By Rosanna Smart

Background

Despite growing evidence about how state-level firearm regulations affect overall rates of injury and death, little is known about whether potential harms or benefits of firearm laws are evenly distributed across demographic subgroups. In this systematic review, we synthesized available evidence on the extent to which firearm policies produce differential effects by race and ethnicity on injury, recreational or defensive gun use, and gun ownership or purchasing behaviors.

Main body

We searched 13 databases for English-language studies published between 1995 and February 28, 2023 that estimated a relationship between firearm policy in the USA and one of eight outcomes, included a comparison group, evaluated time series data, and provided estimated policy effects differentiated by race or ethnicity. We used pre-specified criteria to evaluate the quality of inference and causal effect identification. By policy and outcome, we compared policy effects across studies and across racial/ethnic groups using two different ways to express effect sizes: incidence rate ratios (IRRs) and rate differences. Of 182 studies that used quasi-experimental methods to evaluate firearm policy effects, only 15 estimated policy effects differentiated by race or ethnicity. These 15 eligible studies provided 57 separate policy effect comparisons across race/ethnicity, 51 of which evaluated interpersonal violence. In IRR terms, there was little consistent evidence that policies produced significantly different effects for different racial/ethnic groups. However, because of different baseline homicide rates, similar relative effects for some policies (e.g., universal background checks) translated into significantly greater absolute differences in homicide rates among Black compared to white victims.

Conclusions

The current literature does not support strong conclusions about whether state firearm policies differentially benefit or harm particular racial/ethnic groups. This largely reflects limited attention to these questions in the literature and challenges with detecting such effects given existing data availability and statistical power. Findings also emphasize the need for additional rigorous research that adopts a more explicit focus on testing for racial differences in firearm policy effects and that assesses the quality of race/ethnicity information in firearm injury and crime datasets.

Inj Epidemiol. 2023; 10: 67.

By V A Pear , J P Schleimer , A J Aubel , S Buggs , C E Knoepke , R Pallin , A B Shev , E Tomsich , G J Wintemute , N Kravitz-Wirtz

Extreme risk protection orders (ERPOs) provide a civil mechanism to temporarily remove firearm access from individuals at high risk of harming themselves or others. Evidence and theory suggest that ERPOs can prevent firearm-related harm, but the policy's impact on racial/ethnic equity is largely unknown. To examine potential inequities by race/ethnicity in public perceptions and use of California's ERPO law, we drew on two complementary data sources: 1) a 2020 state-representative survey of California adults, and 2) ERPO court documents for the first 3 years of policy implementation (2016-2018). Majorities (54-89%) of all racial/ethnic groups reported that ERPOs are at least sometimes appropriate, and 64-94% were willing to ask a judge for an ERPO for a family member. However, Black and Hispanic/Latinx survey participants less often perceived ERPOs as appropriate and were less willing to serve as petitioners, with Black participants citing lack of knowledge about ERPOs and not trusting the system to be fair as their top reasons for unwillingness. Similarly, review of ERPO court documents revealed that no family or household members served as petitioners for Black and Hispanic/Latinx ERPO respondents. Additionally, Black respondents were the least likely to have documented access to a firearm and legal representation in court. Racial/ethnic equity in ERPO use may be improved by reducing barriers to petitioning, incorporating non-law enforcement intervention professionals like behavioral health specialists into the ERPO process, providing legal assistance to respondents and petitioners, and investing in the social safety net.

Prev Med. 2022 Dec;165(Pt A):107181. doi: 10.1016/j.ypmed.2022.107181. Epub 2022 Aug 6. PMID: 35940474.

By The Educational Fund to Stop Gun Violence, DC Justice Lab, Cities United, March for Our Lives, Community Justice Action Fund, Consortium for Risk-Based Firearm Policy, and Johns Hopkins Center for Gun Violence Prevention and Policy

