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School Shootings in the U.S.: What Is the State of Evidence?

      See Related Article on p.797
      On March 13, 2019, two assailants, seeking to emulate the attack at Columbine High School in Colorado 20 years ago, opened fire in a school near São Paulo, Brazil, killing 10 people including five students. The incident highlighted the long-standing and far-reaching impacts of U.S. school shootings. All too often, American society finds itself reeling from yet another school shooting, and some of these events receive greater media attention than others. Shootings at Columbine High School, Sandy Hook Elementary School, and Marjory Stoneman Douglas High School are only three of numerous U.S. school shootings occurring over the past two decades. The number of school shootings in the U.S. far exceeds that of several other high-income nations even after accounting for population size [
      The US has had 57 times as many school shootings as the other major industrialized nations combined.
      ,
      Does the U.S. experience far more school shootings than any other country?.
      ]. Yet our knowledge about some of the most basic characteristics of these shootings is incomplete. In this issue of the journal, Livingston et al. take a step toward providing descriptive features of U.S. school shootings [
      • Livingston M.D.
      • Rossheim M.E.
      • Hall K.H.
      A descriptive analysis of school and school shooter characteristics and the severity of school shootings in the United States, 1999–2018.
      ].
      Difficulties in foundational research on school shootings begin with definitional challenges. Disagreements on how to define a school shooting have resulted in the absence of a widely accepted definition and in turn led to the creation of different databases [
      No, there haven’t been 18 school shootings in 2018. That number is flat wrong. Washington Post.
      ]. It is estimated that school shooting data have been collected by more than 20 different entities [
      K-12 school shooting database research methodology.
      ]. Livingston et al. used the Washington Post database of school shootings for their research [
      • Livingston M.D.
      • Rossheim M.E.
      • Hall K.H.
      A descriptive analysis of school and school shooter characteristics and the severity of school shootings in the United States, 1999–2018.
      ]. This database contains shootings that occurred on campuses during, or immediately before or after, the school day when children were at risk. Shootings at after-hours events, accidental discharges that caused no injuries to anyone other than the person handling the firearm, and suicides that occurred privately or posed no threat to other children were excluded. Using these criteria, and after restricting the sample to shootings intended to injure or kill others, Livingston et al. included 179 shootings occurring between April 1999 and May 2018 in their analysis. In contrast, for instance, the school shooting database of the U.S. Naval Postgraduate School includes 657 incidents during that same period [
      K-12 school shooting database research methodology.
      ]. It documents each and every instance a gun is brandished or fired or a bullet hits school property for any reason, regardless of the number of victims, time of day, or day of week.
      Some descriptive epidemiologic features of school shootings included in research by Livingston et al. are noteworthy. Even among events intended to injure or kill others, about 70% did not result in any fatality. Nonetheless, the number of injuries or deaths (“casualties”) ranged widely from 0 to 34. Although much of the media attention has focused on school shootings with multiple victims occurring in majority-white schools, Livingston et al. document that about 61% of school shootings in their database occurred in nonmajority-white schools [
      • Livingston M.D.
      • Rossheim M.E.
      • Hall K.H.
      A descriptive analysis of school and school shooter characteristics and the severity of school shootings in the United States, 1999–2018.
      ]. A large majority of school shootings involved only one shooter who used a handgun.
      In the wake of an increasing number of school shootings in recent years, schools have scrambled to re-evaluate safety plans and implement additional safety measures, spawning a $2.7 billion school security industry [
      2018 was by far the worst year on record for gun violence in schools.
      ,
      Armored school doors, bulletproof whiteboards and secret snipers.
      ,
      • Fox J.
      • Fridel E.
      The menace of school shootings in America: Panic and overresponse.
      ]. Livingston et al. did not evaluate the effectiveness of school security measures in preventing or deterring school shootings; however, their finding that the presence of school resource officers was not associated with the likelihood or frequency of injuries and deaths (“severity of shooting”) is thought-provoking [
      • Livingston M.D.
