Gun violence in schools and on the streets


Gun violence is an issue with many causes and will require solutions that address mental health and poverty.

I vividly recall the extreme sadness that I felt along with everyone in the United States the day reporters broke the news on December 14, 2012, that 20 children and 6 adults, teachers and school personnel, were shot and killed at Sandy Hook Elementary School in Newtown, Connecticut. The gunman, Adam Lanza, aged 20 years, shot 154 rounds of ammunition in less than 5 minutes using a M16 assault 0.22-calibre rifle, and 2 AR-15 semiautomatic pistols.1 His mother had purchased these weapons for him. I also recall the emotional speech that President Obama gave on December 16, 2012, at an interfaith vigil to honor the victims of this horrific tragedy. The Sandy Hook Elementary School shooting is just 1 of 304 fatal school shootings with more than 292,0002 students experiencing gun violence since the Columbine school shooting in Colorado on April 20, 1999.2,3

Poverty and gun violence

In the January/February 2002 issue of Contemporary Pediatrics, Miranda Hester reports on firearm related injuries, “The impact of poverty on gun violence,” and Dr. Steven Selbst wrote a commentary on the report. Data from an investigation on US firearm fatalities among children and young adults revealed an increase in firearm mortality risks was related to increased concentrations of poverty. The Dr. Selbst commentary presented data on the increased number of children younger than 20 years of age living in Chicago, Illinois, and Philadelphia, Pennsylvania, who have had firearm related deaths. Measures to reduce the number of children living in poverty and exposed to gun violence have been proposed by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners. Poverty and gun violence are 2 overwhelming problems that must be addressed at local, state, and national levels to achieve significant changes to overcome the adversity of living in poverty and to stop gun violence. New ways of thinking, listening, and behaving must occur to assure meaningful change occurs through processes of design and implementation that abolish poverty as a way of life and to stop gun violence.

Mental health must be addressed

It seems that every incident of gun violence has the root cause of undiagnosed or poorly managed mental health problems. Are there history questions in your electronic health record (EMR) that address the social determinants of health (SDOH)? Do you use specific screening tools to capture the parameters of the SDOH and refer for needed assistance? Do you assess the mental health status of every child/adolescent using a valid screening tool? Do you routinely refer children for treatment of mental health problems? Do you ask parents and teenagers specifically about guns? For example: 1). Do you have guns in your home? 2). If yes, are the guns securely locked in a case? 3). Does your child have access to guns in your home or with friends? 4). Do you talk to your children about gun violence? 5). Has you child/adolescent gone hunting? 6). Has your child/adolescent been taught to respect guns? 7). Has your adolescent brought a weapon to school? If we do not ask, we will never know if we could have prevented a tragedy!

Click here to access work completed with US Department of Health Resources and Services Administration grant funding for a preceptor development grant, Module 9 entitled: Are you prepared to React in the Event of Workplace Violence: An interview with a police expert. The police expert was the Captain in charge after the shootings at Sandy Hook Elementary School.


1. Ray M. Sandy hook elementary school shooting. Updated February 16, 2022. Accessed February 21, 2022.

2. Cox J, Rich S, Chin A, Muyskens J, Ulmanu M. More than 292,000 students have experience gun violence at school since Columbine. Updated January 24, 2022. Accessed February 21, 2022.

3. Vigderman A, Turner G. A timeline of school shootings since Columbine. Updated August 9, 2021. Accessed February 21, 2022..

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