Today’s interview with Megan Ranney is on guns. We planned this interview after the horrifying shooting in Uvalde. Many people wrote to ask about guns, about their child’s safety, about what they could do. I didn’t think I had the expertise to talk about this, but I thought immediately of Megan. She’s a practicing emergency physician, Academic Dean of the School of Public Health at Brown University, and a longtime researcher on sticky social problems, including violence, mental health, and technology. She’s also a friend, and I was very grateful she agreed to come talk with me about the data behind guns and gun violence.

We purposely organized this interview at some distance from the events in Uvalde, both to give processing space and also to make sure these issues of gun violence stay top of mind and do not arise only when there is a mass shooting.

In the end, we are recording this on the day after the tragic mass shooting in Highland Park, which underscores perhaps that it is extremely hard to find a week free of gun violence in America. I hope this interview with Megan will provide both some data to better understand this and some call to action.

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Emily: Megan, thank you so much for joining me. I’d love for you to briefly introduce yourself.

Megan: Thank you, Emily. It’s a joy and a pleasure to be here with you today, albeit on a difficult topic. My name is Megan Ranney. I’m an emergency physician. I’m the Academic Dean at the School of Public Health here at Brown University. And I’m also a public health researcher. My research focuses primarily on the intersection between technology, violence, and behavioral health.

Emily: Excellent. And we’re going to talk about all of those things today. So I’m hoping to do really two things in this conversation. The first is to talk about some data on gun violence. And the second is to talk a little bit about a call to action, or what you see as policy responses.

But let’s start with the data. One of the facts that people have heard a lot about recently, particularly in the wake of Uvalde, is the statement that firearms are the leading cause of death for children zero to 18. And I’d love for you to unpack that a little bit for us and help us understand: What does that mean in terms of numbers? What does that mean in terms of causes of those firearm deaths? How much should I be thinking about that? Does it vary with geographic location and so on?

Megan: Thank you. You know, as a public health professional, I think we should always start with the data. And it’s important for us to understand both the truth of that statement, which is that firearms are the leading cause of death for children ages one through 19, one through 18, one through 20, depending on how you look at it … if you go up to age 24, firearms remain the leading cause of death for kids, teens, and young adults in those age brackets in the United States. A kid in the U.S. is more likely to die from a gunshot wound than they are to die from a car crash or from COVID — so to put it in context. And that’s a staggering statistic as parents; we don’t think of our kids as being likely to get hurt or die from anything. And it matters and deserves attention.

At the same time, when you dig a little deeper into what the causes of firearm injury and death are, it gets a little more complicated than just saying, oh, it’s the leading cause of death. And I think it’s important for us to talk about the causes and about, like you said, the geography and the demographics, because it then helps to inform evidence-based solutions for this horrific problem.

So when you look down into the data, if we look at all data on firearm injury in the United States, most firearm deaths among kids and adults are suicides, which is something that most people don’t know.

Emily: And is that true among kids as well as among adults?

Megan: Kids are more likely to die from firearm homicide than suicide, but suicide is making up a growing proportion of firearm deaths among kids. Particularly, sadly, black and brown kids are increasingly likely to die of firearm suicide.

Unintentional firearm injury — when you get shot “by accident” — is not common overall in the country, but is relatively common as a cause of death among kids, largely because they find a parent’s gun and pick it up and think it’s unloaded or think it’s a toy.

And then there are the mass shootings. And I think when a parent hears that statistic about guns being the leading cause of death for kids in the U.S., many parents assume that most of those are these horrific public mass shootings, things like Uvalde or Sandy Hook or the shooting in Aurora, Colorado, or what happened just the day before we’re talking in Highland Park.

But the reality is that those mass shootings are just a drop in the bucket of the gun deaths that happen in this country every day. And I say that not to say that those mass shootings don’t matter, but rather just to put in context what it is that we should really be afraid of as parents. As parents, yes, mass shootings, we should work against them, but the real worry for our kids is around firearm homicide, suicide, or, if they’re young, around that unintentional or accidental death.

Emily: When we started talking about having this interview, I think the thing I said to you was, I want parents to leave both less afraid and in some ways more afraid or more focused on the issues that we can try to address with some policy. Not that we can’t try to address mass shootings, but just to sort of focus in on the set of policies that are going to think about these broader issues, which are happening more frequently.

So when we think about that context, are there particular activities that put kids at risk? And how should I think about, as a parent, trying to address those?

Megan: So, there are a few things that put kids at much higher risk. There are also things that lower kids’ risk. And then I think one of the really difficult parts around this conversation, Emily, is that when we do think about those horrific, “never” events, there are things we just can’t control the risk of.

Emily: Which is, of course, the terror of all aspects of parenting.

