Today’s interview with Megan Ranney is on guns. We planned this interview after the horrifying shooting in Uvalde. Many people wrote to ask about guns, about their child’s safety, about what they could do. I didn’t think I had the expertise to talk about this, but I thought immediately of Megan. She’s a practicing emergency physician, Academic Dean of the School of Public Health at Brown University, and a longtime researcher on sticky social problems, including violence, mental health, and technology. She’s also a friend, and I was very grateful she agreed to come talk with me about the data behind guns and gun violence.
We purposely organized this interview at some distance from the events in Uvalde, both to give processing space and also to make sure these issues of gun violence stay top of mind and do not arise only when there is a mass shooting.
In the end, we are recording this on the day after the tragic mass shooting in Highland Park, which underscores perhaps that it is extremely hard to find a week free of gun violence in America. I hope this interview with Megan will provide both some data to better understand this and some call to action.
But let’s start with the data. One of the facts that people have heard a lot about recently, particularly in the wake of Uvalde, is the statement that firearms are the leading cause of death for children zero to 18. And I’d love for you to unpack that a little bit for us and help us understand: What does that mean in terms of numbers? What does that mean in terms of causes of those firearm deaths? How much should I be thinking about that? Does it vary with geographic location and so on?
At the same time, when you dig a little deeper into what the causes of firearm injury and death are, it gets a little more complicated than just saying, oh, it’s the leading cause of death. And I think it’s important for us to talk about the causes and about, like you said, the geography and the demographics, because it then helps to inform evidence-based solutions for this horrific problem.
So when you look down into the data, if we look at all data on firearm injury in the United States, most firearm deaths among kids and adults are suicides, which is something that most people don’t know.
Unintentional firearm injury — when you get shot “by accident” — is not common overall in the country, but is relatively common as a cause of death among kids, largely because they find a parent’s gun and pick it up and think it’s unloaded or think it’s a toy.
And then there are the mass shootings. And I think when a parent hears that statistic about guns being the leading cause of death for kids in the U.S., many parents assume that most of those are these horrific public mass shootings, things like Uvalde or Sandy Hook or the shooting in Aurora, Colorado, or what happened just the day before we’re talking in Highland Park.
But the reality is that those mass shootings are just a drop in the bucket of the gun deaths that happen in this country every day. And I say that not to say that those mass shootings don’t matter, but rather just to put in context what it is that we should really be afraid of as parents. As parents, yes, mass shootings, we should work against them, but the real worry for our kids is around firearm homicide, suicide, or, if they’re young, around that unintentional or accidental death.
So when we think about that context, are there particular activities that put kids at risk? And how should I think about, as a parent, trying to address those?
So, the first is firearm homicide. Your kids’ risk of being killed by a firearm because they’re shot and killed on purpose by someone else is predicted largely by a few things. The first is, sadly, where you live. There’s lots of data showing that kids who are killed in firearm homicide, most of them have it happen within about a thousand meters of their home. And so if you live in a community where gun violence is common, your kid is sadly more likely to get caught in the crossfire or to get involved in circumstances that put them at higher risk. We’ll also say that black and brown youth in this country are disproportionately at risk of being a victim of firearm homicide. That’s for lots of structural, economic, environmental reasons. It’s, of course, related to our country’s history of racism. And those are things that we can fight against.
Risk of being a victim of firearm homicide is also increased if your kid is using substances or involved in communities that are. And so there’s another space where you as a parent can potentially intervene.
You can lower risk by moving, which is easier said than done…
The second group is gun suicide, which again is a rising number of deaths among our kids. Most kids who take their own life with a gun use a family member’s gun — the vast majority of them. And there are about 40% of us in the United States who have a firearm in our household. And you’d better believe that your kid knows where that gun is. I will tell you as an ER doc, sadly, I’ve taken care of more kids than I would like to have ever had to see who have taken their own lives with a parent’s gun. And the parent always thought that it was stored safely. So the biggest thing that you can do to keep your kids safe from firearm suicide is to make sure that if you have a gun, it is stored in a way that the kid truly doesn’t have access to it. It’s behind lock and key. It’s in a biometric safe, or it’s in a safe with a combination lock that your kid doesn’t know.
Relatedly, you also want to make sure that if your kid has friends whose parents have firearms, that those guns are stored safely too. Particularly if your kid is going through a tough time.
The other side of it is that you can offer that yourself. If I have another kid coming over, I can ask that parent: Does your kid have allergies? And just so you know, we don’t have a firearm in the house. We don’t have a pool either. We do have a trampoline. So it can be part of that kind of discussion that we’re all used to having. You know, if you’re going to take my kid out for ice cream, does my kid need a booster seat? It’s part of that larger group of conversations about safety, where you don’t want to — as I know that you talk about, Emily — you don’t want to overplay it. But there is a way to integrate that discussion into the larger group of discussions around food allergies, et cetera, et cetera.
