowledge and utilize our privilege, use our platforms to spread the names of the dead and the injured, promote ideas that can help spread kindness rather than hostility, support those who aren't being heard, take our voices and use them together with the megaphones provided.

We the Wounded of the United States, in Order to form a more perfect Future, establish Justice, ensure domestic Tranquility, provide for the common People, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Generations to Come, do ordain and establish this March for the United States of America.
This story is a part of Teen Vogue's ongoing coverage on gun violence and the growing movement for gun control. Be sure to check out the other features: Meet the Young Activists Fighting to End Gun Violence A Roundtable Talk With 5 Young Gun Control Activists Where to Join the March For Our Lives How the NRA Came to Influence America The Truth About Mental Illness and Gun Violence How to Survive a School Shooting Real Students Read the Haunting Text Messages Sent During Mass Shootings

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In an exclusive op-ed for Teen Vogue's gun control issue, Parkland survivor and activist X González shares why young people are stepping up for gun control.

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In some US States, it's harder to buy medicine than a gun

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In some US States, it's harder to buy medicine than a gun

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In the wake of a shooting at the The Tree of Life Synagogue in Squirrel Hill that has left 11 people dead, Americans again are faced with a familiar story. "It's a very horrific crime scene," said Wendell Hissrich, Pittsburgh's public safety director. "It's one of the worst that I've seen."

"Pennsylvania did not enact significant gun laws in 2017, maintaining its C grade with positive and negative firearm bills still pending," according to the Law Center to Prevent Gun Violence. The center's " Gun Law State Scorecard" rates the state as having the 13th strongest gun protection laws in the nation. "Pennsylvania could raise its grade and save lives by requiring background checks on private sales of long guns, not just handguns, allowing local governments to regulate firearms, and requiring gun owners to report lost or stolen firearms."
Don't miss: 10 things the gun industry won't tell you
Mass shootings have become a seemingly regular occurrence in U.S. life. Last November, in a baptist church Sutherland Springs, 26 people were killed and 20 were injured by a shooter, Devin Patrick Kelley. He died of a self-inflicted gunshot wound while being pursued by police, used an assault-type rifle, despite receiving a "bad conduct" discharge from the U.S. Air Force for domestic violence. He should have been prohibited from buying a gun under a 1996 amendment to the Federal Gun Control Act.

Last February, a shooting at Marjory Stoneman Douglas High School in Parkland, Fla. left 17 people dead. In 2017 at a country music concert in Las Vegas, 58 people were killed and 515 were injured. In 2016, 49 people killed and more than 58 wounded.at a gay nightclub in Orlando, Fla. In 2015, a white supremacist murdered 9 people a church in Charleston, S.C.

Large majorities in both parties continue to favor preventing people with mental illnesses from buying guns, barring gun purchases by people on federal no-fly or watch lists, and background checks for private gun sales and sales at gun shows, according to research carried out this year by the nonpartisan, nonprofit Pew Research Center, a Washington, D.C.-based think tank.

Democrats largely oppose proposals to shorten waiting periods for those who want to buy guns legally (25% favor, 74% oppose), but Republicans are divided (51% favor, 48% oppose), Pew found. Some 77% of Republicans and 90% of Democrats support background checks for private sales at gun shows, while 56% of Republicans and 84% of Democrats support a federal database to track gun sales. One theory for the difference in opinion: A majority of Republicans (56%) say there would be "less crime" if more Americans owned guns versus 51% of Democrats.
Cold medicine buyers are logged in a database
To illustrate the uphill battle such efforts face, here are 4 things in many states that are arguably harder to buy than a gun:

To purchase seemingly innocuous cold medications such as Sudafed, consumers must not only show photo identification, but also have the purchase logged in a database. In addition, stores are required to keep personal information about purchasers for at least two years. The active ingredient, pseudoephedrine, is the same substance used by chemists to cook up the illegal drug methamphetamine - or crystal meth. Zyrtec-D and Mucinex-D also contain pseudoephedrine. In addition, the 2005 Combat Methamphetamine Act limits the amount that can be sold per person and prohibits the purchase of more than nine grams in a 30-day period.

