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Violence Research Initiatives

Violence—defined by the World Health Organization as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”—is a significant public health problem that has profound impacts on lifelong health, opportunity, and well-being. Violence affects people of all ages and backgrounds, though some populations are at disproportionate risk. Violent victimization events are associated with not only physical injury or mortality, but also a range of acute and chronic physical and behavioral health conditions. When firearms are involved with violent events, the risk for injury, mortality, and acute and chronic physical, mental, or behavioral health conditions increases. There is evidence that indirect (witnessing) exposures to violence also have adverse effects on behavioral and physical health that are similar to the effects of direct exposures.

The National Institutes of Health (NIH) supports scientific research to increase our understanding of public health interventions to prevent different forms of violence and the trauma, injuries, and mortality resulting from them. Given that violence research cuts across many NIH institutes and centers and the central role of behavioral and social science research in violence related research, the NIH Office of Behavioral and Social Sciences Research (OBSSR) has increasingly played a coordinating role for this research at NIH. These efforts build off and complement existing NIH Institute, Center, and Office (ICO) priorities and of effective initiatives focused on specific types of violence such as child or elder maltreatment, youth violence, bullying, online harassment and abuse, community violence, intimate partner violence, and sexual violence.

Firearms Mortality and Injury Prevention Research

The FY2020 Further Consolidated Appropriations Act , FY21 Consolidated Appropriations Act , FY22 Consolidated Appropriations Act , and FY23 Consolidated Appropriations Act provided $12.5 million dollars of funding for each of the past 4 years to NIH to conduct research on firearm injury and mortality prevention by taking a comprehensive approach to studying the underlying causes and evidence-based methods of prevention of firearm injury, including crime prevention. Congressional language noted that the research must be ideologically and politically unbiased, that no funds could be used to advocate or promote gun control, and that grantees were required to fulfill NIH requirements around open data, open code, pre-registration of research projects, and open access to research articles.

Firearms Focused Notices of Funding Opportunities (NOFO)

Funded projects.

FY2020 FY2021 FY2022 FY2023

FY2020 and FY2021

OBSSR, along with IC partners, developed Notice of Funding Opportunity (NOFOs) PAR-20-143 , NOT-OD-20-089 , PAR-21-191 and PAR-21-192 , that were intended to build upon the existing NIH research portfolio and address emerging opportunities. The NOFOs took a broad public health approach to firearm injury and mortality prevention, encouraging research on interventions delivered in healthcare and community settings, integration of individual, family, interpersonal, community, and structural or system (e.g., legal, child welfare) approaches and included focusing on both victimization and perpetration of firearm violence across the life course and across populations.

OBSSR worked with other ICs to coordinate two NOFOs, PAR 22-115 and PAR 22-120 , that solicited applications for a coordinating center and a network of research projects to develop and test community/organization level interventions to prevent firearm and related violence, injury and mortality. The goal of the network is to support research projects to develop, implement, and evaluate innovative interventions that seek to modify characteristics of organizations, environments and/or settings to target higher order, “root” causes of firearm mortality and injury. The Coordinating Center will provide cross-network coordination, communication, analytics, engagement, and dissemination efforts to enhance the impact and generalizability of the study findings.

OBSSR coordinated with other ICOs to publish a NOFO ( PAR-23-066 ) that was a re-issue of PAR-22-115 to add additional network sites. In addition, NIH published two NOFOs (PAR-23-107 and PAR-23-108) focused on advanced training and career development for established NIH investigators in related fields to obtain the necessary skills and expertise to integrate firearm injury prevention work into their research. These awards will be a critical first step into expanding the field of qualified researchers and building capacity for the future. OBSSR issued a Notice of Intent to Publish a Funding Opportunity Announcement for Career Enhancement Awards to Advance Research on Firearm Injury and Mortality Prevention ( NOT-OD-23-192 ) on September 29, 2023. This NOFO is expected to be published in Winter 2023/2024 with an expected application due date in Spring 2024.

Meet the Community Firearm Violence Prevention Network

The Community Firearm Violence Prevention Network (CFVP) was seeded in September 2022 with three sites and a coordinating center at the University of Michigan. Three additional sites were added in September 2023. To meet the network and learn more about its projects, people, and activities, please click here .

NIH-Wide Firearms Mortality Prevention NOFO:

On December 16, 2022, OBSSR and NIH ICOs (National Institute on Aging ( NIA ), National Institute on Alcohol and Alcoholism ( NIAAA ), National Institute of Child Health and Human Development ( NICHD ), National Institute on Drug Abuse ( NIDA ), National Institute of Mental Health ( NIMH ), National Institute of Nursing Research ( NINR ), National Institute on Minority Health and Health Disparities ( NIMHD ), The National Center for Complementary and Integrative Health ( NCCIH ), The Sexual & Gender Minority Research Office ( SGMRO ), Office of Disease Prevention ( ODP ) and Office of Research on Women's Health ( ORWH )) released a Notice of Special Interest (NOSI): Firearm Injury and Mortality Prevention Research (NOT-OD-23-039) . The purpose of this Notice is to highlight interest in research to improve understanding of the determinants of firearm injury, the identification of those at risk of firearm injury (including self- and other-directed, victims and perpetrators, accidental injury), the development, piloting, and testing of innovative interventions to prevent firearm injury and mortality, and the examination of approaches to improve the implementation of existing, evidence-based interventions to prevent firearm injury and mortality. This Notice will expire on February 5, 2026.

NIH-Wide Efforts Led by OBSSR

Nih-wide violence research work group.

In 2019, OBSSR initiated a NIH-wide Violence Research Work Group (co-chaired by OBSSR and NICHD) and convened representatives from relevant ICs at NIH. This Work Group (WG) is tasked with examining the current violence research portfolio across NIH, identifying gaps and opportunities for current and future research priorities, and leading initiatives when appropriate.

For more information about the efforts of this working group and NIH supported violence research, please see the published article in Translational Behavioral Medicine titled Published article in Translational Behavioral Medicine titled “ Emerging research areas and contributions of NIH in violence research across the lifespan and throughout different settings ,” coauthored by NIH’s Drs. Caitlin E. Burgdorf, Valerie Maholmes, Stephen O’Connor, and Dara R. Blachman-Demner.

Advancing the Science of Mechanisms of Aggression

Led by a subgroup of the violence research working group, OBSSR and partner ICOs issued a Request for Information (RFI; NOT-OD-22-041 ) to solicit input from the community on research challenges and needs in the biobehavioral mechanisms of aggression; received 27 responses between December 14, 2021, and March 1, 2022. A summary of responses can be found here . In response to identified needs, a workshop " Advancing the Science of Aggression Across Species and Disciplines " was held to bring together researchers to identify gaps and opportunities to move the field forward. Key highlights and action items from the workshop can be found here .

Active NOFOs

On July 8, 2022, OBSSR and NIH ICOs (National Institute on Aging ( NIA ), National Institute on Alcohol Abuse and Alcoholism ( NIAAA ), Eunice Kennedy Shriver National Institute of Child Health and Human Development ( NICHD ), the National Institute on Deafness and Other Communication Disorders ( NIDCD ), National Institute of Dental and Craniofacial Research ( NIDCR ), National Institute on Drug Abuse ( NIDA ), National Institute Of Mental Health ( NIMH ), National Institute of Nursing Research ( NINR ), National Institute on Minority Health and Health Disparities ( NIMHD ), Sexual & Gender Minority Research Office ( SGMRO ), Office of Disease Prevention ( ODP ) and Office of Research on Women's Health ( ORWH )) released a Notice of Special Interest (NOSI): Research on Addressing Violence to Improve Health Outcomes (NOT-OD-22-167) . The purpose of this Notice is to highlight interest in addressing the role of violence in health outcomes and integrating violence-related screening and interventions into health care settings. This Notice is to encourage intervention research focused on addressing exposure to violence - including but not limited to child maltreatment, intimate partner violence/teen dating violence, elder mistreatment, peer violence/bullying, and community violence – to improve individual-level health processes and outcomes. This Notice will expire on October 5, 2025.

OBSSR also engages the research community and the public through outreach activities. OBSSR-hosted upcoming and past violence research initiatives-focused events are listed below.

Upcoming Events

There are no upcoming events at this time.

Past Events

Key Highlights From the Workshop

• Dayu Lin, Ph.D., NYU Grossman School of Medicine
• Terrie E. Moffitt, Ph.D., Duke University, King’s College London
• Speaker: Megan L. Ranney, M.D., Ph.D., Incoming Dean, Yale School of Public Health (July 2023)
• Speaker: Rebecca Cunningham, Ph.D., Professor of Emergency Medicine, Director of the Injury Prevention Center, University of Michigan

Efforts Led by Other NIH ICOs

OBSSR and the violence research working group also serve as a hub for support of IC-led violence related initiatives. Upcoming and past events led by other ICOs relevant to violence research are listed below.

Future Directions in Violence Against Women Research

Request for information (rfi; not-nr-23-008 ).

• Summary Report

National Institute of Mental Health (NIMH) Grantee Meeting

• Violence and the HIV Care Continuum

The Sexual and Gender Minority Research Office (SGMRO) Workshop

SGMRO conducted a multi-phased workshop on violence & related health outcomes in SGM communities . This timeline included a Request for Information, a state of the science workshop, virtual working groups, a final public report out session in August 2021, and a special journal issue .