Megan: Right. Exactly true. And I think we have to put our hands around that and then try to change that risk in other ways, which I know we’ll talk about later today. So I’m going to think about, again, firearm injury and death in terms of those buckets.

So, the first is firearm homicide. Your kids’ risk of being killed by a firearm because they’re shot and killed on purpose by someone else is predicted largely by a few things. The first is, sadly, where you live. There’s lots of data showing that kids who are killed in firearm homicide, most of them have it happen within about a thousand meters of their home. And so if you live in a community where gun violence is common, your kid is sadly more likely to get caught in the crossfire or to get involved in circumstances that put them at higher risk. We’ll also say that black and brown youth in this country are disproportionately at risk of being a victim of firearm homicide. That’s for lots of structural, economic, environmental reasons. It’s, of course, related to our country’s history of racism. And those are things that we can fight against.

Risk of being a victim of firearm homicide is also increased if your kid is using substances or involved in communities that are. And so there’s another space where you as a parent can potentially intervene.

You can lower risk by moving, which is easier said than done…

Emily: Easier said than done.

Megan: …by getting your kid involved in extracurricular mentoring programs; things like Big Brothers Big Sisters actually have been statistically proven to reduce the risk of violence for kids. And by creating environmental changes — things like streetlights, community gardens, actually reduce the risk in a neighborhood of gun homicide. So that’s the first group.

The second group is gun suicide, which again is a rising number of deaths among our kids. Most kids who take their own life with a gun use a family member’s gun — the vast majority of them. And there are about 40% of us in the United States who have a firearm in our household. And you’d better believe that your kid knows where that gun is. I will tell you as an ER doc, sadly, I’ve taken care of more kids than I would like to have ever had to see who have taken their own lives with a parent’s gun. And the parent always thought that it was stored safely. So the biggest thing that you can do to keep your kids safe from firearm suicide is to make sure that if you have a gun, it is stored in a way that the kid truly doesn’t have access to it. It’s behind lock and key. It’s in a biometric safe, or it’s in a safe with a combination lock that your kid doesn’t know.

Relatedly, you also want to make sure that if your kid has friends whose parents have firearms, that those guns are stored safely too. Particularly if your kid is going through a tough time.

Emily: So I want to pause on that, because I think, as a parent, I can understand how I would store my gun safely if I had one, but how do I navigate this with the parents of my kids’ friends? I mean, are we saying, like, should I be calling them and saying, do you have any guns in the house? And if so, how are they stored? That is a potentially awkward conversation, which I think is hard for a lot of people.

Megan: It is a potentially awkward and hard conversation. And so part of it depends on where you are. You and I live in Rhode Island, where rates of firearm ownership are relatively low. If I were living in Montana, if I were living in rural Missouri, I would be having those conversations with parents. And I would have it in a non-accusatory way, the same way as like, hey, does your kid have any allergies? Do you have a pool? Hey, if you have firearms in the house, are they locked up?

The other side of it is that you can offer that yourself. If I have another kid coming over, I can ask that parent: Does your kid have allergies? And just so you know, we don’t have a firearm in the house. We don’t have a pool either. We do have a trampoline. So it can be part of that kind of discussion that we’re all used to having. You know, if you’re going to take my kid out for ice cream, does my kid need a booster seat? It’s part of that larger group of conversations about safety, where you don’t want to — as I know that you talk about, Emily — you don’t want to overplay it. But there is a way to integrate that discussion into the larger group of discussions around food allergies, et cetera, et cetera.

Emily: It’s not unrelated to some of the conversations that people are having to have during COVID, which is, particularly early on: What else are you doing? Are we going to see you? And are you involved in other high-risk COVID encounters? So maybe we just need to all be more comfortable with those conversations and having them in a nonjudgmental way but, nevertheless, the way that we need to.

Megan: That’s exactly right. And I think that the nonjudgmentalism is critical. I do a lot of my work, not just looking at the epidemiology and looking at technology predictors of gun violence, but also working in partnership with communities. And I work in partnership with communities that have firearm owners in them because, again, 40% of Americans have a firearm in the home. And the reality is most, almost all, firearm owners, like almost all non-firearm owners, are responsible, safe, right? It’s not like that by choosing to own a firearm, you’re somehow stupid or unsafe. You take your kids’ safety and your family’s safety just as seriously as someone who chooses not to own a firearm. And you’re going to assume the best of your friends and their community and their parents. And I think that maintaining that nonjudgmentalism is critical for moving us forwards.

Emily: Great. So that was, I’m sorry I interrupted you in the middle of your thing, but let’s keep going with where we were before.

