Center for Injury Research and Prevention

Gun Violence

Gun violence, as many Americans see through television, social media, and other news outlets, is often perceived as random, mass shootings in public places. As horrifying as those events may be, they display but a fraction of the impact of daily gun violence that exists in our neighborhoods and towns. On an average day in America, 93 people (including 7 children and teens) die by gunfire, according to the Centers for Disease Control and Prevention.

Gun violence is a complex and far-reaching epidemic for the U.S. While the causes of violence are many, the presence of a firearm can turn a dangerous situation into a lethal one, whether it be homicide, suicide or accidental injury. The statistics relating to firearm injuries in kids are staggering - click here to learn more. Firearm-related injury and death is an important public health issue for all Americans, regardless of where they live. Firearm mortality rates for young people are the same in big cities as they are in small rural counties, according to CHOP research. The difference is in the intention: Rural areas see more suicides and unintentional gun-related deaths, while urban areas suffer more gun-related homicides. The types of guns used also vary-- handguns predominate in larger cities while long guns and rifles are seen with increased frequency in rural areas.This hits too close to home for the Violence Prevention Initiative team at Children's Hospital of Philadelphia (VPI@CHOP). The Level One Trauma Centers at CHOP and the University of Pennsylvania treated 1,882 children and youth ages 24 years and younger for gun shot wounds in the years 2007-2016-- or roughly 15 gun shot wound-related cases per month.

Gun violence requires a comprehensive approach to prevention and treatment. Across the medical community there is consensus that countermeasures to this national epidemic do exist and can be implemented through enacting laws or improving public policy.

VPI@CHOP Position on Gun Violence

Policy statement on gun violence co-authored by Dr. Nance
Michael L. Nance, MD, a Violence
Prevention Initiative fellow and 
of the Pediatric Trauma Program at CHOP,
co-wrote the APSA policy statement on
"Firearm Injuries and Children."

The Supreme Court of the United States has clearly upheld the right of the individual to bear arms. And, in a nation with more than 350 million firearms, we need to develop policies that focus on how to live in a world with guns, such as policies aimed at reducing the risk and frequency of gunshot injuries and deaths.

Michael L. Nance, MD, a VPI Fellow and director of the Pediatric Trauma Program at CHOP, co-authored the updated policy statement on “Firearm Injuries and Children” for the American Pediatric Surgical Association (APSA) that appears in the November 2013 issue of the Journal of the American College of Surgeons. VPI supports the APSA positions, which are grounded in empirical evidence and clinical expertise, with a focus on children. Below is a summary of the positions, and you can also access a video of Dr. Nance speaking about the policy statement and approaching violence as a public health issue here (please note you will need to create a free account to view the video).

     APSA Positions Supported by VPI:

  • Support a system of universal background checks for all firearms transactions, including private, internet, and gun show sales.
    • Improve accuracy and completeness of the National Instant Criminal Background Check System (NICS).
  • Support all efforts to limit access by children to firearms, including use of gunlocks and safe storage techniques as well as Child Access Prevention (CAP) laws that hold parents responsible for the consequences of a child accessing and using a firearm.
  • Support efforts to improve availability and quality of mental health services for both children and adults to prevent gun violence as well as to help people fully heal from gun violence.
    • Provide resources to train teachers, health care professionals, and social workers to identify mental illness; provide resources to facilitate interaction among school, law enforcement, and mental health agencies; generate social dialogue to reduce the stigma of seeking mental health care.
  • Support removal of 1996 language from congressional appropriations bill that restricts the funding of firearms-related research. This research is necessary to make evidence-based decisions that address this public health problem.
  • Support limits on access to high-capacity magazines and assault-style weaponry.
  • Support removal or clarification of language in the Affordable Care Act censoring discussion about presence of firearms in homes with children between physician and families.
    • It’s especially important to provide such counseling when it is known that a firearm is present in home of a patient assessed to be clinically depressed or in a home with reported domestic violence.
    • A 2003 study showed that 64 percent of individuals who received verbal firearm storage safety counseling from their doctors improved their gun safety practices.
  • Do not support a standard practice of arming teachers, parents, or other officials in the school setting, in the absence of scientific evidence of safety benefits to such practice.

In addition to the APSA positions, CHOP’s VPI Fellows agree with the Pediatric Trauma Society that hospital trauma programs treating a substantial number of children for assault injuries each year should provide violence prevention programs in the communities they serve.

In the past two years, VPI Co-director Joel Fein, MD, MPH and VPI Fellow and Emergency Department Physician Ruth Abaya, MD, MPH have each testified before a Philadelphia City Council Committee on youth gun violence and VPI Fellow and Director of CHOP's Pediatric Trauma Program Mike Nance, MD has testified at a PA House committee hearing on House Bill 1010, a universal background checks-related bill. -- Click here to access the testimony.


Children & Gun Violence: Facts and Statistics-- Click here for more facts and statistics

Counseling on Gun Safety in the Home-- Click here for guidance on talking about preventing child access to guns

Recommended Reading and Resources

Gun Safety & Public Health: Policy Recommendations for a More Secure America. National Alliance of Physicians. August 2013.

Pennsylvania-specific data on violence and injury that includes mechanisms, intent and demographics.

Philadelphia-specific data on city-wide criminal shootings and officer involved shootings.

Centers for Disease Control and Prevention’s WISQARS (Web-based Injury Statistics Query and Reporting System) is an interactive database system that provides customized reports of injury-related data. The database allows users to query for specific states and regions. 

Addressing Violence as a Health Crisis with Health Methods. Statement of the "Violence as a Health Crisis Initiative," January 2017.

America's Frontline Physicians Call on Government to Act on the Public Health Epidemic of Gun Violence. Joint statement from the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and American Psychiatric Associations, February 2018.