June 2, 2022
The Society for Adolescent Health and Medicine (SAHM) stands with the Uvalde, Texas and Buffalo, New York communities in the aftermath of a mass shooting at Robb Elementary school, resulting in the death of 19 students and two teachers just ten days after the racially motivated mass shooting of 10 adults at the Tops Supermarket in a Black community in Buffalo, New York. Children, adolescents, and young adults throughout the world deserve to be safe where they learn, live, work, and play. As a SAHM community, we are heartbroken and appalled by these recurring events, particularly when bold action can prevent or, at a minimum, decrease the frequency of mass and school shootings. School shootings sadden us to the core, as do the relentless occurrences of firearm violence across all corners of our world; in the United States (U.S.) alone, 28 youth ages 0-24 die every day from firearm violence.1 Mass shootings, including those motivated by hate, such as the Tops supermarket shooting, result in the traumatic loss of adolescents’ grandparents, parents and caretakers. SAHM urges a public health approach to prevent firearm violence using our collective resources, education, legislation, and policy to address violence inequities and eliminate firearm violence and reaffirms our position statement on Preventing Firearm Violence in Youth Through Evidence-Informed Strategies.2
Firearms are the leading cause of death among children, adolescents, and young adults in the U.S., and also a significant contributor to mortality worldwide.3,4 Across all ages, there are over 250,000 firearm-related deaths worldwide each year. In 2019, the highest total firearm deaths occurred in Brazil, the United States, Venezuela, and Mexico.5 In 2020, there were 10,197 firearm deaths in youth ages 0-24 in the U.S. with a 28% increase from 2019 to 2020.6 In the U.S., firearm violence disproportionately impacts Black male youth, who are 20 times more likely to die from firearm homicide than white youth.6 Racial inequities in firearm violence are rooted in longstanding structural oppression, racism, poverty, and systemic divestment in communities, and safeguarding youth requires addressing the socio-structural roots of violence. Mass shootings involving four or more victims and school shootings, which comprise a small proportion of firearm-related deaths,7 often galvanize discussion about firearm violence. We must address the ongoing violence that trickles through too many communities every day, quietly traumatizing and eroding our adolescents’ emotional well-being and hopefulness.
The rate of firearm injury and mortality in the U.S. far outpaces rates in other high-income countries, and is on the rise.1,3,8 The U.S. is unique in the rate of civilian-owned firearms.9 According to a 2018 report, U.S. civilians own 393 million firearms.9 In 2019, 4.8% of U.S. high school students reported carrying a gun in the last year, and 4% of adolescents aged 12–18 years reported having access to loaded handguns without adult permission.10,11 Firearm violence occurs in all environments, including urban, suburban, and rural.12 Increased availability of firearms is associated with increased rates of firearm homicide, suicide, and unintentional injury.6 Despite the high prevalence, firearm violence is not inevitable.
SAHM values mental health and recognizes that firearm violence is not a mental health issue. The rates of mental health disorders are similar worldwide, yet, among high-income countries, the frequency of mass shootings is highest in the United States. Individuals with mental health disorders are no more likely to commit mass shootings or acts of firearm violence than those without mental health disorders, except toward themselves by suicide.13 Most symptoms of mental illness are not related to firearm violence, but access to firearms is.14 Blaming mental illness stigmatizes those experiencing a mental health diagnosis. It may lead many to struggle in silence rather than seek treatment out of fear they may be considered dangerous or out of concern that they will be denied the ability to purchase a firearm.15
Research demonstrates that stronger firearm laws are associated with lower firearm homicide rates;16 specifically laws that strengthen background checks and require a permit to purchase a firearm are effective.17 We urge legislators to cast aside political differences and act now to protect children, adolescents, and young adults. SAHM supports the expansion of evidence-informed gun safety legislation to all states to include16-18 (1) universal background checks; (2) assault/semiautomatic weapons ban; (3) prohibition of high-capacity magazines; (4) Extreme Risk Protection Orders; and (5) child access prevention laws. We urge members living in the U.S. to contact local, state, and national legislators to advocate for these evidence-informed legislative actions. We also encourage you to contact your local representatives to make changes to improve the well-being and safety of the neighborhoods that nurture and develop our youth. This is not a discussion about the right to bear arms, but is a discussion to keep our children, adolescents, young adults, and communities safe from violence.
We urge health professional who serve adolescents and young adults throughout the world to take action now:
1. Talk with patients and parents about their thoughts and feelings about the recent shootings, and broader experiences with firearm violence. Creating safe, inclusive, and healing centered spaces where adolescents can discuss their experiences with trusted adults is paramount to supporting coping and recovery.
2. Deliver a UNIVERSAL firearm safety message to all patients and parents, emphasizing that youth living in homes without firearms have the lowest risk for morbidity and mortality due to firearm violence. Youth-serving health professionals should provide universal counseling on safer storage practices and counsel families in higher-risk settings (including when adolescents present with violent behavior, depression, suicidality, or suicide attempt). Safer storage messages should include: storing all guns unloaded and locked in a lock box, gun cabinet, or with cable locks and storing ammunition separately from the weapon and locked. When possible, partner with local organizations to offer on-site safer storage devices in clinical settings. Coupling counseling with safer storage devices in a clinical setting can improve safer storage.19
3. Use your voice as a health professional to educate and advocate for firearm safety. This includes reaching out to schools and youth-serving organizations to share best practices on firearm injury prevention. Contact local leaders to convey this immediate action item to their constituents. Write letters to the editor in newspapers about evidence-based firearm violence prevention approaches, and share a copy of the media recommendations for reporting on mass shootings (www.reportingonmassshootings.org/) and suicide (https://reportingonsuicide.org/) to decrease the likelihood of their recurrence due to social modeling. Ask journalists and news editors to neither name nor show the perpetrator to reduce “copycat” effects.