Active Funding Opportunities

• NIDA: RFA-DA-25-018 : Engaging Survivors of Sexual Violence and Trafficking in HIV and Substance Use Disorder Services (R34 Clinical Trial Optional). Expires August 6, 2024.
• NIMH: NOT-MH-22-095 : NIMH Priorities on Research on Aggression and Violence Against Others. Expires January 8, 2025.
• NIMH: RFA-MH-25-120 : Lethal Means Safety Suicide Prevention Research in Healthcare and Community Settings (R34 Clinical Trial Required). Expires January 24, 2025.
• NIDA: NOT-DA-23-007 : Notice of Special Interest (NOSI): HEAL Initiative: Opioid Use Disorder Care Pathways for Individuals with Histories of Exposure to Violence. Expires July 13, 2025.
• NINR: PAR-24-061 : Nursing Research Education Program in Firearm Injury Prevention Research: Short Courses (R25 Independent Clinical Trial Not Allowed). Expires May 26, 2026.
• NIAAA: NOT-AA-23-003 : Notice of Special Interest: Advancing mHealth Interventions for Understanding and Preventing Alcohol-Related Domestic Violence. Expires September 8, 2026.

Federal Collaborations to Address Violence

OBSSR, along with ICO partners, are engaged in several White House and Federal Partner efforts to address all forms of violence. NIH participation in such efforts ensures that lessons learned from NIH grantees are integrated into ongoing efforts. Recent examples are provided below.

White House Community Violence Intervention (CVI) Collaborative

An 18-month effort (from June 2021-December 2022) involving a cohort of 16 jurisdictions committed to using public funding to scale and strengthen their CVI structure. Investing in community violence interventions to combat the gun violence epidemic is a key part of the administration’s comprehensive strategy to prevent and respond to gun violence. The CFVP network described above aligns well with CVI efforts as it is focused on community level interventions to prevent firearm injury and mortality. In addition, a number of NIH funded grants are working in similar areas.

OBSSR also worked with the Centers for Disease Control and Prevention ( CDC ), Administration for Children and Families ( ACF ), Department of Justice ( DOJ ), U.S. Department of Housing and Urban Development ( HUD ), and other federal colleagues, to coordinate a webinar series to provide subject matter expertise to communities implementing these efforts. Sessions are recorded and uploaded to the Community Violence Intervention page on the Bureau of Justice’s (BJA) National Training and Technical Assistance Center website .

White House Task Force on Online Harassment and Abuse

The White House Task to Address Online Harassment and Abuse was established via Presidential Memorandum on June 16, 2022 to address online harassment and abuse, specifically technology-facilitated gender-based violence. In consultation with survivors, advocates, educators, experts from diverse fields, and the private sector, the Task Force developed specific recommendations to improve prevention, response, and protection efforts through programs and policies in the United States and globally. As part of this effort, NIH hosted a “Understanding and Addressing the Health Impacts of Online Abuse and Harassment Workshop” on December 7-8, 2023, to identify gaps, opportunities, and challenges in advancing a research agenda to better understand the clinical, health, and developmental impacts of online harassment and abuse and develop innovative prevention and intervention efforts.

View workshop information and videocast

Landscape Analysis Summary for the NIH Online Harassment Research Portfolio

National Action Plan to Prevent Gender Based Violence

NIH staff were instrumental in contributing to the development of the plan and are serving on the implementation team. Learn more .

Assistant Secretary for Planning and Evaluation (ASPE) Executive Order

NIH staff contributed to the writing of this report and NIH-funded research was cited in several places.

Executive Order on Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety: A Report on a Review of the Community Impacts of Use of Force and Certain Other Police Activities on Physical, Mental and Public Health. Learn more .

In the News

Bssr spotlights.

Findings from recently published behavioral and social sciences research are highlighted each month in the Research Spotlights Blog . NIH-funded violence research initiatives that have been featured in the blog:

• Some young adult males living in certain major U.S. cities face a higher risk of firearm death than military deployed in Iraq and Afghanistan
• Homicide is a leading cause of maternal mortality in the U.S.
• Reported domestic violence crimes decreased in Chicago during the 2020 COVID-19 stay-at-home order but may not reflect true levels of violence
• Mental illness may not be a factor in most mass shootings
• Violence exposure in childhood impacts brain network connectivity into adolescence
• Evaluating the risk of school violence using natural language processing and machine learning
• Preventing revictimization among recent survivors of sexual violence

More Resources

• To access NIH spending amounts and specific awards, view the Research, Condition, and Disease Categories (RCDC) “Firearms Research” and “Violence Research” on NIH RePORTER . The Firearms RCDC is only for FY2020 and beyond.
• Intimate Partner Violence
• NIH Awards Grants for Firearm Injury and Mortality Prevention Research (2020)
• NIH awards 10 grants addressing firearm violence prevention (2021)
• NIH Research to Prevent Firearm Injury and Mortality (2022)
• NIH Awards Additional Research and Training Grants to Support Firearm Injury and Mortality Prevention Science (2023)
• CDC Violence Prevention
• Schoolsafety.gov Safe Storage Fact Sheet

Contact Information

For more information on OBSSR’s Violence Research Initiatives, feel free to contact:

Dara R. Blachman-Demner, Ph.D. Health Scientist Administrator Email: [email protected] Phone: 301-496-8522

31 Center Drive, Building 31, Room B1C19 Bethesda, MD 20892

Email: [email protected]

Phone: 301-402-1146

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The Effects Of Violence On Health

Affiliations.

• 1 Frederick Rivara ( fpr@uw. edu ) is the Seattle Children's Guild Endowed Chair in Pediatric Research and a professor in the Department of Pediatrics at the University of Washington, in Seattle.
• 2 Avanti Adhia is a senior fellow in the Department of Pediatrics, University of Washington.
• 3 Vivian Lyons is a doctoral candidate in the Department of Epidemiology, University of Washington.
• 4 Anne Massey is a doctoral candidate in the Department of Epidemiology, University of Washington.
• 5 Brianna Mills is a research scientist in the Harborview Injury Prevention and Research Center, University of Washington.
• 6 Erin Morgan is a doctoral candidate in the Department of Epidemiology, University of Washington.
• 7 Maayan Simckes is a doctoral candidate in the Department of Epidemiology, University of Washington.
• 8 Ali Rowhani-Rahbar is the Bartley Dobb Professor for the Study of Violence and an associate professor in the Department of Epidemiology, University of Washington.
• PMID: 31589529
• DOI: 10.1377/hlthaff.2019.00480

Violence in its many forms can affect the health of people who are the targets, those who are the perpetrators, and the communities in which both live. In this article we review the literature on the health consequences of many forms of violence, including child physical and sexual abuse, intimate partner violence, elder abuse, sexual violence, youth violence, and bullying. The biological effects of violence have become increasingly better understood and include effects on the brain, neuroendocrine system, and immune response. Consequences include increased incidences of depression, anxiety, posttraumatic stress disorder, and suicide; increased risk of cardiovascular disease; and premature mortality. The health consequences of violence vary with the age and sex of the victim as well as the form of violence. People can be the victims of multiple forms of violence, and the health effects can be cumulative.

Keywords: Adolescents; Adverse childhood experiences; Children’s health; Depression; Health policy; Mental health; Post traumatic stress disorder; Stress; Violence.

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Effectiveness of Violence Prevention Interventions: Umbrella Review of Research in the General Population

Seena fazel.

1 University of Oxford, UK

Matthias Burghart

2 University of Konstanz, Germany

Daniel Whiting

3 University of Nottingham, UK

Associated Data

Supplemental material, sj-docx-1-tva-10.1177_15248380231195880 for Effectiveness of Violence Prevention Interventions: Umbrella Review of Research in the General Population by Seena Fazel, Matthias Burghart, Achim Wolf, Daniel Whiting and Rongqin Yu in Trauma, Violence, & Abuse

To address the societal harms of violence, many violence prevention interventions have been developed, tested, and implemented in the general population. These have been reported in systematic reviews and meta-analyses, which have typically focused on one type of intervention or outcome. We aimed to provide a comprehensive overview of the current evidence regarding the effectiveness of different psychosocial interventions in reducing all forms of violence toward others. We have conducted an umbrella review of previous meta-analyses using standard approaches and converted findings on effectiveness into odds ratios. We tested for the underlying quality of the meta-analytic evidence by examining heterogeneity, excess statistical significance, prediction intervals, and small study effects. We identified 16 meta-analyses, including nine investigating psychosocial interventions, and five legislative and policy changes. Most meta-analyses reported positive effects of tested interventions. The strongest effects were found for sports-based initiatives, and the weakest for general population programs aimed at early childhood, youth development, and reducing sexual assault perpetration by men. Legislative changes had varying effectiveness. We conclude that simple, scalable, and cost-efficient programs, such as sport-based initiatives, have the clearest empirical support as population-based approaches to violence prevention.