This report urges us to think carefully about the relationship between gun violence prevention and racial equity. Racial equity impact assessments (REIAs), such as the assessment proposed in this report, guide advocates, policy makers, and researchers through a thorough examination of policies with an equity lens to anticipate the potential outcomes and mitigate foreseeable risks. It requires one to ask fundamental questions about when to justify involvement with the criminal legal system, identify the costs and benefits of engagement, and think about alternatives to minimize harm. This framework acknowledges that solutions to gun violence, however well intentioned they may be, can exacerbate or compound upon the harms suffered by impacted communities if they are made without careful analysis and the input of those directly affected by it. Gun violence affects everyone. It inflicts an enormous burden upon our country, particularly within under-resourced Black and Latino/Hispanic communities. The politics of guns and race have long been intertwined, but racial equity only recently became a focal point of discussions among gun violence prevention groups, catalyzed by the advocacy of community-based and BIPOC2-led organizations. In partnership with many stakeholders across the gun violence prevention movement, this racial equity framework is a resource that can be used by policymakers, researchers, and organizations working in gun violence prevention. Representatives from the six authoring organizations comprised a small working group to plan development of the report and convened a series of conversations to share proposals and review feedback from expert contributors. In addition to advancing racial equity, the core values of inclusion, collaboration, and consensus-building guided the project from early stages through completion. Building upon existing racial equity work and guidance, this report is informed by the public health model of social determinants of health and has been tailored to the specific needs of gun violence prevention. The tools and recommendations proposed in this report are derived from relevant academic literature, racial equity impact assessments, and frameworks for building more equitable social movements. The racial equity framework for gun violence prevention is divided into three main sections: The first section introduces the most relevant considerations about gun policy and race. It helps contextualize the issue of racial disparities in gun violence and the role of the criminal legal system. The second section is the racial equity impact assessment tool (REIA) for gun violence prevention policy. It includes the analysis of the foundational assessments that were considered to develop the tool and a practical explanation of each of the questions that comprise the REIA. The third section provides resources to build a more equitable gun violence prevention movement. It describes the need to center and invest in BIPOC-led organizations and presents a set of recommendations for developing and sustaining a more equitable gun violence prevention movement.

The Authors, 2022. 54p.

Nuclear Threat Initiative

From the document: "NTI [Nuclear Threat Initiative] convened a dialogue among nongovernmental U.S. and Russian cyber/information security and nuclear weapons policy experts. Following initial conversations in Moscow in 2019 about the findings from NTI's Cyber-Nuclear Weapons Study Group, the Track II dialogue was established and proceeded virtually in plenary and small-group sessions in 2020 and 2021. The participants are listed in Appendix 1. Expert participants built on a shared understanding that nuclear weapons systems must be protected from cyber threats, as well as other threats involving information and communications technologies (ICT), and that despite the current geopolitical environment, the unique U.S.-Russian nuclear relationship requires bilateral cooperation to maintain stability. They addressed topics including possible crisis scenarios and escalation pathways, opportunities for building confidence and predictability in the relationship, and bilateral cyber-nuclear norms that could mitigate the risks. The group generated ideas for joint and parallel actions to reduce cyber-nuclear weapons risks for both governments to consider and adopt. The following recommendations are designed to help avoid or mitigate the risks of a cyberattack prompting a nuclear crisis. The recommendations in this paper offer policymakers in Russia and the United States--and in other countries--options for reducing the risks of a cyber or information security attack that could lead to nuclear war." This record contains a Russian version following the English publication.

Nuclear Threat Initiative . 2023. 40p.

By Pew Research Center

In an era marked by deep divisions between Republicans and Democrats, few issues are as politically polarizing as gun policy. While a few specific policy proposals continue to garner bipartisan support, the partisan divisions on other proposals – and even on whether gun violence is a serious national problem – have grown wider over the last few years.

Today, just over half of Americans (53%) say gun laws should be stricter than they currently are, a view held by 81% of Democrats and Democratic-leaning independents but just 20% of Republicans and Republican leaners. Similarly, while nearly three-quarters of Democrats (73%) say making it harder to legally obtain guns would lead to fewer mass shootings, only 20% of Republicans say this, with most (65%) saying this would have no effect.

The new national survey by Pew Research Center, conducted from April 5-11, 2021 among 5,109 adults, finds that 73% of Democrats consider gun violence to be a very big problem for the country today, compared with just 18% of Republicans who say the same. The current partisan gap on this question is 11-percentage-points wider than in 2018 and 19 points wider than in 2016.

Washington, DC: Pew Research Center, 2021. 29p.

