The Smoking Gun
Every day in the United States, an average of 96 human lives end at the barrel of a gun.  In fear, in anger, in self-defense, or all of the above, people are being taken away from their loved ones without the possibility of return in split-seconds of impulsivity and disconnect. The blowback shocks our communities and we begin to cope, addressing visible wounds as our society continues to bleed out from other pain points. In moments of undivided attention such as the one we are experiencing now, we must remind ourselves to consider the whole of this problem as we push for change.
As a major threat to the safety and wellbeing of the public, gun violence is a social condition that needs to be addressed immediately. Defined as the deliberate use of physical power or force, actual or threatened, against oneself or others, violence either results in or has serious potential of resulting in psychological harm, injury, and death.  As the name suggests, gun violence specifically pertains to violence carried out using a firearm and the condition can appear in cases of homicide, suicide, aggravated assault, and robbery.  By addressing gun violence as a public health issue, countless lives can be saved, but first, we have to bite the bullet and face the reality of the situation.
Since 1968, gun violence has resulted in 1.3 million American deaths, which outnumbers the death toll of all wars in the nation’s history combined.  In 2011 alone, a total of 478,400 incidences of fatal and nonfatal firearm violence were committed in the United States.  In 2013, gun violence resulted in 33,636 firearm deaths in the United States, establishing a mortality rate of 10.6 per 100,000 population.  Some may claim that the United States is #1 and this is definitely true, when it comes to ranking 1st for having the highest firearm-related mortality rate in the developed world. 
The Targeted Demographic
Gun violence affects individuals of all ages, sexes, and races in the United States, but the phenomenon especially has a disproportionate impact on the youth, males, and communities of color. 
Teenagers and young adults in the United States are most likely to be victims of gun violence.  In 2010, firearm homicide had a rate of 10.7 per 100,000 for individuals aged 18 to 24 years old, compared to 8.1 for individuals aged 25 to 34 and 0.3 for individuals aged 11 or younger.  Among young people in the United States, homicide continues to be a leading cause of death and of the 4,828 youth aged 10 to 24 that were homicide victims in 2010, 82.8% were murdered with a firearm.  Furthermore, the third leading cause of death for youth among the ages of 10 and 24 is suicide and the most used method for suicide is none other than firearms, found in 45% of the cases.  Unfortunately, compared to a child in other developed countries, an American child has 13 times the likelihood of being killed by a firearm. 
Males are the most common targets of gun violence.  In 2010, firearm homicide had a rate of 6.2 per 100,000 for males, compared to 1.1 for females. 
Communities of Color
Communities of color, specifically Blacks, Indians, and Latinos, are disproportionately affected by gun violence.  In 2010, Blacks accounted for 56% of firearm homicides, while only representing about 13% of the United States population.  The group with the next highest rate of firearm homicides was Indian male teenagers, with 19.3 firearm homicides per 100,000, followed by Latino male teenagers, which had 17.8 firearm homicides per 100,000.  Comparatively, white male teenagers had a much lower rate of firearm violence, representing 9.4 firearm homicides per 100,000. 
Etiology of Gun Violence
Theoretical perspectives on violence range from instrumental to reactive.  Instrumental violence takes places when harming another person comes secondary to the acquisition of an external goal, for example, money, material goods, status, and security.  Reactive violence, or expressive violence, occurs when physical violence is precipitated by an angry or hostile reaction to a dangerous situation or perceived threat.  Reactive violence is often the unthoughtful and impulsive reaction to a provocation, whether imagined or real.  In many cases, violent actions fall into the middle ranges of the instrumental-reactive continuum and include some mixture of both factors. The theories of violence may be applied specifically to gun violence as well.
Through another lens, researchers are also beginning to see that gun violence behaves like an infectious disease.  According to this theory, exposure to violence is conceptually similar to exposure to a contagious disease.  Acts of violence are like germs that get lodged and fester in the brain.  In the impressionable minds of children and young adults, repeatedly experiencing or witnessing violence may alter neurological functioning; cognitive pathways which influence anger and violent behavior are more easily activated.  Victimized individuals become more prone to normalizing violence, while enhancing threats.  Caught in this state of mind, individuals are more likely to be violent, thus, exposure to violence makes being violent a learned behavior.  Gun violence is like an infectious disease epidemic and it will continue to spread unless it is interrupted.
Individual and lifestyle factors that increase one’s risk of perpetrating gun violence include biological, environmental, socialization, cognitive, and situational factors.  Biological factors, including evolutionary factors, inherited genes, brain structures, and hormones, have an influence on an individual’s predisposition to violent behavior.  The interaction between biological factors and social environment may also influence violent behavior, as brain damage and violence have been linked to environmental factors, such as toxic materials found in the environment, dietary deficiencies, traumatic head injuries, drug and alcohol ingestion, and birth trauma.  Socialization factors increase one’s risk of gun violence if violence becomes a learned behavior from significant others, including family, friends, and the media.  Cognitive factors may influence gun violence as they are the foundational beliefs, ideas, and patterns of thinking that emerge as a result of lifetime experiences; for example, some gang members may believe that it is acceptable to respond to every perceived or imagined sign of disrespect with violence.  Situational factors encourage violent behavior through the characteristics of the environment alone, such as the presence of drugs, alcohol, and guns. 