Violence against others is a public safety and health problem globally ( World Health Organization, 2014 , 2022 ). It is characterized as any intentional use of physical force or power, threatened or actual toward another person that either results in or has a high likelihood of causing injury, death, or psychological harm. It has severe impacts on the physical and psychological morbidity of victims at the population level. The economic burden is considerable with estimates that interpersonal violence costs globally $15 trillion annually or 12% of the worldwide gross domestic product ( Iqbal et al., 2021 ). On an individual level, research has consistently shown that both violence perpetration and victimization are associated with negative behavioral and health-related outcomes. In young people, these include poorer educational outcomes and an increased risk of premature mortality ( Fry et al., 2018 ; Smiley et al., 2021 ). Across all ages, increased risks of psychiatric symptoms and diagnoses, suicidal behaviors, and further violence have been reported ( de Ruiter et al., 2022 ; Hailes et al., 2019 ; MacIsaac et al., 2017 ; Smith et al., 2020 ; Wright et al., 2019 ). It is also linked to psychological effects on families and carers of victims, healthcare workers, and community-related harms.

To address these harms, many violence prevention interventions have been developed. These include universal ones aimed at the general population, and targeted ones for those at increased risk for violent behavior (e.g., individuals who misuse substances). In addition, indicated interventions, directed at individuals who have perpetrated violence before (e.g., convicted persons), have been tested. Regardless of the level of intervention, violence prevention programs need to be supported by evidence of their efficacy ( , World Health Organization, 2022 ). However, most violence intervention programs have not been properly tested ( Kovalenko et al., 2022 ; , Nation et al., 2003 ), some of which may be harmful as they might increase the risk of violence or other adverse outcomes. Those with no effect on individual outcomes are also harmful in wasting limited resources. The proliferation of new interventions can mean that policymakers are unable to keep up and appraise new evidence ( Kovalenko et al., 2022 ; Matjasko et al., 2012 ). Although there has been an increase in systematic reviews that aim to summarize the evidence, they are typically limited in terms of selecting one intervention or outcome to examine (e.g., Eggers del Campo & Steinert, 2022 ). They are also limited by their methodological quality, which varies widely and results in conflicting findings, which further complicates interpretation of the evidence.

One comprehensive summary of “what works” in violence prevention is a meta-review that is a decade old ( Matjasko et al., 2012 ), which examined the effectiveness of youth violence prevention programs. Its findings suggested that interventions based on cognitive-behavioral therapy, parental training, peer mediation, or certain school-based approaches were most effective at reducing violence among adolescents. Interventions based solely on deterrence (e.g., “Scared Straight,” which organizes visits to correctional facilities by juveniles who have offended or children at risk of doing so), on the other hand, were associated with increased offending risk. This meta-review is now dated and did not make a clear distinction between the different levels of intervention (i.e., universal, targeted, and indicated). This is potentially important as previous research has shown that universal violence interventions are often less effective than targeted and indicated ones ( Dodge, 2020 ). In addition, the previous meta-review lacked a quality assessment of included reviews and quantitative synthesis, and was limited to youth violence, rather than including interventions for individuals of all ages. Therefore, it is important to address this gap in the literature and clarify the effectiveness of universal interventions, due to its potential impact at a population level and in reducing societal costs of violence and antisocial behaviors.

The Present Umbrella Review

To address limitations in the previous literature, we conducted an umbrella review of the evidence on the effectiveness of universal violence prevention interventions for all age groups. An umbrella review is a synthesis of existing systematic reviews and allows the findings of reviews to be compared and contrasted, allowing for a more comprehensive analysis of the current evidence than any individual review on a specific topic (Aromataris et al., 2015). In addition, umbrella reviews can summarize systematic reviews using a structured quality assessment and are increasingly used to obtain a clearer overview of a field where there is a large research literature and where individual systematic reviews may have reported conflicting findings. A previous umbrella review examined targeted interventions in mental health populations ( Wolf et al., 2017 ). Thus, the objective of the current study is to provide a comprehensive overview of the effectiveness of psychosocial interventions for violence in the general population.

Search Strategy and Eligibility Criteria

We conducted a comprehensive systematic search strategy following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Moher et al., 2009 ). In all, 10 databases were searched from inception to April 2022: Cochrane Database of Systematic Reviews, DARE, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, Medline, PsycINFO, PROSPERO, PubMed, Scopus, and Web of Science. In each database, the same combination of the following search terms was used to search the title, abstract, and keywords of an article: ((( prevent* OR risk management OR risk reduction OR deter* ) AND ( violen* OR homicid* OR assault* OR rape OR robber* OR bully* )) OR ( recidiv* OR reoffend* OR repeat offend* )) AND ( systematic review OR meta-analysis ). In addition, reference lists of relevant reviews and Google Scholar were hand-searched.

A review was eligible for inclusion if it was a meta-analysis that examined the effectiveness of a universal violence prevention intervention (i.e., not including reviews that focused on interventions for high-risk populations or individuals with a history of violent behavior) and reported outcome data for interpersonal violence perpetration. Violence was defined based on an adapted WHO definition for individuals (intentional use of physical force or power, threatened or actual toward another person that either results in or has a high likelihood of resulting in injury, death, or psychological harm) and did not include self-directed violence (i.e., self-harm or suicide), violence victimization, or attitudes towards violence. Both published and unpublished reviews in any language were considered. Primary studies and reviews with methodologies other than a meta-analysis (e.g., systematic reviews, meta-reviews) were excluded as we intended to provide quantitative comparisons and assess quality.

Data Extraction

Data extraction followed a two-stage process. First, titles and abstracts of all articles retrieved from the systematic search were screened and excluded from further consideration if inclusion criteria were not met. Then studies were read by two independent reviewers (MB and AW) and, if eligible for inclusion, entered into a standardized data extraction form. Extracted data included relevant information on the population, intervention, outcome, setting, number of included studies and participants as well as statistical information including effect size, confidence and prediction interval, level of heterogeneity, and the meta-analytical model used. Where data were missing, corresponding authors were contacted by email. Any conflicts that arose during the extraction process were resolved in consultation with SF.

Data Analysis

Because the reported effect sizes varied across reviews, these were converted to a common metric, namely odds ratios (ORs). Statistical approximations were used for all conversions. In instances where no formula exists to directly calculate an OR, the effect size was first converted to Cohen’s d ( Borenstein et al., 2011 ). In addition, the final effect sizes were transformed such that OR values >1 indicate that the intervention resulted in violence reduction, whereas OR values <1 indicate an unfavorable effect.

When reviews reported pooled effect sizes for separate interventions, each intervention was included in the umbrella review as a distinct and independent effect ( Higgins et al., 2019 ). If, however, multiple pooled effect sizes were calculated as part of a moderator analysis, only the one with the highest quality rating (see below) was considered for all subsequent analyses (e.g., follow-up measures were preferred over measures taken immediately after the intervention). In addition, as several eligible articles examined the effectiveness of universal and targeted violence prevention interventions simultaneously, it was necessary to disentangle their findings ( Aromataris et al., 2015 ). That is, the statistical analysis of the included meta-analysis was repeated by including only those primary studies that focused exclusively on universal prevention strategies. In the absence of the data required to rerun the analyses (e.g., missing standard errors), these were requested from the corresponding author. When authors did not respond or could not provide the information, it was approximated from forest plots using the WebPlotDigitizer R-package ( Rohatgi, 2022 ). Finally, to prevent overlap between reviews, only the largest meta-analyses of those with overlapping primary studies were included in our main analyses.

Quality of Evidence

The overall quality of each included meta-analysis was assessed using six different approaches proposed in previous umbrella reviews ( Bellou et al., 2017 ; Fazel et al., 2018 ). First, the Assessing the Methodological Quality of Systematic Reviews (AMSTAR; Shea et al., 2007 ) was scored. The AMSTAR consists of 11 items that are summed to produce a final score indicating low (0–3 points), medium (4–7 points), or high (8–11 points) methodological quality. Second, the ratio between the pooled overall effect size of a meta-analysis and the effect size of its largest included study was calculated as a measure of statistical excess bias ( Kavvoura et al., 2008 ). Since the largest included study is considered the most accurate ( Lipsey & Wilson, 2001 ), a ratio >1 is a strong indication of the presence of excess statistical significance ( Kavvoura et al., 2008 ). Third, the between-study heterogeneity within each review was quantified using the I 2 statistic ( Higgins et al., 2019 ). I 2 quantifies the proportion of variability across studies that is not due to chance. Values >50% were considered large ( Ioannidis et al., 2007 ; Solmi et al., 2018 ). Fourth, the 95% prediction interval of a review’s overall pooled effect size was inspected ( IntHout et al., 2016 ). Prediction intervals that include the null effect (i.e., OR = 1) indicate potentially nonsignificant findings in a new population ( Higgins et al., 2019 ; Riley et al., 2011 ). Fifth, Egger’s regression asymmetry test was used to assess small-study effects ( Egger et al., 1997 ). Significant results in this test were considered evidence of publication bias ( Sterne et al., 2011 ). Sixth, reviews with more than 1,000 participants were rated as being of higher quality than reviews with fewer participants given the greater statistical power of larger meta-analyses ( Borenstein et al., 2011 ). Finally, to summarize these distinct quality assessments, they were aggregated into an overall quality score, ranging from 0 (low quality) to 6 (high quality). Missing data on quality criteria were scored as 0.

Study Characteristics

The systematic literature search yielded a total of 5,378 articles. After screening titles and abstracts, the full texts of 116 papers were reviewed for eligibility, resulting in 30 meta-analyses. When overlap between these reviews was accounted for, 16 meta-analyses with 22 pooled effect sizes remained in our main analyses. Results of all other eligible reviews are reported in Supplemental Table 1 .