Megan: So, we talked about homicide, we talked about, then, suicide, right? So how to reduce your kids’ risk of firearm suicide. That same discussion is also going to reduce the risk of unintentional or accidental injury. P.S., telling your kid not to touch a firearm actually has been shown to not work. So the best thing is just to make sure they’re not around it unless you’re standing next to them, right? I have plenty of friends and colleagues who go hunting with their kids, whose kids participate in 4H. That’s a very different type of environment. So outside of that, kids shouldn’t be around firearms unsupervised, and a firearm should be locked up.

And then the last part is how to reduce that risk of mass shootings. And that’s a bigger discussion, which we can get into. I’ll tell you what I discuss with my kids, which is we have conversations about the kids in their school and who’s being bullied? Who’s bullying? Are there things that are making them concerned? Who do they have in their school to go to if they’re worried about someone that’s in their classroom? And making sure that we have those support systems set up for “see something, say something.”

Emily: That makes sense. I do want to get on to the mass-shooting and the gun-control-policy questions. But you know, one of the things that we highlighted in my pre-discussion notes was the question of dating violence. And I wonder if you would touch on that briefly. I know most of the people who are listening to this probably have younger kids. But it is also the case that, you know, people have older kids. And for adults, my sense is that is an important part of the conversation, and maybe for older teens as well.

Megan: Thank you for asking that. When we actually look at risk factors for any type of firearm death, domestic violence, or dating violence — whether you’re a perpetrator or a victim — bullying and acute emotional crises are some of the strongest predictors of risk. For women in the United States starting at about age 14 or 15, the leading reason for us to be killed by a gun is because we’re shot by a partner. And so this gets into a broader discussion about how you help your kids of all genders, how you help to create kids that are able to recognize risk factors, get out of a relationship, and help those around them. Knowing that if they’re not a victim of dating violence or domestic violence, there’s a high chance that one of their friends will be. So that gets into kind of a bigger parenting discussion about how you create that support system for kids, how you help kids to be aware of the risk factors. But as a parent, one of the biggest things is, god forbid, if your kid is ever involved in dating violence or domestic violence, to make sure that neither they nor their partner own or have access to a firearm. Because that just increases the chance of lethality by somewhere between five and 20 times.

Emily: I mean, some of what you’re saying in the parenting space of this, I think, echoes much of what we know about bullying and how kids are resilient around those issues in school — which is that having a supportive, open set of communication tools at home, which allow them to express out what is going on, ends up mattering for a lot of different things.

Megan: My kids are 10 and 13, and I was definitely of the mindset of: my kids are not going to be on social media, right? But then it’s how they all socialize. And particularly over the last two years, as in-person socialization was less common, they spent a lot more time on Minecraft and TikTok and all those things. And I am actually a really big believer — and the data backs it up, including my own research data — that there are ways to have good conversations with your kids around social media, conversations about what those group chats are like, who’s being bullied, who’s saying what … where you’re not telling the kids that as soon as they come to you with a case of bullying that you’re just going to shut off their social media use. But rather, you use it as a chance to help walk them through conflict-resolution skills and to provide support to their friends. Because you can do the very best that you can for your kid, but you’re not the parents of other people’s kids. But your kid can help their friends.

I talk a lot, when I talk about gun violence, about that being the terminal event. People don’t just one day pick up a gun and decide to shoot themselves or shoot someone else, for the most part. There’s usually a long series of events that get them to that point. And yes, we want to separate them from the firearm at that end moment. But we also need to do the work to pick up on all those warning signs earlier and change someone’s course. And so it does relate to the discussions about bullying. It’s a both/and.

Emily: It’s a both/and. All right, so let’s turn to gun-control measures. I would love to hear your thoughts on what are appropriate next steps. Congress has done some things in the past few weeks which seem at least in the right direction. But I’d love to hear what else you think should be done and, honestly, what you think people can do if they would like to push the agenda that you are suggesting.

Megan: So here, too, it is a both/and. The history of public health, as you know from your discussions around COVID, shows that policies can be tremendously effective. Policies can also be tremendously ineffective and can even backfire. There are some policies that absolutely make sense, but we have to start from that baseline level-setting, Emily, which is that there are about 400 million firearms in private hands in the United States right now. That’s give or take 50 to 100 million, because we actually don’t know exactly how many there are.

So, recognizing that, there are a few things. The first is that things like background checks absolutely make a difference in terms of new purchases of firearms, making sure that people who buy guns don’t have any of those really well-established warning signs that mean that they should be disqualified.

The second is having ways to get firearms out of people’s hands safely if they cross over, right? If they’re showing signs or have actually had behaviors that make them higher-risk. Those types of laws can be things like domestic-violence-related policies, like the partial closing of the boyfriend loophole with this new Senate policy. Here in Rhode Island, we have even stronger laws, where, before you’re convicted, when you have an ex parte domestic-violence order, in theory the police can take someone’s firearms away temporarily. Similarly, there are these things called red flag laws, which allow usually family or law enforcement to do something in the short term when someone’s showing impulsivity or suicidal impulses. Or if someone’s having dangerous postings on social media, that there’s something you can do to separate that person from firearms.