4. Collaborate with schools to foster safe, nurturing, inclusive environments for all children and adolescents. Schools must be a haven for students to foster trusting relationships with peers and supportive adults, achieve their educational ambitions, and envision hopeful futures. The Safe Schools Initiative recommends a multifaceted approach that includes interventions to foster respectful environments where youth can build social-emotional competence, develop threat assessment teams to identify and link youth to support services, and create safety procedures to prevent school shootings.20 Universal evidence-based school violence prevention programs focused on antibullying and positive youth development can improve school safety.21
5. Address the root causes of firearm violence including poverty, racial inequity, and systemic divestment in communities. Transformational investment to address social determinants of health is linked with reductions in firearm violence. We must hold public and private organizations and government agencies accountable to ensure that all youth and communities have the resources and services to thrive.
Our children, adolescents, and young adults count on us to protect them. We know how to prevent firearm violence. It is time to come together and create the collective will to protect them. We stand together in a unified vision for a more peaceful future.
The Society for Adolescent Health and Medicine (SAHM), founded in 1968, is a nonprofit multidisciplinary professional society of 1,200 members committed to the promotion of health, well-being, and equity for all adolescents and young adults by supporting adolescent health and medicine professionals through the advancement of clinical practice, care delivery, research, advocacy, and professional development. Through education, research, clinical services, and advocacy activities, SAHM enhances public and professional awareness of adolescent health issues among families, educators, policymakers, youth-serving organizations, students in the field, and other health professionals worldwide.
1. Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). . www.cdc.gov/injury. Accessed May 26, 2022.
2. Preventing Firearm Violence in Youth Through Evidence-Informed Strategies. J Adolescent Health. 2020;66(2):260-264.
3. Lee LK, Douglas K, Hemenway D. Crossing Lines — A Change in the Leading Cause of Death among U.S. Children. New England Journal of Medicine. 2022;386(16):1485-1487.
4. The Global Burden of Disease Injury Collaborators. Global Mortality From Firearms, 1990-2016. JAMA. 2018;320(8):792-814.
5. Gun Deaths By Country. https://worldpopulationreview.com/country-rankings/gun-deaths-by-country. Accessed June 1, 2022.
6. Johns Hopkins Center for Gun Violence Solutions. A Year in Review: 2020 Gun Deaths in the U.S. Available: https://publichealth.jhu.edu/gun-violence-solutions. 2022.
7. Gun Violence Archive Standard reports — mass shooting all years. https://www.gunviolencearchive.org/. Accessed May 26, 2022.
8. Grinshteyn E, Hemenway D. Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010. The American Journal of Medicine. 2016;129(3):266-273.
9. 2018 Small Arms Survey. https://www.smallarmssurvey.org/database/global-firearms-holdings. Accessed May 26, 2022.
10. Underwood JM, Brenner N, Thornton J, al. e. Youth Risk Behavior Surveillance–United States, 2019. MMWR Surveillance. 2019;69(SS-01):1-88.
11. Zhang A, Musu-Gillette L, Oudekerk B.A. Indicators of school crime and safety: 2015. https://nces.ed.gov/pubs2016/2016079.pdf. Published 2016. Accessed.
12. World Population Review. Washington, District of Columbia Population 2022. https://worldpopulationreview.com/. Accessed Accessed February 2, 2022.
13. Bushman BJ, Newman K, Calvert SL, et al. Youth violence: What we know and what we need to know. Am Psychol. 2016;71(1):17-39.
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15. Risk and Protective Factors for Gun Violence in Male Juvenile Offenders. Journal of clinical child and adolescent psychology. 2020:1-16.
16. Santaella-Tenorio J, Cerdá M, Villaveces A, Galea S. What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries? Epidemiol Rev. 2016;38(1):140-157.
17. DiMaggio C, Avraham J, Berry C, et al. Changes in US mass shooting deaths associated with the 1994–2004 federal assault weapons ban: Analysis of open-source data. Journal of trauma and acute care surgery. 2019;86(1):11-19.
18. Bridges FS, Tatum KM, Kunselman JC. Domestic violence statutes and rates of intimate partner and family homicide: A research note. Criminal Justice Policy Review. 2008;19(1):117-130.
19. Barkin S, Kreiter S, DuRant RH. Exposure to violence and intentions to engage in moralistic violence during early adolescence. Journal of adolescence. 2001;24(6):777-789.
20. Vossekuil B. The final report and findings of the Safe School Initiative: Implications for the prevention of school attacks in the United States. Diane Publishing; 2004.
21. Kingston B, Mattson SA, Dymnicki A, et al. Building Schools' Readiness to Implement a Comprehensive Approach to School Safety. Clin Child Fam Psychol Rev. 2018;21(4):433-449.