Included meta-analyses were published between 2010 and 2022. The number of included participants ranged from 400 to 35,000, with a median of 5,546. The majority of reviews ( k  = 9) synthesized evidence for psychosocial interventions, most of which consisted of parent and teacher training on antibullying strategies and child skills training (e.g., social and emotional learning, recognition of dating violence). Five articles examined legislative and policy changes such as increasing alcohol taxes, expanding closed-circuit television (CCTV) surveillance, vacant lot remediation (i.e., greening, mowing, gardening of unused land), and implementing conservative gun laws. Violence prevention interventions based on physical activity (e.g., martial arts) were examined in two reviews ( Harwood et al., 2017 ; Spruit et al., 2016 ). Other strategies include female economic empowerment and male-targeted sexual assault prevention programs. Overall, outcomes varied considerably across reviews, including aggression, cyberbullying, bullying, gun violence, disruptive behavior, violent crime, and sexual violence (see Supplemental Table 2a for details). Most interventions primarily focused on addressing bullying behaviors, including cyber and physical bullying, conduct problems, and other antisocial behaviors such as dating violence, particularly among adolescents and young adults. However, in adult groups, outcomes tended to be more severe, including violent crime, sexual and intimate partner violence, and gun violence. Designs used to test interventions varied considerably ( Supplemental Table 2b ), although most were quasi-experimental studies (with a control group) or investigations that involved outcome assessment conducted before and after an intervention. Only one meta-analysis was based solely on randomized controlled trials (RCTs; Eggers del Campo & Steinert, 2022 ).

Main Findings

ORs ranged from 1.04 to 2.66 with a median OR of 1.19. All 16 meta-analyses reported positive effects of intervention (i.e., OR > 1). That is, interventions were associated with a lower risk of the targeted prevention outcomes such as violence and other antisocial behaviors. As tested interventions were heterogeneous, results were also assessed separately for different types of intervention programs ( Tables 1 and ​ and2; 2 ; Figure 1 ). The largest effect size was found for interventions based on physical activity, particularly one focused on martial arts training. Some community-based changes were associated with strong effects, such as law enforcement for gun control, but there was variation between various policy and legal initiatives. Some community-based interventions had no effects, such as gun buy-back programs and CCTV surveillance. Legislative changes around alcohol price and availability had small effect sizes. Psychosocial interventions against bullying and cyberbullying, such as the KiVa program, which focuses on bystanders, teaching children to recognize and respond when they see bullying, reported positive findings but with small effect sizes. Psychosocial programs targeting sexual and general violence through youth development interventions (delivered online), male-specific sexual assault programs, and female economic empowerment had broadly similar findings but with more variation and wider confidence intervals.

Effect Sizes of all Meta-Analyses Assessing the Effectiveness of Universal Violence Prevention Interventions (Ranked by Quality Score).

Note. Quality score ranges from 0 (low quality) to 6 (high quality), and reports: no. positive quality items/no. quality items reported. “Mowing” interventions: trash/debris removal, mowing vegetation regularly. “Greening” interventions: trash/debris removal, grading land, planting new grass/trees, installing fences, maintaining lots. “Gardening” interventions: grading soil, planting turfgrass, mowing, and various landscaping. k  = number of studies included in a meta-analysis; n  = number of participants included in a meta-analysis; OR = odds ratio; CI = confidence interval; n.s. = not significant; RCTs = randomized controlled trials.

p  < .05 = statistically significant with a confidence level smaller than .05.

Critical Findings.

Effectiveness of universal violence prevention interventions from previous meta-analyses.

Note . ■ = confidence interval was given; ▲ = no confidence interval given, but the p value reported as <.05; × = no confidence interval given, but results reported as statistically nonsignificant (n.s.).

Quality ratings indicated variable but mostly low quality in the meta-analytic literature ( Figure 2 ; Supplemental Table 3 ). There were (1) wide prediction intervals, with all 16 reviews either not reporting them or including the null effect, suggesting that future studies might find no effects or opposite effects; (2) large heterogeneity across primary studies, with 16 out of 26 studies with an I 2 of 50% or higher; and (3) excess statistical significance in half of the included meta-analyses. Small sample sizes ( n  < 1,000) and small study effects were found in two reviews. However, lack of information in many reviews limited the evaluation of all aspects of the quality assessment.

Visual representation of quality assessment.

Note . Each panel represents the results of one of the six quality assessments performed, with orange and green generally indicating a low and high score, respectively. The sum of reviews within each panel does not always equal the total number of all included meta-analyses, since data were missing in some cases. Detailed quality assessment results for each review are shown in Supplemental Table 3 .

In this umbrella review, we summarized the findings of 16 meta-analyses on the effectiveness of universal violence prevention interventions. Overall, our findings suggest a mostly small but positive impact on reducing violence, with the primary effectiveness measure, calculated from effect sizes of included meta-analyses, and reported as odds ratios (ORs) ranging from 1 to 3. All the included meta-analyses reported pooled ORs higher than 1, which was also observed for the wider set of 30 meta-analyses that included overlapping underlying reviews ( Supplemental Table 1 ). In general, we found support for sports-based and anti-bullying interventions targeting children and youth. However, there are mixed findings regarding the effectiveness of policy change programs.

The findings of this umbrella review have important implications for practice, policy, and research ( Table 3 ). We found certain types of universal violence prevention interventions were more promising than others. Of note, the strongest effects were for interventions based on martial arts training ( Harwood et al., 2017 ). The quality of the underlying meta-analyses also varied widely with higher-quality reviews finding small but positive effects of school-based interventions ( Moy & Hazen, 2018 ) and an online program for intimate partner violence ( Spencer et al., 2021 ).

Implications of the Review on Effectiveness of Universal Violence Prevention Interventions for Practice, Policy, and Research.

We found evidence in support of sports-based interventions for reducing externalizing problems in children and youths. The review on martial arts training made a distinction between traditional and modern martial arts practices and included only the former ( Harwood et al., 2017 ). Traditional styles (e.g., Aikido) describe internally focused techniques that emphasize self-reflection, ancient philosophies, and breathing techniques, while modern martial art forms lack these components (e.g., boxing; Hernandez & Anderson, 2015 ). This distinction may suggest that it is not the physical engagement in the training itself that mediates the positive effects of the intervention but rather the additional elements of traditional martial arts practices ( Harwood et al., 2017 ). The second meta-analysis on physical activity interventions ( Spruit et al., 2016 ) investigated sports programs in general but yielded a smaller and nonsignificant pooled effect size. This difference could be secondary to the absence of the cognitive and self-reflective components in the physical interventions studied. However, overall, such approaches provide a simple, scalable, and potentially cost-effective violence prevention measure.

Psychosocial anti-bullying programs, targeting school-aged children and youths, produced consistent evidence of effectiveness but with small effect sizes. The high base rate of bullying, estimated to be 35% in adolescents ( Modecki et al., 2014 ), is an important context to these findings. Anti-bullying initiatives are therefore more likely to have a detectable impact than those that target less prevalent violent outcomes ( Beelmann & Lösel, 2021 ). Another possible reason for their effectiveness is that bullying is a relatively low-severity form of violence, which is less likely to occur within a pattern of entrenched antisocial behaviors than more serious violence, and thus may be more responsive to treatment ( Moffitt, 2018 ).

Legislative and policy changes, aiming at reducing severe forms of crime, such as general and gun violence in the general population, produced the most heterogeneous results in this umbrella review. A number of factors may explain this. First, the outcome measure for these types of studies usually has a high outcome threshold, such as criminal arrest or conviction. Second, specificity is a key principle for an effective prevention program ( Nation et al., 2003 ); however, all but one meta-analysis ( Makarios & Pratt, 2012 ) investigated legislation that aimed to reduce violence-related crime (e.g., burglary, vandalism) rather than violent offenses specifically. Third, it is possible that the distal effect of policy changes on violent outcomes may only be noticeable after several years and not be captured in the time span of research studies. The findings on the positive effects of alcohol legislation on price and availability on reducing violence, although associated with smaller effect sizes, are important from a population perspective due to the underlying high prevalence of alcohol use and misuse ( Wagenaar et al., 2010 ).

In view of the high cost-benefit ratio of universal programs ( Beelmann & Lösel, 2021 ; Greenberg & Abenavoli, 2017 ), this umbrella review suggests that some universal interventions, if implemented, require a review of their impact to justify their continuation. Where implementation is expensive or resource-intensive across criminal justice, health, and educational services, the highest quality evidence in support should be required before wholescale adoption. At the same time, many universal interventions are simple, relatively cheap, and quick to implement because they do not require a preselection of individuals ( Beelmann & Lösel, 2021 ). Moreover, they are usually associated with additional benefits beyond violent reduction, such as increased prosocial skills ( Durlak et al., 2011 ), less substance use ( Bonell et al., 2016 ), or improved dating violence knowledge/attitudes ( De La Rue et al., 2017 ).

Limitations

Some limitations should be noted. First, the definition of violence was necessarily broad, which was consequently associated with expected high levels of heterogeneity. Direct comparisons between certain programs need to be made with caution due to different outcome thresholds and prevalence. Second, most primary studies in the included meta-analyses used short follow-up periods for the evaluation of interventions. Thus, the reported effect sizes are likely to be an overestimation of the true long-term effects. Third, most meta-analyses in this umbrella review did not provide sufficient data for the comprehensive quality assessment. Fourth, all included reviews reported overall positive effects, which suggests that publication and allegiance biases are prominent in this area.