And then there’s another whole series of laws around banning certain categories of guns, around changing ages for firearm ownership, around having stricter permitting procedures, particularly for concealed carry … those can have impact and have been put in place in other countries effectively. But those first two groups of policies that I talked about will help decrease risk for many Americans, effectively: background checks, red flag laws, and stronger domestic-violence restraining orders will absolutely have a short-term impact, and we’re seeing them make progress.

The other side of it is, in addition to policy, there also have to be changes in social norms and in the education that we do around the policy. I’m going to go back to those red flag laws for a minute, because I think they’re one of the powerful tools that we have. The reality is that study after study has shown that even in states with red flag laws, most doctors, most family members, and even most law enforcement officers don’t know that those are an option. So a law is only as good as its enforcement and the behaviors around it. And if a community doesn’t believe in it, and if a community doesn’t use it, it’s not going to make a difference. Same thing for safe-storage laws, which I didn’t mention in that list. Safe-storage laws — basically mandating that if you have a gun in the house, you have to have it stored locked-up — are associated with lower rates of kids being hurt, but there’s a lot of conflict as to whether the storage laws follow good practice in a community or whether the laws lead to good practice.

So to me, the thing that we need to do is to push for passing good policy for making sure that we have the ability to manage who safely owns a gun. And for us to also work really strongly on changing those social norms around what safe and responsible firearm ownership looks like.

Emily: And how can people support the work to do those things?

Megan: So, there’s a bunch of different things that can help support that. They range from activism organizations, things like Moms Demand or Everytown or Brady; to groups like one that I belong to and helped start, called AFFIRM Research — it’s AFFIRM at the Aspen Institute — that’s actually a partnership between firearm owners and non-firearm owners to help change conversations about identifying and acting on risk in the firearm-owning community; to things like getting involved with neighborhood and community organizations, which really does make a difference. Again, I mentioned putting in community gardens, mentoring organizations, domestic-violence shelters — all of those things help to decrease the risk as well.

Emily: Excellent. So, before we end, is there something you wish people knew or a misconception that you feel we must fight against? I want your last word, if you have one.

Megan: So, my biggest thing that I try to fight against is the misconception that mental illness is what causes firearm deaths in this country.

Firearms suicides are, of course, related to depression and hopelessness. But in general, most firearm injuries and deaths in this country are not related to mental illness. And in fact, people who are seriously mentally ill are not significantly more likely to kill someone else than the average person is walking down the street.

There have been studies of mass shooters showing that one of the biggest predictors is actually a history of prior violence. These are folks who have deep-seated personality disorders, hatred, often white nationalism, as part of their creed. And we’ve got to move beyond labeling them mentally ill, because that just stops us all from making progress.

Emily: Good last word. Thank you so much for doing this. I really appreciate it.

Megan: Sure. You know, can I say one more thing? You and I are recording this the day after the July 4th shooting in Highland Park, and as a mom, as well as a community member and an ER doc, I think one of the toughest things to grapple with is this sense of those mass shootings being unpredictable.

We can put our kid in seat belts, we can have our kid wear bike helmets, we can also make really evidence-based judgments about where to restrict, where that level of risk lies, right? And I think that you and I are actually pretty similar in terms of letting our kids take a lot of risks in life, because overall the chance of them getting hurt by most of these things is really small and they need to learn how to judge on their own.

And I think that one of the things that is toughest about the topic that we’re talking about today is that that risk feels so unquantifiable, and my saying, yeah, mass shootings are less than 1% of children dying from gun death in this country, doesn’t feel sufficient when we think about, yeah, but it could be the parade that I go to. Right? And so I just want to be clear to the folks that are listening that I’m not trying to say that either mass shootings or homicides or suicides don’t matter. But rather, it’s that we need to be able to have our kids out in society and doing things. And we need to find ways to channel our fear into action and into areas of control rather than letting that fear dominate us.

Our kids are more likely to get shot in our neighborhood or even in our home, if we have a firearm in the home, than they are in a school, in a movie theater, or at a parade, but we can also take actions to help reduce that risk when we’re at a school, a movie theater, or a parade. Maybe not on behalf of our individual kid, but on behalf of society. And I think that one of the biggest things that we need to do and that your listeners can be helpful with is helping us grapple with this legitimate fear and keeping it from dominating our lives and keeping us from going out and doing things.

And I hope if nothing else that this discussion has helped move some people forward into understanding what the actual numbers are and where they can go next to help create action.

Emily: Amazing. Thank you, thank you, thank you.