And then the last part is how to reduce that risk of mass shootings. And that’s a bigger discussion, which we can get into. I’ll tell you what I discuss with my kids, which is we have conversations about the kids in their school and who’s being bullied? Who’s bullying? Are there things that are making them concerned? Who do they have in their school to go to if they’re worried about someone that’s in their classroom? And making sure that we have those support systems set up for “see something, say something.”
I talk a lot, when I talk about gun violence, about that being the terminal event. People don’t just one day pick up a gun and decide to shoot themselves or shoot someone else, for the most part. There’s usually a long series of events that get them to that point. And yes, we want to separate them from the firearm at that end moment. But we also need to do the work to pick up on all those warning signs earlier and change someone’s course. And so it does relate to the discussions about bullying. It’s a both/and.
So, recognizing that, there are a few things. The first is that things like background checks absolutely make a difference in terms of new purchases of firearms, making sure that people who buy guns don’t have any of those really well-established warning signs that mean that they should be disqualified.
The second is having ways to get firearms out of people’s hands safely if they cross over, right? If they’re showing signs or have actually had behaviors that make them higher-risk. Those types of laws can be things like domestic-violence-related policies, like the partial closing of the boyfriend loophole with this new Senate policy. Here in Rhode Island, we have even stronger laws, where, before you’re convicted, when you have an ex parte domestic-violence order, in theory the police can take someone’s firearms away temporarily. Similarly, there are these things called red flag laws, which allow usually family or law enforcement to do something in the short term when someone’s showing impulsivity or suicidal impulses. Or if someone’s having dangerous postings on social media, that there’s something you can do to separate that person from firearms.
And then there’s another whole series of laws around banning certain categories of guns, around changing ages for firearm ownership, around having stricter permitting procedures, particularly for concealed carry … those can have impact and have been put in place in other countries effectively. But those first two groups of policies that I talked about will help decrease risk for many Americans, effectively: background checks, red flag laws, and stronger domestic-violence restraining orders will absolutely have a short-term impact, and we’re seeing them make progress.
The other side of it is, in addition to policy, there also have to be changes in social norms and in the education that we do around the policy. I’m going to go back to those red flag laws for a minute, because I think they’re one of the powerful tools that we have. The reality is that study after study has shown that even in states with red flag laws, most doctors, most family members, and even most law enforcement officers don’t know that those are an option. So a law is only as good as its enforcement and the behaviors around it. And if a community doesn’t believe in it, and if a community doesn’t use it, it’s not going to make a difference. Same thing for safe-storage laws, which I didn’t mention in that list. Safe-storage laws — basically mandating that if you have a gun in the house, you have to have it stored locked-up — are associated with lower rates of kids being hurt, but there’s a lot of conflict as to whether the storage laws follow good practice in a community or whether the laws lead to good practice.
So to me, the thing that we need to do is to push for passing good policy for making sure that we have the ability to manage who safely owns a gun. And for us to also work really strongly on changing those social norms around what safe and responsible firearm ownership looks like.
Firearms suicides are, of course, related to depression and hopelessness. But in general, most firearm injuries and deaths in this country are not related to mental illness. And in fact, people who are seriously mentally ill are not significantly more likely to kill someone else than the average person is walking down the street.
There have been studies of mass shooters showing that one of the biggest predictors is actually a history of prior violence. These are folks who have deep-seated personality disorders, hatred, often white nationalism, as part of their creed. And we’ve got to move beyond labeling them mentally ill, because that just stops us all from making progress.
We can put our kid in seat belts, we can have our kid wear bike helmets, we can also make really evidence-based judgments about where to restrict, where that level of risk lies, right? And I think that you and I are actually pretty similar in terms of letting our kids take a lot of risks in life, because overall the chance of them getting hurt by most of these things is really small and they need to learn how to judge on their own.
And I think that one of the things that is toughest about the topic that we’re talking about today is that that risk feels so unquantifiable, and my saying, yeah, mass shootings are less than 1% of children dying from gun death in this country, doesn’t feel sufficient when we think about, yeah, but it could be the parade that I go to. Right? And so I just want to be clear to the folks that are listening that I’m not trying to say that either mass shootings or homicides or suicides don’t matter. But rather, it’s that we need to be able to have our kids out in society and doing things. And we need to find ways to channel our fear into action and into areas of control rather than letting that fear dominate us.
Our kids are more likely to get shot in our neighborhood or even in our home, if we have a firearm in the home, than they are in a school, in a movie theater, or at a parade, but we can also take actions to help reduce that risk when we’re at a school, a movie theater, or a parade. Maybe not on behalf of our individual kid, but on behalf of society. And I think that one of the biggest things that we need to do and that your listeners can be helpful with is helping us grapple with this legitimate fear and keeping it from dominating our lives and keeping us from going out and doing things.
And I hope if nothing else that this discussion has helped move some people forward into understanding what the actual numbers are and where they can go next to help create action.
Community Guidelines
Emily:
Megan, thank you so much for joining me. I’d love for you to briefly introduce yourself.