In addition, the heterogeneity of the included reviews might be explained by sample characteristics and study settings. For example, information about background characteristics of the sample, such as gender and socioeconomic status, and settings in which interventions were implemented (community centers vs. clinics), should be improved and can be examined as potential explanations for the heterogeneity when this literature is updated. Furthermore, most of the studies were conducted in high-income countries, and it is not known whether findings can be generalized to low- and-middle income countries where resources are more limited. In many contexts, cultural adaptation will be required, and testing this should be part of any implementation process.

Implications

The findings of this umbrella review have some direct policy implications. First, in contrast to much expert opinion (Lannen & Ziswiler, 2014), psychosocial interventions that have been widely implemented in high-income countries, and predominantly target early childhood, parents, and teachers of preschool and early years children, have smaller effects than physical activity programs aimed at adolescents and young adults. Therefore, such interventions, such as sports clubs, with the associated relevant facilities, should be a primary focus for policy and research. Second, anti-bullying initiatives, which were found to have a small but consistent effect on a high-prevalence behavior, could be considered as part of any broad violence prevention strategy. Overall, universal programs may be best suited as a quick, resource-efficient, and large-scale prevention method. In contrast, targeted and indicated interventions, which typically have stronger effects but are more resource-intensive, could be reserved for more severe forms of violence. These interventions may be longer in duration, require specially trained staff for delivery, and engage multiple agents (e.g., health services, family, peers, and community residents).

Future work should consider what are the key ingredients and mechanisms that explain effective interventions. In addition, the lack of stronger effects for broad psychosocial interventions, such as thinking or social skills training, suggests that more focused universal prevention approaches should be evaluated, including those based on group-based interventions and addressing modifiable risk factors, including substance misuse.

Universal violence prevention interventions, particularly those aimed at early childhood, have mostly small effects on violence perpetration and require more evidence in support before further implementation. Simple, scalable, and cost-efficient programs, such as sport-based initiatives, appear to have more empirical support than other population-based approaches to violence prevention.

Supplemental Material

Author biographies.

Seena Fazel is professor of forensic psychiatry at the University of Oxford.

Matthias Burghart is a PhD student in clinical psychology at the University of Konstanz.

Achim Wolf completed his DPhil in psychiatry at the University of Oxford and now works as a research scientist at Evidera.

Daniel Whiting is a clinical associate professor of forensic psychiatry at Nottingham University.

Rongqin Yu is a senior researcher at the University of Oxford.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Seena Fazel and Achim Wolf were funded by the Wellcome Trust (Grant no. 202836/Z/16/Z).

Supplemental Material: Supplemental material for this article is available online.

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Meet the public health researchers trying to rein in america's gun violence crisis.

Christine Spolar

A digital illustration of a circle of hands extending from the edge of the image, each holding a sheet of paper. The papers overlap in the center and, like a puzzle, come together to reveal a drawing of a handgun. Oona Tempest/KFF Health News hide caption

A digital illustration of a circle of hands extending from the edge of the image, each holding a sheet of paper. The papers overlap in the center and, like a puzzle, come together to reveal a drawing of a handgun.

Gun violence has exploded across the U.S. in recent years — from mass shootings at concerts and supermarkets to school fights settled with a bullet after the last bell.

Nearly every day of 2024 so far has brought more violence. On Feb. 14, gunfire at the Super Bowl parade in Kansas City, Missouri, killed one woman and wounded 22 other people. Most events draw little attention — while the injuries and toll pile up.

Gun violence is among America's most deadly and costly public health crises. But unlike other big killers — diseases like cancer and HIV or dangers like automobile crashes and cigarettes — sparse federal money goes to studying or preventing it.

That's because of a one-sentence amendment tucked into the 1996 Congressional budget bill: "None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control."

Its author was Jay Dickey, an Arkansas Republican who called himself the "point man" for the National Rifle Association on Capitol Hill. And for nearly 25 years the amendment was perceived as a threat to, and all but paralyzed, the CDC's support and study of gun violence.

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Even so, a small group of academics have toiled to document how gun violence courses through American communities with vast and tragic outcomes. Their research provides some light as officials and communities develop policies mostly in the dark.

It has also inspired a fresh generation of researchers to enter the field – people who grew up with mass shootings and are now determined to investigate harm from firearms. There is momentum now, in a time of rising gun injury and death, to know more.

The reality is stark:

Gun sales reached record levels in 2019 and 2020. Shootings soared. In 2021, for the second year , more people died from gun incidents — 48,830 — than in any year on record, according to a Johns Hopkins University analysis of CDC data. Guns became the leading cause of death for children and teens. Suicides accounted for more than half of those deaths, and homicides were linked to 4 in 10.

Gun deaths hit their highest level ever in 2021, with 1 person dead every 11 minutes

Black people are nearly 14 times as likely to die from firearm violence as white people — and guns were responsible for half of all deaths of Black teens ages 15 to 19 in 2021, the data showed.

Harvard research published in JAMA in 2022 estimated gun injuries translate into economic losses of $557 billion annually , or 2.6% of the U.S. gross domestic product.

With gun violence touching nearly every corner of the country, surveys show that Americans — whatever their political affiliation or whether they own guns or not — support policies that could reduce violence .

Quashing a quest for knowledge

It is no secret that many strategies for reducing harm from guns proposed today — from school metal detectors to enhanced policing, to the optimal timing and manner of safely storing guns, to restrictions on gun sales — have limited scientific ballast because of a lack of data.

It could have been otherwise.

U.S. firearm production surged in the late 1980s , flooding communities with more than 200 million weapons . In that era, Mark Rosenberg was the founding director of the CDC's National Center for Injury Prevention and Control and his agency, over time, was pivotal in helping to fund research on gun violence and public health.

Mark Rosenberg, one of the nation's top authorities on gun violence and public health, was the founding director of the National Center for Injury Prevention and Control at the CDC. Oona Tempest/KFF Health News hide caption

Rosenberg thought then that gun violence could go the way of car crashes. The federal government spent $200 million a year on research to redesign roadways and cars beginning in the 1970s, he said, and had seen death rates plummeted.

"We said, 'Why can't we do this with gun violence?'" Rosenberg said. "They figured out how to get rid of car crashes — but not cars. Why can't we do the same thing when it comes to guns?"

The Dickey Amendment sidelined that dream.

A study published in 1993 concluded that "guns kept in the home are associated with an increase in the risk of homicide," a finding on risk factors that prompted an uproar in conservative political circles. To newly elected representatives in the midterm "Republican Revolution" of 1994, the research was a swipe at gun rights. The NRA stepped up lobbying, and Congress passed what's known as the Dickey Amendment in 1996.

Some Democrats, such as the influential John Dingell of Michigan (a onetime NRA board member who received the group's " legislative achievement award "), would join the cause. Dingell proposed his own bills, detailed last summer by The New York Times .

Under heavy political pressure, the CDC ousted Rosenberg in 1999. Soon after, some CDC administrators began alerting the NRA to research before publication.

"It was clearly related to the work we were doing on gun violence prevention," Rosenberg, now 78, said of his job loss. "It was a shock."

Gun researchers who persevered

The quarter-century spending gap has left a paucity of data about the scope of gun violence's health effects: Who is shot and why? What motivates the violence? With what guns? What are the injuries? Can suicides, on the rise from gunfire, be reduced or prevented with safeguards? Does drug and alcohol use increase the chances of harm? Could gun safeguards reduce domestic violence? Ultimately, what works and what does not to prevent shootings?

If researchers say they "lost a generation" of knowledge about gun violence, then American families lost even more, with millions of lives cut short and a legacy of trauma passed down through generations.

Rebecca Cunningham, the vice president of research at the University of Michigan and an emergency medical doctor, organized a national conference last fall on the prevention of firearm harm that drew more than 750 academics and public health, law, and criminal justice experts. "You can feel momentum" for change, she says. Oona Tempest/KFF Health News hide caption

Imagine if cancer research had been halted in 1996 — many tumors that are now eminently treatable might still be lethal. "It's like cancer," said Rebecca Cunningham, vice president for research at the University of Michigan, an academic who has kept the thread of gun research going all these years. "There may be 50 kinds of cancer, and there are preventions for all of them. Firearm violence has many different routes, and it will require different kinds of science and approaches."

Cunningham is one of a small group of like-minded researchers from universities across the United States, who refused to let go of investigating a growing public health risk, and they pushed ahead without government funds.

Garen Wintemute has spent about $2.45 million of his money to support seminal research at the University of California-Davis. With state and private funding, he created a violence prevention program in California, a leader in firearm studies. He has documented an unprecedented increase in gun sales since 2020 — about 15 million transactions more than expected based on previous sales data.

Daniel Webster, a Johns Hopkins University researcher, has focused on teenagers and guns. Oona Tempest/KFF Health News hide caption

Daniel Webster at Johns Hopkins University focused on teenagers and guns — particularly access and suicides — and found that local police who coped with gun risks daily were willing to collaborate. He secured grants, even from the CDC, with carefully phrased proposals that avoided the word "guns," to study community violence.

At Duke University, Philip J. Cook explored the underground gun market, interviewing people incarcerated in Chicago jails and compiling pivotal social science research on how guns are bought, sold, and traded.

David Hemenway , an economist and public policy professor at Harvard, worked on the national pilot to document violent deaths — knowing most gun deaths would be recorded that way — because, he said, "if you don't have good data, you don't have nothin'."