By Anne-Séverine Fabre, Nicolas Florquin, Aaron Karp, and Matt Schroeder

The Caribbean region suffers from some of the world’s highest rates of violent deaths, with firearms used in the majority of these crimes. Although most homicide victims are men, the Caribbean as a region also faces one of the world’s highest rates of violent deaths among women. While much emphasis has been placed on firearms control at both the political and operational levels, illicit firearms and the dynamics of illicit arms markets in this region have received little research attention. In response, the Caribbean Community (CARICOM) Implementation Agency for Crime and Security (IMPACS) partnered with the Small Arms Survey to carry out a comprehensive evidence-based study of illicit arms trafficking to and within the Caribbean, and the socio-economic costs of firearm-related violence in the region. This Report examines these issues by drawing on data and information collected from 13 of the 15 CARICOM member states and from 22 Caribbean states in total. The study also incorporates the results of original fieldwork undertaken by regional partners, including interviews with prison inmates serving firearm-related sentences, and research in selected hospitals related to gunshot wounds and the associated medical costs and productivity losses for patients..

Geneva, sWIT: Small Arms Survey, 2023. 178p.

By The Small Arms Survey

The use of improvised explosive devices (IEDs) in West Africa expanded dramatically over the last decade. IED-building networks have established material and training links across conflict areas in West and Central Africa, and their designs have remained constant and inexpensive throughout the region—helping to increase their use in attacks against domestic and international security forces, UN peacekeepers, and civilians.

Out of Control: The Trafficking of Improvised Explosive Device Components and Commercial Explosives in West Africa—a new report from the Small Arms Survey’s Improvised Explosive Devices (IEDs) in West Africa project—analyses data from more than 2,200 IED-related incidents between March 2013 and September 2022, and stresses the importance of coordinated regional approaches in eliminating illegal IED use in West and Central Africa.

Geneva, SWIT: Small Arms Survey, 2023. 124p.

By Patrick Sharkey and Megan Kang

Background:

The recent rise of gun violence may lead to the perception that the problem of gun mortality in the United States is intractable. This article provides evidence to counter this perception by bringing attention to the period spanning from 1991 to 2016 when most US states implemented more restrictive gun laws. Over this period, the United States experienced a decline in household gun ownership, and gun-related deaths fell sharply.

Methods:

The main analysis examines the conditional association between the change in gun regulations at the state level and the change in gun mortality from 1991 to 2016. We include a range of robustness checks and two instrumental variable analyses to allow for stronger causal inferences.

Results:

We find strong, consistent evidence supporting the hypothesis that restrictive state gun policies reduce overall gun deaths, homicides committed with a gun, and suicides committed with a gun. Each additional restrictive gun regulation a given state passed from 1991 to 2016 was associated with −0.21 (95% confidence interval = −0.33, −0.08) gun deaths per 100,000 residents. Further, we find that specific policies, such as background checks and waiting periods for gun purchases, were associated with lower overall gun death rates, gun homicide rates, and gun suicide rates.

Conclusion:

State regulations passed from 1991 to 2016 were associated with substantial reductions in gun mortality. We estimate that restrictive state gun policies passed in 40 states from 1991 to 2016 averted 4297 gun deaths in 2016 alone, or roughly 11% of the total gun deaths that year.

More Americans were killed by gunfire in 2021 than in any previous year on record.1 This single statistic encompasses several social problems and challenges, including violent crime, the rise of suicides, mass shootings, intimate partner violence, and police shootings. But all of these problems are connected to each other by a common feature: guns.

Epidemiology 34(6):p 786-792, November 2023.

By Terry L. Schell, Samuel Peterson, Brian G. Vegetabile, Adam Scherling, Rosanna Smart, Andrew R. Morral

To understand how rates of firearm ownership may be affected by public policy and how they may affect crime rates or other key outcomes in the United States, researchers need measures of firearm ownership at the state level. As part of the Gun Policy in America initiative, RAND researchers developed annual, state-level estimates of household firearm ownership by combining data from surveys and administrative sources. First, they used a small-area estimation technique to create state-level ownership estimates for each of 51 nationally representative surveys assessing household firearm ownership rates. They then used structural equation modeling to combine these survey-based estimates with administrative data on firearm suicides, hunting licenses, subscriptions to Guns & Ammo magazine, and background checks into the final measure of household firearm ownership. The resulting measure represents the proportion of adults living in a household with a firearm for each state in each year between 1980 and 2016. Other researchers can use these annual, state-level measures to test theories about the relationship between firearm ownership and crime, injury, and public policy.