In contrast, less than a dozen states and the District of Columbia require registration of some or all firearms. "These laws enable law enforcement to identify, disarm, and prosecute violent criminals and people illegally in possession of firearms. Registration systems also create accountability for firearm owners and discourage illegal sales," according to the Law Center to Prevent Gun Violence. " Title II" weapons, which include machine guns and sawed-off shotguns, however, must be registered under the National Firearms Act.
Wireless contracts involve a credit check
"Firearm registration laws also help law enforcement retrieve firearms from persons who have become legally prohibited from possessing them through criminal convictions or other prohibitions," according to the Giffords Law Center to Prevent Gun Violence in San Francisco. "Comprehensive registration laws require gun owners to renew their registration annually or explain why they should no longer be legally responsible for the weapon. During the renewal process, owners undergo additional background checks to ensure that they have not fallen into a class prohibited from possessing firearms."

A credit check is usually necessary when buying a cellphone with a two-year contract - something that's not required to buy a gun. If you want to buy a wireless contract without one, however, many carriers ask consumers to hand over an extra $500 as a security deposit. The reason: Companies sell iPhones for roughly one-third of the original market price and make back that money over the course of a two-year wireless contract. A gun, on the other hand, is a one-off transaction (ammunition aside). Consumers can often negotiate a better deal for guns when paying cash. This company offers no credit-check financing for guns with a " shoot now, pay later plan."

This online firearm store has a "shoot today, pay later" policy for purchases of up to $3,500. "To bypass the credit check, the financier requires a screen shot of your online banking," it says.
Puppy owners often need references and home visits

Adopting a pet is not to be taken lightly. The American Society for the Prevention of Cruelty to Animals advises people to be prepared. Prospective adopters must be 21, bring two forms of identification - a government-issued ID and a proof of address - but, unlike gun buyers, may be asked to provide personal references. To make sure that the pet is not going to a dysfunctional home, some pet organizations like the Big Dog Ranch Rescue in Wellington, Fla., also have one of their team members perform a home visit before handing over the pet.

The Federal Bureau of Investigation's National Instant Criminal Background Check System (NICS) conducts federal background checks to ensure transactions don't violate federal or state laws. Since the NICS was initiated in 1998, 1.32 million people have been denied guns. That said, federal law only requires licensed dealers to conduct checks and most states do not require background checks for firearms purchased at gun shows from private individuals.
Hunting licenses require Social Security numbers
Some experts estimate that between 22% and 40% of gun sales occur in "no questions asked" transactions online or at gun shows where, in most states, background checks are not required. "Recent efforts to strengthen background check laws at the state level have had an impact," according to the Giffords Law Center. "Firearm owners who acquired their most recent firearm in the last two years were much more likely to have undergone a background check than those who acquired guns in previous years, but nearly one-quarter of gun owners who obtained a firearm in the last two years did so without a background check."

Federal law requires U.S. citizens to provide their Social Security numbers before buying recreational hunting or fishing licenses. (The same, incidentally, is required for getting a credit card.) As part of federal welfare reform, states can deny hunting and fishing licenses to those who have failed to keep up on their child support - and having their Social Security number is one way to find a deadbeat mom or dad. What's more, the state can deny a person from buying a recreational license if he or she is in arrears on child support. A Social Security number is a unique identifier that does not change over the course of a person's life.

Licensed gun dealers must ask for a government-issued identification like a driver's license. "A Social Security card does not, by itself, contain sufficient information to identify a firearms purchaser," according to the Bureau of Alcohol, Tobacco, Firearms and Explosives. "However, a purchaser may be identified by any combination of government-issued documents." While some gun buyers have said that sellers at gun shows have asked for a Social Security number before selling a gun, a Social Security number is not needed to buy a gun in most states. Providing one is listed as " optional " in most states.

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In some U.S. states, it's harder to purchase Sudafed than a gun

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In the wake of a shooting at the The Tree of Life Synagogue in Squirrel Hill that has left 11 people dead, Americans again are faced with a familiar story. "It's a very horrific crime scene," said Wendell Hissrich, Pittsburgh's public safety director. "It's one of the worst that I've seen."

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TED Talk: Why gun violence can't be our new normal (VIDEO)

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TED Talk: Why gun violence can't be our new normal (VIDEO)

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Why gun violence can’t be our new normal

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It doesn’t matter whether you love or hate guns; it’s obvious that the US would be a safer place if there weren’t thousands of them sold every day without background checks. Dan Gross, president of the Brady Campaign to Prevent Gun Violence, makes a passionate, personal appeal for something that more than 90 percent of Americans want: background checks for all gun sales. “For every great movement around the world, there’s a moment where you can look back and say, ‘That’s when things really started to change,’” Gross says. “For the movement to end gun violence in America, that moment is here.”