Hemenway, writing in the journal Nature in 2017, found a 30% rise in gun suicides over the preceding decade and nearly a 20% rise in gun murders from 2014 to 2015. The data was alarming and so was the lack of preventive know-how, he wrote. "The US government, at the behest of the gun lobby, limits the collection of data, prevents researchers from obtaining much of the data that are collected and severely restricts the funds available for research on guns," he wrote. "Policymakers are essentially flying blind."

David Hemenway, a Harvard economist and public policy professor, anchored the work that led to the most ambitious database of U.S. gun deaths today. Oona Tempest/KFF Health News hide caption

His work helped create the most ambitious database of U.S. gun deaths today — the National Violent Death Reporting System . Funded in 1999 by private foundations, researchers were able to start understanding gun deaths by compiling data on all violent deaths from health department, police, and crime records in several states. The CDC took over the system and eventually rolled in data from all 50 states.

Still, no federal database of nonfatal gun injuries exists. So the government would record one death from the Super Bowl parade shooting, and the 22 people with gunshot injuries remain uncounted — along with many thousands of others over decades.

Philanthropy has supported research that Congress would not. The Joyce Foundation in Chicago funded the bulk of the grants, with more than $33 million since the 1990s. Arnold Ventures ' philanthropy and the Robert Wood Johnson Foundation have added millions more, as has Michael Bloomberg, the politician and media company owner. The Rand Corp. , which keeps a tab of ongoing research, finds states increasingly are stepping up.

Timothy Daly, a Joyce Foundation program director, said he remembers when the field of gun harm was described by some as a "desert." "There was no federal funding. There was slim private funding," he said. "Young people would ask themselves: 'Why would I go into that?'"

Research published in JAMA in 2017 found gun violence "was the least-researched" among leading causes of death. Looking at mortality rates over a decade, gun violence killed about as many people as sepsis, the data showed. If funded at the same rate, gun violence would have been expected to receive $1.4 billion in research funds. Instead, it received $22 million from across all U.S. government agencies.

There is no way to know what the firearm mortality or injury rate would be today had there been more federal support for strategies to contain it.

A reckoning and new push for research

As gun violence escalated to once unthinkable levels, Congressman Dickey came to regret his role in stanching research and became friends with Rosenberg. They wrote a pivotal Washington Post op-ed about the need for gun injury prevention studies. In 2016, they delivered a letter supporting the creation of the California Firearm Violence Research Center.

Both men, they emphasized, were NRA members and agreed on two principles: "One goal must be to protect the Second-Amendment rights of law-abiding gun owners; the other goal, to reduce gun violence."

Dickey died in 2017, and Rosenberg has only kind words for him. "I did not blame Jay at all for what happened," he said. The CDC was "under pressure from Congress to get rid of our gun research."

As alarm over gun fatality statistics from diverse sectors of the nation — scientists, politicians, and law enforcement — has grown, research in the field is finally gaining a foothold.

Even Congress, noting the Dickey Amendment was not an all-out ban, appropriated $25 million for gun research in late 2019, split between the CDC — whose imperative is to research public health issues — and the National Institutes of Health. It's a drop in the bucket compared with what was spent on car crashes, and it's not assured. House Republicans this winter have pushed an amendment to once again cut federal funding for CDC gun research.

Still it's a start. And with growing interest in the field, the torch has passed to the next generation of researchers.

In November, Cunningham helped organize a national conference on the prevention of firearm-related harm. More than 750 academics and professionals in public health, law, and criminal justice met in Chicago for hundreds of presentations. A similar event in 2019, the first in 20 years, drew just a few dozen presentations.

"You can feel momentum," Cunningham said at the conference, reflecting on the research underway. "There's a momentum to propel a whole series of evidence-based change — in the same way we have addressed other health problems."

During a congressional hearing weeks later , Yale University School of Public Health Dean Megan L. Ranney bluntly described the rising number of gun deaths — noting the overwhelming number of suicides — as a warning for lawmakers. "We are turning into a nation of traumatized survivors," she said, urging their support for better data and research on risk factors.

Cassandra Crifasi, co-director of the Johns Hopkins Center for Gun Violence Solutions, was in high school when the Columbine massacre shook the country. Oona Tempest/KFF Health News hide caption

Cassandra Crifasi, 41, was a high school sophomore when the Columbine massacre outside Littleton, Colorado, shook the country. She recently succeeded Webster, her mentor and research partner , as co-director of the Johns Hopkins Center for Gun Violence Solutions.

Crifasi has spent much of her career evaluating risk factors in gun use, including collaborative studies with Baltimore police and the city to reduce violence.

Raised in Washington state, Crifasi said she never considered required training in firearms an affront to the Second Amendment. She owns guns. In her family, which hunted, it was a matter of responsibility.

"We all learned to hunt. There are rules to follow. Maybe we should have everybody who wants to have a gun to do that," she said.

Crifasi pointed to the 2018 shooting at Marjory Stoneman Douglas High in Parkland, Florida — which left 17 dead and 17 injured — as a turning point. Students and their parents took "a page out of Mothers Against Drunk Driving — showing up, testifying, being in the gallery where laws are made," she said.

"People started to shift and started to think: This is not a third rail in politics. This is not a third rail in research," Crifasi said.

Shani Buggs, a lead investigator at the California Firearm Violence Research Center, has studied anxiety and depression among young people who live in neighborhoods with gun violence. Oona Tempest/KFF Health News hide caption

Shani Buggs worked in corporate management before she arrived at Johns Hopkins to pursue a master's in public health. It was summer 2012, and a gunman killed 12 moviegoers at a midnight showing of "The Dark Knight Rises" in Aurora, Colorado. The town's pain led the national news, and "rightfully so," Buggs said. "But I was in Baltimore, in East Baltimore, where there were shootings happening that weren't even consistently making the local news."

Now violence "that once was considered out of bounds, out of balance — it is more and more common," said Buggs who recently joined the California Firearm Violence Research Center as a lead investigator.

Buggs' research has examined anxiety and depression among youths who live in neighborhoods with gun violence — and notes that firearm suicide rates too have drastically increased among Black children and adolescents.

There is a trauma from hearing gunshots and seeing gun injuries, and daily life can be a thrum of risk in vulnerable communities, notably those largely populated by Black and Hispanic people, Buggs said. Last year, Buggs organized the Black and Brown Collective with a core group of about two dozen scientists committed to contextualizing studies on gun violence.

"The people most impacted by the gun violence we usually hear about in America look like our families," she said of the collective.

"They are not resilient. People are just surviving," Buggs said. "We need way more money to research and to understand and address the complexity of the problem."

KFF Health News , formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

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Gun violence was leading cause of death for US kids and teens in 2021, study finds

This story discusses suicide. If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline. You can also text HOME to 741741 or visit  SpeakingOfSuicide.com/resources  for additional resources.  

Gun-related deaths among children in the U.S. reached a distressing peak in 2021 , claiming 4,752 young lives and surpassing the  record total  seen during the first year of the pandemic, a new analysis of Centers for Disease Control and Prevention data found. 

The alarming statistic clearly indicated that America’s gun violence epidemic has gotten worse, experts say. 

More than 80% of the gun deaths were among males 19 and younger. Black male children were more likely to die from homicide. White males 19 and younger were more likely to kill themselves with guns.

“This is undoubtedly one of our chief public health crises in this country,” said Dr. Chethan Sathya, a pediatric trauma surgeon at Northwell Health in New York and the lead author of the study, which was published Monday in the journal Pediatrics. “The most likely reason that your child will die in this country is at the hands of a firearm. That’s not acceptable.”

This grim reality marks the second consecutive year in which gun-related injuries have solidified their position as the leading cause of death among children and adolescents, surpassing motor vehicles, drug overdoses and cancer. 

There are no signs of this trend slowing, Sathya said.

Nearly two-thirds of the deaths in 2021 were homicides, although unintentional shootings have killed many children. No matter how young the victims, pediatric gun-related deaths have left their mark on nearly every corner of the U.S. 

In recent months, a 3-year-old in  Florida  died after shooting himself with a handgun. In  California , a 3-year-old killed his 1-year-old sister with a handgun. A 2-year-old in  Michigan  died after finding an “unsecured firearm.” Just last week, a 6-year-old in Florida  was fatally shot  by a 9-year-old. 

Black children continue to be disproportionately affected.

From 2018 to 2021, there was a nearly 42% increase in the rate of children killed by guns, according to the analysis. The fatalities continued to increase in 2021, with more than 4,700 reported gun-related child deaths, an almost 9% increase in the rate compared with 2020.

Researchers had expected to see a decrease in gun-related deaths among children in 2021, following their sharp increase in 2020, which had been believed to be driven by pandemic-induced lockdowns and children being confined at home. 

Those projections, however, were not realized.

“This was surprising to many of us,” Sathya said, adding that the country has potentially entered an “alarming new baseline” in which it will continue to see more gun deaths in children.

Out of those 2021 fatalities, 64.3% were homicides, 29.9% were suicides and 3.5% resulted from unintentional injury, according to the analysis. 

The burden of gun homicides among children has disproportionately affected communities of color. 

Black children accounted for 67.3% of gun-related homicides, with a nearly twofold death rate increase from 2020. White children accounted for 78.4% of gun-related suicides. 

Overall, Black children represented half of all gun-related deaths.