Santa Monica, CA: RAND, 2020. 78p.

By Sherry F. Colb

Most debates over gun rights are either interpretive, about the meaning of the Second Amendment, or empirical, about whether guns enhance or undermine safety. My goal in this essay is to introduce a third factor into the debate: the “imaginary narrative.” When I say “imaginary,” I mean to suggest a narrative that does not reflect typical or common experience. I use the context of guns and domestic violence to illustrate the phenomenon. The pro-gun imaginary narrative, when it comes to domestic violence, involves a victim confronting her abuser. Because she has a firearm, she is able to protect herself from him. But that fantasy does not comport with the reality of intimate partner abuse. I propose here that we acknowledge and interrogate imaginary narratives lest our laws and policies become disconnected from the true needs of our society.

New York: Brennan Center for Justice at New York University School of Law, 2021. 10p.

By Saul Cornell

A proper understanding of the founding era concept of police is essential to the future of Second Amendment jurisprudence. District of Columbia v. Heller never addresses the police power and its centrality to early American rights theory or antebellum jurisprudence. The omission is striking because Heller does devote considerable attention to antebellum southern cases addressing the issue of public carry, and this body of law was strongly influenced by police power jurisprudence. A genuinely historical treatment of founding era rights theory — including the right to keep and bear arms — provides scant support for Heller’s dismissal of the right of the people to regulate their internal police in the case of firearms. Nor does the antebellum southern case law that Heller highlights as the key to unlocking the meaning of the Second Amendment support such a claim. Reconstruction did not change these basic facts. If one applies Heller’s professed originalist methodology neutrally, and Justice Scalia is correct that rights are entrenched with the scope that they had when constitutionalized, then the right of the people to regulate their own police, including firearms, must be treated with the same originalist reverence. Judges, including originalist judges, must recognize the awesome power of the people: including the right to regulate arms.

New York: Brennan Center for Justice at New York University School of Law, 2021. 17p.

By Matthew J. Lacombe

The tumultuous year of 2020 may mark an important turning point in the political development of the National Rifle Association (NRA) and, as a result, the broader gun rights movement. This essay explores how the year’s events — and the role of guns and gun rights supporters in them — were in numerous ways a culmination of the NRA’s approach to politics over the course of several prior decades. This approach involves linking guns to a broader, right-wing populist worldview; mobilizing political action among gun rights supporters by portraying that worldview as deeply threatened by government and media elites; and building alliances with like-minded politicians, most notably Donald Trump. The essay then explores how the aftermath of the events of 2020 leaves the NRA in a difficult position. With Trump (the NRA’s close ally) out of office, some within the GOP looking to move on from his approach to politics following the failed January 6 insurrection, and Democrats more supportive of gun control than at any other point in recent history, the NRA may find itself somewhat politically alienated. Moreover, given its current organizational challenges and its position on the right wing of the GOP, the NRA may also struggle to recruit the many Americans who bought guns for the first time in 2020 — a group that could potentially diversify the gun owning community and renegotiate the sociopolitical meaning of guns in important ways. Only time will tell the NRA’s future, but what is clear now is that the tumultuous events of 2020 can be traced to the organization’s past and will surely impact both its future and the future of the gun debate.

New York: Brennan Center for Justice at New York University School of Law, 2011. 8p.

By Darrell A. H. Miller

To an external observer, the moral and historical foundations of the insurrectionary Second Amendment must look bizarre. Instead of building an insurrectionist theory around the one group — enslaved Africans — who, by the framers’ own measure, had the most right to resist tyranny, we have a Second Amendment theory of righteous revolution built on the grievances of slave owners. But the peculiarity does not stop there. It must seem equally odd to outsiders that insurrectionist theory never adequately accounts for the fact that this one group, African Americans — with centuries of moral justification behind them — decided in the middle of the 20th century to reject violent political dynamism in favor of nonviolence. In short, what would Second Amendment insurrectionism look like if it started with the enslaved African and ended with the march across Edmund Pettus Bridge? This essay attempts to reckon with these twin paradoxes and reorient our thinking about the credibility of the insurrectionary Second Amendment.

New York: Brennan Center for Justice at New York University School of Law, 2021. 11p.