Understanding gun violence requires understanding gun laws. The Second Amendment, which protects “the right of the people to keep and bear Arms”, makes it legal for individuals to obtain firearms through standard age requirements and conditions.  Under Federal law, all United States citizens who pass a background check have the power to purchase rifles and shotguns at the age of 18 from licensed firearm dealers, while other firearms can legally be purchased at the age of 21.15 Regarding the United States-permitted private firearm sales, there are no official background check requirements necessary before obtaining possession.  Weak gun laws make finding guns easy; thus, opportunities for gun violence are enabled. Where there are fewer guns, there is less of a prevalence of gun violence.  Unfortunately, United States has allowed itself to become the nation with the highest firearm ownership per capita in the world, boasting 88.8 firearm owners per 100. 
Even when laws should serve as protective factors against gun violence, individuals can still get ahold of a firearm as easily as they can pull the trigger. Illegal gun trafficking, occurring on the streets of troubled neighborhoods, makes committing crimes involving guns simple.  Crime may place guns into young hands, but it doesn’t end there. The supply is due to demand. In the circle of violence, exposure to gun violence in crime-filled, disadvantaged neighborhoods leads to individuals being more likely to carry firearms.  In high-violence communities, common temptations for carrying a gun include protection from drug trading, protection from disrespect, and protection from repeated bullying. 
Furthermore, gun violence and crime shroud poverty-stricken communities. For example, disproportionately greater levels of violence are found within San Francisco neighborhoods with economic levels below the poverty level.  People of color, who still struggle with inequity in this country, make up the majority of the population of these neighborhoods.  Ultimately, living in poverty has been observed to affect access to resources, educational outcomes, and mental health; thus, influencing and increasing the prevalence of gun violence and violence, overall. 
Surveillance and Prevention
At this time, the CDC’s National Violent Death Reporting System (NVDRS) is the surveillance system being used to monitor firearm-related fatalities in the United States. Found within the CDC’s Injury Center: Web-based Injury Statistics Query and Reporting System (WISQARS), NVDRS pulls together data on all types of violent deaths, including firearm-related homicides, suicides, and lethal injuries by law enforcement officers.  The state-based surveillance system pools data from various sources, such as local and state coroner, medical examiner, crime lab, law enforcement, and vital statistics records to form a comprehensive, interactive online database.  The system may also include information on mental health problems, physical health problems, recent problems with relationships, finances, or a job, and circumstances of death for more of an overview. Due to funding, NVDRS currently collects data from only 32 states, so the data is not nationally representative, but the goal is to eventually include all 50 states, all United States territories, and the District of Columbia in the system.  Ultimately, the data presented through this surveillance system can be used to develop, implement, and evaluate violence prevention strategies in order to save lives. 
As gun violence is an urgent, complex, and multifaceted public health concern, it demands evidence-based, multifaceted solutions. 
In the realm of primary prevention strategies, public health activities are often utilized to interrupt the spread of violence.  First and foremost, surveillance, like NVDRS, is used to track firearm-related injuries and deaths, attain insight about the causes of gun violence, and determine the impact of interventions.  Then, risk factors associated with gun violence, like depression and poverty, and protective factors that guard against gun violence, like youth access to trusted adults, must be identified.  Once the factors of gun violence have been thoroughly researched and identified, developing, implementing, evaluating, and institutionalizing successful interventions to build resilience and reduce risk factors is the ultimate goal.  Primary prevention seeks to prevent opportunities of gun violence with an integration of measures to promote and strengthen gun control, safety, justice, security and health systems, all while eliminating alienation and poverty and building resilience in the general population. 
On the secondary prevention level, strategies are designed to identify and treat those who have already been exposed to the risk factors of gun violence.  Interventions in this category mainly focus on individuals and groups at high risk of perpetuating violence and those with increased risk of getting caught in the crossfire of dangerous gangs and violent groups, in order to reduce impairments and injuries.  For example, interventions of behavioral threat assessments are increasing in schools and workplaces around the country.  When an individual exhibits troubling behavior, for instance, openly threatening others or shows evidence of planning an attack, behavioral assessment teams work to get the individual support immediately, whether through counseling or more intensive therapeutic programs, and monitor progress.  Conflict resolution programs, which have shown to reduce fights, and mental health screenings can also be used to spot and treat high risk violence perpetrators.  Secondary prevention programs can help those experiencing interpersonal conflicts and emotional difficulties, before their issues escalate to violence. 
For those who have been unfortunately affected by gun violence, tertiary prevention strategies intend to offer the necessary support, so that such tragedies do not happen again. Tertiary interventions comprehensively respond to those who are already traumatized and impaired from gun violence in order to minimize detrimental impacts, such as secondary illnesses, injuries, and re-victimization.  Regarding the perpetrator, incarceration is a common tertiary response for gun violence, although there are better, proven alternatives such as mental health counselling and substance abuse treatment.  In the case of victims, psychosocial support, rehabilitation services, trauma counselling, and employment assistance may empower individuals by exposing them to opportunities to move forward and break the cycle of violence. 
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** Disclosure: This paper was written in March 2015. Statistics have changed since then.
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