The disparities between Black and white children match what has been found in earlier research, according to Nirmita Panchal, a senior policy analyst at KFF, formerly known as the Kaiser Family Foundation. 

“Communities of color have seen a stark increase in these deaths compared to their white peers,” she said. Furthermore, young survivors of gun-related injuries may face additional challenges that extend beyond their physical trauma, she added. They are also more susceptible to developing mental health problems and substance use disorders.

When examining gun-related deaths among children geographically, southern states — such as Louisiana, Mississippi, Alabama and South Carolina — and Montana bore a greater burden of fatalities, although researchers are beginning to see increasing rates in the Midwest, according to the analysis.

Older adolescents, ages 15 to 19, accounted for 82.6% of gun-related deaths in 2021. Across the U.S., higher poverty levels correlated with higher death rates from guns.

“Structural inequity, structural racism, social determinants of health, food insecurity are all root drivers of violence,” including gun violence, Sathya said.

Dr. Emily Lieberman, a pediatrician with Lurie Children’s Hospital, survived the  Highland Park Shooting in Chicago  last year, along with her husband and two children.

“I was not a hero that day. I saved no one, I helped no one but my family, and when I did leave that day alive, I knew that I was changed forever,” she said.

Lieberman said she wished she had been surprised by the latest statistics on pediatric gun deaths. But because of a lack of legislation from lawmakers targeting guns, she believes the death toll will only be higher next year.

“We are seeing every day countless children dying, perishing from gun violence,” she said. “It is affecting everyone, everywhere and only getting worse.”

Panchal noted members of Congress have focused on youth mental health, including expanding school-based mental health services and providing trauma care.

Sathya said he has advocated for better background checks and safer storage of weapons. He also said there needed to be more research into the root causes of gun violence.

“Although we can say this is an issue that might not affect everybody, it really does,” he said. “If you look at the spikes in gun injuries, it’s hitting all communities. It doesn’t matter where you live.”

This story originally appeared on NBCNews.com .

Berkeley Lovelace Jr. is a health and medical news reporter for NBC News.

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• Frontiers in Global Women's Health
• Quality of Life
• Research Topics

The Impact of US Health Policy on Women's Health and Wellbeing

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About this Research Topic

As the 2024 US presidential election approaches, the scrutiny and debate surrounding health policy is intensifying. Health policy remains a central issue in the US political discourse. Following the Supreme Court’s decision to overturn Roe v Wade in 2022, thus revoking federal protection of abortion rights, it is clear that the outcome of this year’s election will have significant implications for women's health and wellbeing—both in the US and globally via foreign policy. For this reason, there is an urgent need to explore how current and proposed health policies can shape the future of women's healthcare. This call for papers seeks to compile a comprehensive collection of studies that advance the understanding of how US health policies influence women's health outcomes, access to healthcare, and overall wellbeing both in the US and beyond. We are particularly interested in empirical research, policy analysis, and theoretical papers that may encompass, but are not limited to, the following topics: • Reproductive health among marginalized and minoritized communities o Effects of federal and state policies on reproductive health among sexual and gender minorities, young people, survivors of sexual violence, ethnic minorities, immigrants (e.g., asylum seekers) and other historically oppressed or disenfranchised groups. • Reproductive Health, Rights, and Justice o Effects of federal and state policies on access to contraception, abortion, and fertility-related services. o Impact of policy changes on maternal health outcomes and maternity care services. • Impact of policy changes on medical education, residency training, and retention of physicians and workforce interested in providing contraception, abortion, and fertility-related services Healthcare Access and Affordability o Analysis of the Affordable Care Act (ACA) and subsequent reforms on women's health insurance coverage. o Barriers to healthcare access for women in rural and underserved communities, including ethnic and socioeconomic disparities. • Mental Health and Wellbeing o Influence of mental health policies on the provision of services for women, including postpartum depression care. o Intersection of gender, mental health, and healthcare policy (e.g., trauma-informed care, survivor-centered care for survivors of gender-based violence). • Health Equity and Social Determinants of Health o Exploration of how health policies address or exacerbate health disparities among women of different ethnicities and socioeconomic backgrounds. o Impact of structural and social determinants like food insecurity, water insecurity, poverty, housing, education, and employment on women's health as mediated by policy. • Innovations and Future Directions o Promising interventions or program evaluations with policy implications. o Emerging health policy innovations aiming to improve women's health outcomes. o Forward-looking analyses on potential policy changes and their implications for women's health

Keywords : US health policy, women's health, women's wellbeing, health policy, health equity, affordable care act, abortion, reproductive rights, contraception

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• St. Petersburg

St. Petersburg racism study: Black residents face higher mortality, lower wages

• Margo Snipe Former Times Reporter

ST. PETERSBURG — From birth, Black infants face mortality rates two to five times higher than white infants.

It’s a statistic that sheds light on only one aspect of the disparities affecting St. Petersburg’s Black residents, which were outlined in a recent study of structural racism in the city presented to the City Council in early December.

Beginning in infancy, well-documented inequities — across myriad facets of life and perpetuated by structural racism — cause what experts call the “weathering” effect of racism. This effect adds stress to the daily lives of Black residents, thus leading to deteriorating health.

This summer, the council voted unanimously to declare racism a public health crisis in unison with cities across the nation.

Unequal access to healthy food, culturally competent health care, safe and affordable housing and stable job opportunities — often referred to as social determinants of health — perpetuate health disparities, from high rates of COVID-19 infection, hospitalization and death, to Black men dying from colon cancer at early ages. The maternal mortality rate for Black women is four to five times higher than that for white women, regardless of income, education or lifestyle.

In Pinellas County, Black residents face a higher mortality rate than any other racial group for all top causes of death, except lung cancer, according to the study, which examined city and county data.

Ultimately, white residents are more likely to outlive Black residents. In some neighborhoods, the study reports, white residents’ life expectancy is well over a decade longer than that of Black residents.

The study says health is only one of many facets of daily life in which Black folks encounter structural racism.

The history of St. Petersburg’s racist history is on display in the 200-page study that examines its modern-day impact. It quantifies the structural racism ingrained in the city’s policies and practices.

The $50,000 study was conducted by a team from the University of South Florida, including math professor Ruthmae Sears, who served as the lead investigator, as well as information systems professor Johannes Reichgelt, psychology professor James McHale, education professor Dana Thompson Dorsey, environmental geography professor Fenda Akiwumi, historian Gwendolyn Reese, and activists Tim Dutton and Gypsy Gallardo. Y. Michelle Bradham-Cousar, Jabaar Edmond and student collaborators Jalessa Blackshear and Casey Lepak also contributed.

The study defines structural racism as “an institutional system that perpetuates inequality, disparities, and injustices within a community,” which includes historic and modern policies and practices that contribute to inequities. It also defines race according to the U.S. Census.

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The authors argue increased awareness and acceptance of the generational impacts of racist policies will help produce solutions to reduce the gaps across all disparities created over decades.

In addition to health, the study examines the inequities that persist within the criminal justice system, education and economics.

The median income of Black residents is 73 percent of that of white residents, regardless of education level, the study says. Additional education raises income but does not erase the racial gap. And it varies by field.

In Pinellas, the 2016 median hourly wage was $20.20 for white employees, while the average wage for Black employees was $14.80. Under that calculation, Black employees earned $216 less in pay for a 40-hour week, the study says, and earned $11,000 less a year compared to white employees.

Inequities can be seen in home ownership rates, too, where rates are significantly lower in areas of the city with a large percentage of Black residents compared to predominantly white areas. Nationally, just over 40 percent of Black Americans own their home compared to over 70 percent of white Americans.

The study examined the criminal justice system and found that in most offenses that involve officer discretion — when officers have leeway whether to make an arrest — the percent of Black folks charged far exceeds their representation in St. Petersburg’s population.

For example, more than 70 percent of all residents charged with “resisting arrest with violence” in 2020 and the first three months of 2021 were Black, though they make up only about 20 percent of city residents.

After the study was presented, a majority of the council has since voted to accept its findings. Members Robert Blackmon, Ed Montanari and Gina Driscoll voted against a program of reparations to address the inequities.

Mayor-elect Ken Welch will make history Thursday when he is inaugurated as the first Black mayor in St. Petersburg history. He believes the study strengthens the need for the city to act to improve racial equity.

“We can’t be afraid to have these conversations,” said Welch. “It is difficult but it is reality.”

The study recommends the city undertake these solutions:

• Continue supporting the work started in the study.
• Create an equity department under the mayor’s office.
• Create and implement a measurable accountability strategy for addressing race equity.
• Evaluate the possibility of reparations.
• Advance the unanimous approval of a permanent resident race equity board.

The Foundation for a Healthy St. Petersburg provides partial funding for Tampa Bay Times stories on equity. It does not select story topics and is not involved in the reporting or editing.

Read the study

Read the report on the effects of historical and modern-day racism on the lives of St. Petersburg’s Black residents.

Former Times Reporter

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World Suicide Prevention day 2024 “Changing the Narrative on Suicide”

Being a critical global issue, suicide affects individuals and communities worldwide. World Suicide Prevention Day, established in 2003 by the International Association for Suicide Prevention (IASP) in conjunction with the World Health Organization (WHO) on 10 September of each year, focuses on reducing stigma and raising awareness among organizations, governments, and the public, giving a singular message that suicide can be prevented.