By John J. Donohue

The January 6 attack on the U.S. Capitol has important lessons for much of the widespread, current Second Amendment litigation designed to eradicate beneficial gun safety regulation across the country. First, the value of Washington, DC, laws in constraining the gun carrying of the riotous crowd was evident and likely saved many lives. Second, flirtations with the idea that armed citizens should be ready to fight the federal government were shown to be absurd: there is no circumstance in which private citizens in modern America could promote democracy by using assault weapons to kill government employees to show their disapproval of what they perceive to be “tyrannical” government. Third, the idea that gun owners can be expected to oppose rather than support a tyrant was dealt a fatal blow by the violence at the U.S. Capitol. The time has come to earnestly acknowledge and embrace the wise restraints on firearms that make the American public free and to reject the specious mask of zeal for unlimited gun rights that has become a mainstay of too many American politicians.

New York: Brennan Center for Justice at New York University School of Law, 2021. 11p.

By Jennifer Carlson

The summer of 2020 was a summer of mass unrest. Protesting the thousand-plus, disproportionately Black and Indigenous lives taken every year by police violence, millions of Americans mobilized for racial justice and police accountability under the banner of Black Lives Matter. Their message was not new — the Black Lives Matter movement was founded years earlier in the aftermath of George Zimmerman’s acquittal for the murder of Trayvon Martin — but its urgency felt renewed amid egregious cases of anti-Black racism, police violence, growing political polarization, and white supremacist extremism. The killings of Ahmaud Arbery, George Floyd, Dion Johnson, and Breonna Taylor — a handful among thousands — yet again spotlighted police complicity with and perpetuation of anti-Black violence, invigorating months of protests and calls for police accountability, police demilitarization, police defunding, and even police abolition. The demands themselves differed in substance; some focused on closing down police departments altogether, while others emphasized the fiscal necessity of redirecting public funding from police to other agencies.1 But the gist of these calls was unanimous: they insist that to transform rather than merely reform the institutions within American society that perpetuate anti-Black racism, police must be decentered as the go-to institution for solving not just problems of crime but social problems more generally. Anti-Black racism within policing is one slice of the entrenched tendency in 20th- and 21st-century America to treat a wide panoply of social problems as problems of crime and bloat the criminal justice system as the catchall state apparatus to address those problems — a dynamic that legal scholar Jonathan Simon describes as “governing through crime.”2 The protests, the demands, and the community organizing of 2020 may have been immediately focused on the criminal justice system, but because that system has so thoroughly penetrated vast realms of American society as a core vector of anti-Black racism, the message carried by the protesters reached far and wide — including gun politics. Often buttressing the well-worn terms of the gun debate, those in favor of increased gun regulations declared that “police violence is gun violence,” while others promoted gun ownership as a way to put the message to “defund the police” into practice. But the challenge that the summer 2020 Black Lives Matter protests have posed to American gun politics goes far beyond rehashing the usual sides of the gun debate in the key of anti-Black police violence. Rather, this challenge invites those invested in the gun debate to consider their own complicity with the criminal justice system and how, by decentering crime and criminalization within the gun debate, that debate might be transformed. In short, the summer 2020 protests challenge us to imagine anti-racist gun politics.

New York: Brennan Center for Justice at New York University School of Law, 2021. 10p.

By Joseph Blocher

Although the Second Amendment tends to dominate the discussion about legal limits on gun regulation, nothing has done more to shape the state of urban gun law than state preemption laws, which fully or partially limit cities’ ability to regulate guns at the local level. The goals of this short Essay are to shed light on this “Statutory Second Amendment” and to provide a basic framework for evaluating it.

89 University of Chicago Law Review 557-580 (2022)

By Joseph Blocher, FoNoah Levine

Litigation, scholarship, and commentary about gun rights and regulation tend to focus nearly exclusively on the Second Amendment’s right to keep and bear arms—a constitutional guarantee that was for all intents and purposes legally inert until the Supreme Court’s decision in District of Columbia v. Heller. But to fully understand the landscape of gun litigation, it is important also to account for other constitutional gun rights claims—those that do not derive, at least not directly, from the Second Amendment.

In Part I of this short Article, we highlight some of the most prominent of these claims, including those deriving from the Due Process Clause, Takings Clause, and the First Amendment. Our goal in doing so is primarily to describe and illustrate, not to evaluate, though it is worth noting that some of these claims appear much stronger than others—and perhaps stronger than some courts have credited. Moreover, and perhaps surprisingly, some of these constitutional claims sometimes cut against the interests of gun owners (for example by calling into question the constitutionality of “parking lot” laws that require private business owners to permit guns on their property).