      • Rossheim M.E.
      • Hall K.H.
      A descriptive analysis of school and school shooter characteristics and the severity of school shootings in the United States, 1999–2018.
      ]. These findings are based on bivariable analyses, and the point estimates are imprecise; nonetheless, the inability of resource officers to prevent certain school shootings in the past and criticism that some resource officers focus on punitive measures against the students suggest that further research is needed to understand the effectiveness of school resource officers in preventing the occurrence and mitigating the severity of school shootings [
      • Fox J.
      • Fridel E.
      The menace of school shootings in America: Panic and overresponse.
      ].
      Although used only in about 20% of school shootings studied by Livingston et al., the use of rifles and shotguns was strongly associated with casualties and fatalities. The Centers for Disease Control and Prevention has reported that firearm injuries were the cause of death in about 63% of single-victim and 92% of multiple-victim school-associated homicides during 1994–2018 [
      • Holland K.M.
      • Hall J.E.
      • Wang J.
      • et al.
      Characteristics of school-associated youth homicides — United States, 1994–2018.
      ]. Handguns were used in 69% of single-victim incidents and 52% of multiple-victim incidents, whereas long guns were used in 8.5% of single-victim incidents and 38% of multiple-victim incidents. Livingston et al. did not have data on how the firearm was obtained, but previous research has suggested that a majority of firearms used in school shootings were obtained from home [
      More than 223,000 students have experienced gun violence at school since Columbine.
      ]. Livingston et al. report greater severity of school shooting being associated with older age of the shooter who may not have been a student [
      • Livingston M.D.
      • Rossheim M.E.
      • Hall K.H.
      A descriptive analysis of school and school shooter characteristics and the severity of school shootings in the United States, 1999–2018.
      ]. Collectively, these findings highlight the importance of multipronged preventive measures that go beyond the school setting.
      Among high-income countries, the U.S. rates of crime are not an outlier [
      • Zimring F.E.
      • Hawkins G.
      Crime is not the problem: Lethal violence in America.
      ]. However, the U.S. rates of lethal violence, mainly due to firearm homicides, far exceeds that of other economically comparable nations. The frequency and severity of U.S. school shootings are partly a reflection of the availability and accessibility of firearms and permissive gun laws. Future research should examine specific risk and protective factors for school shootings and explore firearm and nonfirearm policy that could reduce its toll. These measures should be augmented with interventions focusing on fostering positive school climate to reduce some of the risk factors already known to be associated with firearm access or carrying (e.g., bullying victimization and perpetration) and promote protective factors (e.g., emotional, social, and mental health) [
      • van Geel M.
      • Vedder P.
      • Tanilon J.
      Bullying and weapon carrying.
      ,
      Call for action to prevent gun violence in the United States of America. Interdisciplinary Group on Preventing School and Community Violence.
      ].
      Since the Columbine High School shooting, about 223,000 students attending 229 K-12 schools have experienced a shooting on campus during school hours [
      More than 223,000 students have experienced gun violence at school since Columbine.
      ]. School shootings can have profound direct and indirect traumatic consequences for both youth and the broader society [
      • Travers Á.
      • McDonagh T.
      • Elklit A.
      Youth responses to school shootings: A review.
      ]. Time will judge the yield of the recent surge in spending on safety measures to make schools “hard targets.” In the meantime, enacting and enforcing gun policy measures (e.g., universal background checks, permit to purchase laws, firearm access restrictions, and extreme risk protection order policies) as well as further mental health and education expenditure couched in a public health approach may play a more important role in averting these tragedies, preventing injuries, and saving lives [
      Call for action to prevent gun violence in the United States of America. Interdisciplinary Group on Preventing School and Community Violence.
      ,
      • Kalesan B.
      • Lagast K.
      • Villarreal M.
      • et al.
      School shootings during 2013–2015 in the USA.
      ,
      Here’s how to prevent the next school shooting, experts say.
      ].

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