As an effort to encourage a positive change, IASP has announced the new theme for World Suicide Prevention Day 2024-2026 as “Changing the Narrative on Suicide”. The aim of the theme is to raise awareness about the importance of changing the narrative surrounding suicide and transforming the way suicide is perceived. Changing the narrative requires a systemic change, shifting from a culture of silence and stigma to one of openness, understanding, and support. It also involves (1) advocating for policies and legislations that prioritize mental health, increase access to care, and provide support for those in need, (2) investing in research to better understand the complexities of suicide and (3) developing evidence-based interventions. Furthermore, a call to action named, “Start the Conversation” is to be issued encouraging individuals, communities, organizations, and governments to engage in open and honest discussions about mental health and suicide. Every conversation contributes to a more supportive and understanding society where suicide is preventable, and everyone feels valued and understood with the collaborative effort.

Suicide accounts for more than one in every 100 deaths globally and for every death by suicide there are more than 20 suicide attempts. In 2019, an estimated 703 000 people across all ages (or 9 per 100 000 population) lost their lives to suicide globally, and 77% of all suicides occurred in Lower Middle-Income Countries, where most of the world’s population lived. In 2019, the suicide was  the fourth leading cause of death among 15–29-year-olds and accounted for 8% of all deaths.

Suicide and self-harm remain a significant public health concern in Sri Lanka. Sri Lanka has achieved a substantial reduction in suicide since 1997, mostly by the implementation of national bans on identified toxic pesticides. Despite these reductions, there is a higher than global average rate of suicide recorded continuously in Sri Lanka. The suicidal rate in Sri Lanka in 2022 was 27 per 100 000 and 5 per 100 000, in males and females respectively, with an overall suicide rate of 15 per 100 000 population based on the national police statistics. The rate of suicide increases by age, with the highest rate among older males (55+ years: 65 per 100 000) while, among females, it is  found mainly in young women (17–25 years: 10 per 100 000). Analysis by method categorizations shows that in 2022, the highest proportion of suicide deaths was due to hanging (69.9%), followed by pesticide self-poisoning (14.0%), other methods (12.2%), and non-pesticide self-poisoning (3.9%). (figure 1).

Suicide by hanging, over the past 20 years, has been steadily increasing among males and females. Hence, although the current suicide rate in Sri Lanka is substantially lower than it was during the 1990s, the upward trend in hanging seen in the last few years, particularly among older men and young women, is of concern.

Figure 1: Age-standardized suicide rate by method in males and females in Sri Lanka, 1997–2022 (Reflections on the trends of suicide in Sri Lanka, 1997–2022: The need for continued vigilance,  https://doi.org/10.1371/journal.pgph.0003054 )

WHO advocates for countries to take action to prevent suicide, by implementing a comprehensive national suicide prevention strategy, adopting ‘LIVE LIFE’, WHO’s approach to suicide prevention, detailing the practical aspects of implementing evidence-based interventions for preventing suicide. Reducing the global suicide mortality rate by one third by 2030 is both an indicator and a target in the United Nations Sustainable Development Goals (SDGs) and in WHO’s Comprehensive Mental Health Action Plan 2013– 2030.

Among the several important South-East Asia Regional Committee resolutions related to mental health, SEA/RC65/R5 on non-communicable diseases, mental health and neurological disorders, along with the regional strategies developed to address suicide, have urged the Member States to develop comprehensive policies and strategies for promotion of mental health and prevention of suicides. Through the ‘Paro Declaration’ on universal access to people-centred mental health care and services, Member States further committed to expand community-based mental health services, and develop and implement multisectoral policies across the life-course, addressing mental health risks.

The ongoing monitoring of suicide rates should be a priority during the coming years, while addressing the current risk factors for suicide in Sri Lanka, such as significant financial insecurity, unemployment, depression, alcohol misuse, and domestic violence. WHO Sri Lanka supported the Ministry of Health to develop and implement the Suicide Prevention Strategy and Suicide Prevention Action plan which is being implemented at the primary health care level as a resource that guides policy makers to address the risk factors. Further WHO rendered its support in capacity building of the healthcare workforce as well as other categories of staff in provision of psychosocial support mainly by training the National Youth Services counselors on psychosocial counselling, training of Sunday school teachers on psychosocial support and mental well-being, training of media personnel on responsible reporting of suicide and training of health care staff to extend and strengthen the national mental health helpline (1926) at district level.

International Association for Suicide Prevention- Changing the Narrative on Suicide - IASP

World Mental Health Report- World Mental Health Report (who.int)

Bandara P, Wickrama P, Sivayokan S, Knipe D, Rajapakse T (2024) Reflections on the trends of suicide in Sri Lanka, 1997–2022: The need for continued vigilance. PLOS Glob Public Health 4(4): e0003054. https://doi.org/10.1371/journal.pgph.0003054

Knipe DW, Metcalfe C, Fernando R, Pearson M, Konradsen F, Eddleston M, et al. Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data. BMC Public Health. 2014;14(1):839. Epub 2014/08/15. pmid:25118074; PubMed Central PMCID: PMC4148962.

Tombolo Books' Social Justice Book Club has selected Under the Skin by Linda Villarosa as their September book. Join us at the Foundation Monday, September 9, at 6:30 PM to join the discussion.

attended 46+ Equity Education engagement opportunities (including events, training sessions, and community meetings) in 2020!

The Foundation works to address the root causes of problems which harm the health and quality of life of BIPOC residents in Pinellas County; outdated racist ideas which still show up in present day life. FHSP believes that more than treating a symptom, entire systems should be transformed. Systems change begins with multi-sector collaboration, and can either be updated to be more equitable, or innovated - to start fresh. We know that when outcomes improve for some, the community as a whole gets stronger.

The YouGood? campaign united service providers under one banner to create a continuum of care. By destigmatizing mental health with the help of local artists, the program generated enough media attention to promote the free services to 750k residents.

The Foundation acts as a connector, a listening ear, and a source of funding, technology, physical and digital space, data, relationships, training, and equity education. These resources (or "fuel") accelerate racial equity work that has been envisioned, brought to life, and led by the community.

due to the efforts of funded partners. Previously 44.4% of low income households, and 27% of middle-class households were without an internet subscription in the South St. Petersburg CRA.

The Foundation for a Healthy St. Petersburg is a private foundation formed in 2013 following the sale of the nonprofit Bayfront Health St. Petersburg. It is the steward of $170 million in assets to support racial equity and health equity in Pinellas County. The Foundation inspires and empowers people, ideas, information exchange, organizations and relationships to end differences in health due to institutional racism.

Redlining led to racial residential segregation which persists today. Those who live in Vinoy/ Snell Isle average 82 years, and those who live in Campbell Park, a predominantly Black neighborhood, average 66.5 years.

• Join the Movement

Advancing Health, Elevating Equity

The Foundation for a Healthy St. Petersburg works to achieve racially equitable health outcomes and improve the determinants that shape them. We convene, lead, scale, and fund critical work to eliminate racial disparities, change systems, and strengthen our community.

Led by Community

Listening well means truly hearing the lived experience of those in our community. Community voices underscore what’s not working well, highlight where solutions are already underway, and shape meaningful action.

Focused on Race

Race is the biggest variable in health differences among residents in Pinellas County. Health equity is inseparable from racial equity so to build a healthier community, race must be at the forefront of our efforts and solutions.

Fueling for Change

The Foundation strategically invests money towards racial equity initiatives and fuels community through relationships, connections to support networks, research and data, access to technology, and physical space.

Driven By Data

Problems are put into perspective by data. Equity data and analysis help illustrate the scale and impact of issues, can point to new connections, and ensure the solutions we invest in are doing the work they promised to do.

A Vision of Equity

Equitable regions—where everyone in the community is able to live a long, healthy life—are more prosperous, and experience stronger, more sustained growth. By investing in equity, Pinellas County helps build a more stable, resilient community that is more likely to experience lasting social and economic success.

2023 Annual Report

The year 2023 marked an exciting new chapter in our history as we identified our 2023 and 2024 priority focus areas, deepened our impact with a post-pandemic return to full staffing and new leadership, strengthened key partnerships, and expanded touchpoints for community engagement and collaboration. Read the full report to learn more about our work to advance health and empower equity in the South St. Petersburg community we’re proud to call home.

Looking Back to Move Forward

Today’s social change advocates can learn a great deal from stories about people who have previously stood together to challenge the status quo and fight for equity. This evolving project serves as an entry point for education, understanding, and further exploration into the history and opportunity for social change in Pinellas County.

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When Mary Murph’s daughters were diagnosed with Sickle Cell Disease more than 50 years ago, information on the condition was hard to find. In her quest to better understand what her daughters were facing and how she could help, Murph wrote dozens of letters to groups all over the country before finally receiving a handful […]

Funded Partner Spotlight: 360 Eats

After graduating from college, Cameron Macleish found himself living in a dumpster diving community in Melbourne, Australia. At first, rescuing food seemed like a major life hack to save money. Soon after, however, he saw the amount of food waste he was witnessing as a major problem – and also an opportunity. After returning home […]

Funded Partner Spotlight: The Modern Griot Corporation

When Modern Griot Corporation Founder Lola Morgan lost her brother in 2016, her family didn’t have the resources to process their grief and work toward healing. Eight years later, Morgan is a certified mental health first aid practitioner and life coach who offers others what she wishes someone had offered her. “After losing my brother, […]

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