In the second Part of the Article, we address two broad and more speculative questions. First, how do these constitutional claims interact with more traditional Second Amendment arguments? Evaluating that question suggests much about how litigants perceive the relative strength and utility of their rights—for example, whether other rights are a more fruitful basis for gun-related claims. And, going forward, the answers will depend greatly on what the Supreme Court decides in the pending case of New York State Rifle & Pistol Association v. Bruen, which involves the question of whether the right to keep and bear arms extends outside the home.

We conclude by asking what this polycentric constitutional understanding of gun rights illustrates about the constitutional rights and interests of others, including those who support gun regulation as a means to preserve not only their own physical safety, but their freedom to engage in free speech, assembly, worship and other constitutionally salient activities.

77 New York University Annual Survey of American Law 175-198 (2022)

By The Southern Poverty Law Center (SPLC_

Since 2020, guns have been the leading cause of death in the United States for children and teens. While the proliferation of gun access and gun violence often dominate national, state and local headlines, little has been done to understand the views young people have on these pervasive issues.

To address this gap, Everytown for Gun Safety Support Fund, the Polarization & Extremism Research & Innovation Lab (PERIL) and SPLC came together to study young people’s access to guns, experiences with gun violence, feelings of safety and mental wellbeing, as well as their views on male supremacy, racial resentment and the Second Amendment.

Our U.S. Youth Attitudes on Guns Report provides groundbreaking insights into young people's perceptions, fears and proximity to guns and gun violence. This nationally representative survey of 4,156 Americans aged 14 to 30 and qualitative focus groups lay bare the ubiquity of guns and gun violence in the lives of young Americans.

Montgomery, AL: SPLC, 2023.

By Sean Morales-Doyle, Robyn Sanders, Allison Anderman, and Jessica Ojeda

Over the last 20 years, several distinct developments have increased the risk of gun violence in American elections.

A marked shift in the US Supreme Court’s approach to the Second Amendment and an aggressive pro-gun movement have caused significant deregulation of guns in some states and cast a shadow of legal uncertainty on strong gun regulations in others. Moreover, as the political system has grown more polarized and prone to violence, politicians have spread disinformation about voting rules to sow distrust in our de

The result: voting and elections have become the targets of threats and intimidation just as the nation faces a proliferation of guns, more frequent gun violence, and fewer legal protections. This is a toxic combination. Still, most states’ laws do not adequately protect voters or the election system.

New York: Brennan Center for Justice at New York University School of Law; San Francisco: Giffords Law Center to Prevent Gun Violence, 2023. 29p.

By Bailey K. Roberts, Colleen P. Nofi, Emma Cornell, Sandeep Kapoor, MD, MS-HPPL,b,c,d,e Laura Harrison, MPH,c,d Chethan Sathya

BACKGROUND AND OBJECTIVES: In 2020, firearm injuries became the leading cause of death among US abstract children and adolescents. This study aimed to evaluate new 2021 data on US pediatric firearm deaths and disparities to understand trends compared with previous years. METHODS: Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research was queried for firearm mortalities in children/adolescents from 2018 to 2021. Absolute mortality, death rates, and characteristics were reported. Death rates were defined per 100 000 persons in that population per year. Death rates across states were illustrated via geographic heat maps, and correlations with state poverty levels were calculated. RESULTS: In 2021, firearms continued to be the leading cause of death among US children. From 2018 to 2021, there was a 41.6% increase in the firearm death rate. In 2021, among children who died by firearms, 84.8% were male, 49.9% were Black, 82.6% were aged 15 to 19 years, and 64.3% died by homicide. Black children accounted for 67.3% of firearm homicides, with a death rate increase of 1.8 from 2020 to 2021. White children accounted for 78.4% of firearm suicides. From 2020 to 2021, the suicide rate increased among Black and white children, yet decreased among American Indian or Alaskan Native children. Geographically, there were worsening clusters of firearm death rates in Southern states and increasing rates in Midwestern states from 2018 to 2021. Across the United States, higher poverty levels correlated with higher firearm death rates (R 5 0.76, P < .001).

Pediatrics, August 21, 2023.