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From a small-town pharmacist to a commercial pilot, it's not just gunmakers that are funding the National Rifle Association's political battles.

The organization's overall revenue, which includes membership dues, program fees and other contributions, has boomed in recent years - rising to nearly $350 million in 2013. The majority of this money funds NRA initiatives like member newsletters, sporting events and gun safety education and training programs.

These help the NRA recruit new members and spread its pro-gun message. But to influence laws and keep its chosen leaders in power, it has a separate pool of money to use.

A CNNMoney analysis of federal campaign finance records shows that much of this money comes from everyday Americans. And these contributions, which the NRA uses to keep pro-gun lawmakers in office, are on the rise.

Some political funding comes from big corporations, many within the gun industry, which donate millions to the NRA. But companies are barred from donating to the NRA's political action committee, which the agency uses to fill campaign coffers, run ads and send out mailers for and against candidates.

That's where individual donations come in.

Since 2005, the NRA Political Victory Fund has received nearly $85 million in contributions from individual donors. After the 2012 Sandy Hook shooting, donations to this political action committee surged as gun owners worried that their rights to buy and own guns were at risk.

The call for stricter gun control laws from leaders like President Obama in the wake of this tragedy fueled these fears and prompted the NRA to rally its members to fight against new regulations.

As a result, gun sales soared, and so did donations.

Donations in the 2014 election cycle were up by more than 50% compared to the prior two years, and nearly doubled from a decade ago.

"Americans look to the NRA to defend their constitutional right to self protection," NRA spokesperson Jennifer Baker told CNNMoney. "When gun control advocates ramp up their efforts to pass gun control people voice their opposition by donating to the NRA."

Contributions came from nearly 30,000 donors, with around 90% of donations made by people who gave less than $200 in a single year. According to the NRA, the average donation is around $35.

The NRA's ability to raise so much money from small donations is highly unusual for a special interest group, demonstrating its wide reaching support, said Sarah Bryner, research director at the Center for Responsive Politics.

Only one person has donated even close to the maximum amount allowed by federal law, which is $5,000 per year: a computer programmer from Houston. Since 2005, he has donated $50,050 -- just shy of the $55,000 allowed for the 11-year period (including this year).

"It is a good percentage of my income [5% to 10%], but I want to do everything I can easily do to preserve my freedoms," said the donor, who requested to remain anonymous. "I hope the money will be used to help conservative or libertarian minded candidates win elections."

He said he worries that gun control advocates are trying to prevent the average citizen from owning guns at all. He had previously donated to Republican candidates directly, but since he also wanted to support pro-gun Democrats, he has switched to donating almost exclusively to the NRA -- trusting it to distribute the money effectively.

"It is much easier to fight these bans now with money than to fight laws later with lawyers and evasion," he said. "I think having the average citizen armed is a powerful deterrent to would be abusers."

Another top donor is an Air Force veteran from Texas who ranked as an expert with both the .38 revolver and the 9 millimeter pistol while he was on active duty.

Currently he works as a commercial airline pilot, and he says he supports the NRA's mission to stand up for the right of self defense. He says he has a concealed weapon permit and regularly carries a handgun.

"I'd like to see my contributions used to help elect solid gun rights supporters where possible, the most electable gun rights supporters where necessary, and the least objectionable candidate if that's the best we can do," he said.

And they're joined by an eclectic group of other top donors.

These 10 donors all gave more than the former CEO of the oldest family-owned gunmaker in the country. Alan Mossberg, the now-retired CEO of O.F. Mossberg & Sons, donated $12,000 during this same time period. The company claims to be the largest manufacturer of pump-action shotguns in the world.

In addition to its PAC, the NRA also has a powerful lobbying arm, the nonprofit NRA Institute for Legislative Action, which lobbies for new laws and runs issue-based campaign ads of its own.

Unlike the PAC, it isn't able to donate directly to candidates. But it is able to receive millions of dollars in donations from corporations. The group is not required to disclose the names of its contributors or the details of these contributions, though some major gunmakers like Smith & Wesson and Sturm, Ruger & Company have announced large donations in the past (though the NRA says that the vast majority of money comes from individual donors just like the PAC).

