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In US trauma centers, firearms are the second leading cause of trauma-related death in pediatric patients.1 In children (<18 years), firearms are associated with one of the highest case fatality rates (16.7%) of all injury mechanisms.2 According to the Gun Violence Archive, in 2019 alone, 3774 children experienced gun violence, including 985 killed and 2789 injured.3 The US Centers for Disease Control and Prevention reports multiple-victim school homicide rates have increased significantly between 2009 and 2018, following 15 years of decline.4 Considering the overall burden of gun violence, mass shootings are responsible for a relatively small number of deaths and injuries. However, these events also expose other residents, notably children, in the nearby communities to violence. This study examines the location of mass shootings relative to schools and places frequented by children, highlighting the potential risk of exposure to violence in our communities.
Mass shootings were defined as events involving 4 or more people injured or killed by a firearm in a single setting. The events were documented in the Gun Violence Archive for calendar year 2019.4 Using Google Maps, we calculated the walking distance (miles) from the geocoded address of the event to the nearest school (K-12) and places of interest (POIs), ie, places where children congregate. Places of interest included athletic fields, playgrounds, parks, recreation centers, and zoos. Because this study involved only publicly available databases, it was exempt per 45 CFR 46.104 and did not involve informed consent. Analysis was completed using Stata, version 15.1 (StataCorp). The data were publicly available from the Gun Violence Archive and consisted of links to publicly reported news stories.
During 2019, there were 418 mass shootings occurring in 40 states. There were 2178 people shot, with a case fatality rate of 21.2% (462 killed and 1716 injured). A pediatric patient (<18 years) was involved in 121 mass shooting events (28.9%), with 182 injured (10.6%) and 42 killed (9.9%). One in 5 mass shootings occurred at or within a block (≤0.1 miles) of a school or POI, and more than 90% of events occurred within a mile of a school or POI (Figure). The median distance from a mass shooting event to a school was 0.4 miles and to a POI, 0.7 miles. Overall, 9.6% occurred at a school or POI (Table).
Bubble size is proportional to the number of those exposed/survivors. Bubbles are plotted based on distance to the nearest school or place of interest (POI) (x-axis) in 0.1-mile increments for first 1.5 miles and 0.5-mile increments thereafter. The cumulative percentage of events is represented on the y-axis, with 91.4% of events occurring within 1 mile of a school or POI.
Once random and rare, mass shootings have now become commonplace, high-profile events in the United States with an accelerating rate of occurrence. In 2019 alone, there were 418 mass shootings archived in the Gun Violence Archive, the most since it began reporting in 2014. These events are happening in communities where children live, learn, and play. In 2019, 75% of mass shooting events occurred less than 0.5 miles from a place frequented by children (Figure), and more than 90% of the events are within 1 mile. While the number of injured or killed is distressing, this study highlights that countless other members of the community, notably children, are potentially at risk owing to the proximity of these events to everyday places (eg, schools and recreation centers). Because of this juxtaposition, children may experience gun violence in a variety of ways including direct exposure, observing the event, hearing gunshots, or building lockdown. Exposure to gun violence has been shown to be detrimental to children. For younger children (2-9 years), simply hearing gunshots in a public space was predictive of elevated stress; for older children (10-17 years), direct witnessing of gun violence was associated with elevated stress.5 In a review of literature, Barboza6 noted that youths exposed to gun violence report numerous psychological challenges, including anger, disassociation, anxiety, and depression.
Data for this analysis were obtained from a publicly accessible database of reported shootings. While not independently verified, this dataset would be an underestimate if there is error.
As we struggle to identify solutions to a growing epidemic, we need to consider not just those who are injured or killed but also the potential for other children to experience long-term emotional consequences as a result of this subset of violence in our communities. All must be addressed.
Corresponding Author: Michael L. Nance, MD, Division of Pediatric Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (firstname.lastname@example.org).
Accepted for Publication: April 17, 2020.
Published Online: September 8, 2020. doi:10.1001/jamapediatrics.2020.3371
Author Contributions: Dr Nance had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Nance, DeSimone, Lorch, Passarella, Myers.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Nance, DeSimone.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: DeSimone, Passarella, Cronin.
Obtained funding: Lorch.
Administrative, technical, or material support: Nance.
Supervision: Nance, Kreinces, Myers.
Conflict of Interest Disclosures: Drs Nance, Lorch, and Myers, Mr DeSimone, and Mss Passarella and Cronin reported grants from the Agency for Healthcare Research and Quality during the conduct of the study. No other disclosures were reported.
Funding/Support: Drs Nance, Myers, and Lorch are supported by grant 5R01HS023806 from the Agency for Healthcare Research and Quality.
Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Nance ML, DeSimone JD, Lorch SA, et al. Locations of Mass Shootings Relative to Schools and Places Frequented by Children. JAMA Pediatr. 2020;174(11):1109–1110. doi:10.1001/jamapediatrics.2020.3371
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