The NRA says that both lobbying and campaign funds represent a relatively small chunk of its overall budget and disputes criticism that it speaks only for the gun industry. Instead, it says that it's the money and support from Americans all over country that make its political efforts so effective.

"Congress isn't necessarily listening to the NRA, they're listening to our members," said Baker. "They know our members support the Second Amendment and vote and give money."

With the money its PAC receives, the NRA spends the majority on supporting Republican candidates. But there are a few Democrats in the mix as well, including The Blue Dog PAC for conservative Democrats. Here are some of the top recipients of campaign donations in past years:

CNNMoney (New York) October 15, 2015

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From a small-town pharmacist to a commercial pilot, it's not just gunmakers that are funding the National Rifle Association's political battles. The organization's overall revenue, which includes membership dues, program fees and other contributions, has boomed in recent years - rising to nearly $350 million in 2013.

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TED Talk: A Parkland Teacher's Homework for Us All (VIDEO)

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TED Talk: A Parkland Teacher's Homework for Us All (VIDEO)

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A Parkland teacher’s homework for us all

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Diane Wolk-Rogers teaches history at Marjory Stoneman Douglas High School in Parkland, Florida, site of a horrific school shooting on Valentine’s Day 2018. How can we end this senseless violence? In a stirring talk, Wolk-Rogers offers three ways Americans can move forward to create more safety and responsibility around guns -- and invites people to come up with their own answers, too. Above all, she asks us to take a cue from the student activists at her school, survivors whose work for change has moved millions to action. “They shouldn’t have to do this on their own,” Wolk-Rogers says. “They’re asking you to get involved.”

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This organization works on reporting about gun violence in America. This page has a bunch of articles about people trying to fix gun violence. Take a look at the proposed solutions.

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The only newsroom dedicated to covering gun violence.

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Investigation

Gun violence is often portrayed as an intractable problem, but a growing body of evidence shows that there are existing interventions that can save lives right now. These programs rarely get the careful, sustained attention they deserve. This project seeks to change that.

$750 million
The amount of money the federal government made available in 2022 to states looking to fund crisis intervention programs over five years

50%
The decrease in gun violence during events run by CeaseFire 365, which challenges Baltimore residents to help reduce violence in their neighborhoods for a weekend

$1.9 billion
How much money Chicago spent on policing in 2022

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The programs, policies, and people driving positive change in America's gun violence problem.

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This news clip has both video and an article

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Extreme risk protection orders, more commonly referred to as "red flag" laws, have been passed across the country as a means to prevent gun violence - but there are many questions about what these laws involve and how well they work.

Until 2018, just five states had adopted red flag laws. The number of states implementing such laws surged after the 2018 shooting at Marjory Stoneman Douglas High School in Parkland, Florida.

The nonprofit group Everytown for Gun Safety has been a big advocate for these laws. They're vital to preventing gun violence, said Chelsea Parsons, Everytown's director of implementation.

"They provide a proactive opportunity to prevent tragedies," she said. "You don't have to wait for somebody to commit a crime when there are clear warning signs that this person having access to firearms poses a clear risk."

Here's what to know about red flag laws and their impact on gun violence.

What are red flag laws?

These laws allow people to petition for the temporary confiscation of an individual's firearms if that person is deemed to be a risk to themself or to others.

Petitioners first ask a judge to issue a confiscation order. They present evidence about the risk they believe the individual poses. The judge decides when to issue an order.

"The basic idea behind these laws is that they allow a court to order a firearm to be temporarily taken away from a person who presents an immediate risk to themselves or others," said Joseph Blocher, co-director of Duke University's Center for Firearms Law.

Who can petition for a firearm to be removed?

Laws about who can petition vary from state to state. In some states, coworkers, employers, teachers, doctors and family and household members can file petitions for gun removal. But Parsons said in most states it's still largely law enforcement officers who can petition for the orders, sometimes referred to as ERPOs, for extreme risk protection orders.

"It can be an extremely intimidating process to go to court on your own, file a petition like this during a moment of intense crisis," Parsons said.

The organization recommends policymakers focus on the needs of petitioners outside of law enforcement to make sure the process is accessible.

Everytown maintains a list of state laws and who is permitted to petition for a firearm to be removed in each state.

Are red flag laws constitutional?

Critics argue red flag laws go against the Second Amendment. While there have been Second Amendment challenges to these laws, they've each failed, Blocher said.

In Hope v. State, the Connecticut Appellate Court in 2016 concluded that the state's firearm removal law does not violate the Second Amendment because "it does not restrict the right of law-abiding, responsible citizens to use arms in defense of their homes."

There have also been challenges based on due process.

"Normally when you're deprived of some constitutional interest, like possession of a gun, you are entitled to notice and a hearing and those kinds of things," said Blocher. "Red flag laws permit these emergency orders to be entered without, necessarily, a full hearing. So I think people want to know, is there enough process here to protect people from being wrongfully deprived of their guns?"

Which states have them?

More than 20 states, along with Washington, D.C., have passed red flag laws as of June 2023. They are:

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Hawaii

Illinois

Indiana

Maryland

Massachusetts

Michigan (going into effect early in 2024)

Minnesota (going into effect early in 2024)

Nevada

New Jersey

New Mexico

New York

Oregon

Rhode Island

Vermont

Virginia

Washington

How quickly can an order be issued and what happens next?

There are two types of orders: emergency, or ex parte, orders and final orders, according to the Giffords Law Center, a research organization that advocates for more restrictive gun control measures.

The emergency order can be issued without the gun owner present during the court hearing, Blocher said. The order is usually short term and lasts a week or two. Another hearing then happens with the gun owner present to make their case.

Based on the judge's ruling at the second hearing, someone's gun can be removed for a longer duration. The final order lasts for a year in most states. At that point, it can either expire or be renewed. Gun owners can also request hearings to have their firearms returned. How often they can petition the court depends on the state the individual lives in.

What problems have states experienced with implementation and enforcement?

In Colorado, where a red flag law was signed in 2019, nearly half of the state's counties declared themselves Second Amendment sanctuaries.

The shooter who opened fire with an AR-15-style rifle inside Colorado Springs' last year, killing five people and wounding 17 others, had previously been arrested for making threats. The state has a red flag law, but no ERPO was filed. In Colorado, law enforcement, family and household members, certain medical professionals and certain educators can file petitions, according to Everytown.

"The sheriff in El Paso County has previously said he would not use the state's ERPO law except in 'exigent' circumstances," Allison Anderman, senior counsel and director of local policy at Giffords Law Center, said.

Victims' families and survivors of the shooting there have said they the sheriff's office for failing to block the shooter from buying guns before the attack. The El Paso County Sheriff's has not responded to repeated CBS requests for comment on the issue, but the official policy on the issue is still that deputies will not petition for an ERPO "unless exigent circumstances exist, and probable cause can be established pursuant to 16-3-301 C.R.S that a crime is being or has been committed."

"It is the policy of the Sheriff's Office to respect and protect the constitutional rights of all those we serve," according to the department's policy posted online. "The El Paso County Sheriff's Office will ensure that the rights of people to be free from unreasonable search and seizures, and to receive due process of law, are safeguarded and maintained."

Other states face problems because of a lack of coordination and investment, Anderman said.

Why are some states not considering red flag laws?

Some feel red flag laws infringe on the Second Amendment right to bear arms. Republican Sen. Mike Crapo, who represents Idaho, which does not have a red flag law, has said he's working on ways to address gun violence "without abridging Second Amendment rights."

Texas Sen. Ted Cruz, also a Republican, has said he supports the ability of states to make their own ERPO laws, but does not support them federally. Texas does not have a red flag law. Cruz has said red flag laws "pushed by Democrats and gun control advocates" are designed to deprive Americans of fundamental rights.

Across the U.S., Blocher has found many are concerned about being wrongfully deprived of their guns without trial.

"I think there's a misconception that these extreme risk protection orders are a criminal punishment. They're not," he said. " They're like a restraining order and those are civil."

What about a federal law?

There's no federal red flag law, but in February, the Justice Department announced it would be sending out more than $230 million to help states and the District of Columbia administer red flag laws and other crisis-intervention programs. Biden also signed legislation in June 2022 making it easier for states to put red flag laws into place. The bill includes incentives for states to pass red flag laws.

Neither Blocher nor Andrew Willinger, executive director of the Duke Center for Firearms Law, believe a federal red flag law is likely.

"The focus is really on not necessarily moving toward a federal law but improving these laws at the state level," Willinger said.

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What are red flag laws - and do they work in preventing gun violence?

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Extreme risk protection order laws allow people to petition to have an individual's firearms temporarily taken away. Here's how they work.

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Solution: See Something, Say Something App

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Solution: See Something, Say Something App

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"If you see something, say something."

That's not just a slogan for subway stations and airports.

It's also a concept embraced by the Say Something Anonymous Reporting System, started by the non-profit Sandy Hook Promise Foundation. Schools in 23 states have set up an anonymous tip line serving more than 5 million students in grades 6 through 12. The idea is to report unusual behaviors or potential acts of gun violence by other students.

A new study, published in the journal Pediatrics Wednesday, evaluated the tip line as it was used by one southeastern state - North Carolina - to see how successful it was at catching firearm-related threats.

Researchers found there were more than 18,000 tips submitted to the Anonymous Reporting System, known as SS-ARS, during the four years studied, from 2019 to 2023.

"What we found is that 10% of tips contain reference to a firearm," says Elyse Thulin, an assistant professor Institute for Firearm Injury Prevention at the University of Michigan and the lead author on the study. "So youth are turning to SS-ARS to submit information about what can be very highly risky situations."

The research is urgent because gun violence has been the leading cause of death of children and teens in the U.S. since 2020, when it surpassed car accidents.

While the gun-related tips seen in the study also included concerns about bullying, interpersonal conflicts and suicide, 38% were about potential school shootings and nearly a quarter were about seeing or knowing of a weapon.

A separate analysis of the data by the Sandy Hook Promise Foundation shows that the tips and interventions that followed prevented six planned school shootings during the course of the four years.

The tips and the follow-ups also prevented 38 instances of school violence and more than 100 planned suicides. They also led to more than 1,000 mental health interventions.

Thulin explains that the system is more than just a phone line. It begins with training a school community, including students and staff, to identify signs of potential violence and self harm. Students can then anonymously report a potential threat through an app, a phone number or a website.

"Youth have a particularly important viewpoint," Thulin says. "They often know much more than the adults do about what's going on in their relationships, and in their school communities."

So they're often the first to notice a concerning behavior or potential threat.

Thulin says when a student reports something to the tip line, it goes to trained crisis counselors at the Sandy Hook Crisis Center, which serves the whole country and is open 24-7 all year round.

"These individuals are trained to live triage the tips," Thulin says. " teens can actually have a conversation with a crisis center counselor live. And the average report or the average response time is under a minute."

The crisis counselors engage with the tipster to get as much information as possible, figure out if there may be an immediate threat to anyone's safety, and then loop in relevant school staff about the level of intervention needed.

If the tip is about an imminent threat, then they also loop in local law enforcement and possibly an emergency medical team.

"We found that 50% of the time that tips containing a firearm were requiring that urgent response," Thulin says. That's significantly higher than for non-firearm related tips.

Thulin and her colleagues chose to study a state where the tip line is available in all school districts. They did not name the state in their research, because they were concerned knowledge of the ongoing study could influence students' willingness to use the tip line. Other sources, including the Sandy Hook Promise Foundation, suggest that it is North Carolina.

Beverly Kingston, who directs the Center for the Study and Prevention of Violence at the University of Colorado, Boulder, wasn't involved in the study, and says its findings are heartening.

"It demonstrates that anonymous reporting systems can be a useful and a practical intervention or strategy to address gun violence and other concerning behaviors," Kingston tells NPR.

Kingston, who's involved in supporting Colorado's anonymous youth tip line called Safe2Tell, says these findings come at a time when gun violence has become a major public health problem.

According to a new report by the National Institute for Health Care Management Foundation says more than 42,000 people died from gun related injuries in 2023.

"In a country that has the level of firearms that we have, we need to have anonymous reporting," says Kingston. "It's a system that should be everywhere."

Kingston sees the findings as something actionable state can do on an issue that is too often stuck in polarizing politics. "There's a lot of hopelessness, people thinking that there's nothing we can do to prevent violence," she says. "And there's so much we can do."
If you or someone you know may be considering suicide or is in crisis, call or text 988 to reach the Suicide & Crisis Lifeline.

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'Say Something' tip line in schools flags gun violence threats, study finds

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A new study in Pediatrics shows that an anonymous tip line for students is catching some gun threats before they can escalate. It is part of an effort to treat gun violence as a public health problem.