Crystal Turner fell apart when two of her four children were shot and killed in Columbus, Ohio, nearly five years ago.
Her son, Donell McDonald, 23, and her daughter, Jenea Harvison, 29, were both gunned down by Harvison’s estranged husband at a daycare facility Harvison owned.
“Nothing prepares you,” Turner said. “That one event has changed our lives forever.”
Turner and her family are not alone. Firearm-related injuries kill nearly 40,000 Americans each year — more than die in fatal car crashes — and the nation’s firearm homicide rate is more than 25 times that of comparable affluent countries.
While researchers have long said the gun violence problem should be evaluated like any other public health epidemic, there’s been meager funding for research for the past two decades.
That’s finally changing.
In December, Congress approved $25 million in federal funding to study gun safety. The money, to be split evenly between the National Institutes of Health and Centers for Disease Control and Prevention, will be used to examine gun violence from a public health perspective.
Experts in the field concede the amount is small in comparison to the scope of the issue but are celebrating it as a watershed moment for gun safety. They say researchers may finally be able to answer basic questions about gun ownership and evaluate the effectiveness of firearm policies and violence prevention efforts.
“There are, without a doubt, thousands of people who are dead today who would be alive if we had been able to continue to do what we have been able to do for other health problems – to research the problem,” said Garen Wintemute, an emergency physician and director of the Violence Prevention Research Program at the University of California Davis.
Some working to combat violence on the nation’s most dangerous streets, however, say the money would be better spent on proven intervention programs.
“The research has already been done,” said Robbin Carroll, founder of I Grow Chicago, an organization on the city’s South Side working to address the root causes of violence. “We know communities that don’t have gun violence, and we know which ones do. How do we invest money and get into those communities?”
‘This is our lane’
Since 1996, there’s been an effective government freeze on gun safety research. That year, Congress — under pressure from the NRA — approved the Dickey Amendment, which forbids CDC to “advocate or promote gun control.” Federal lawmakers also slashed the agency’s funding by $2.6 million, the same amount it spent on firearm violence research the previous year.
While the Dickey Amendment did not specifically ban research on gun violence, it had a “chilling effect,” experts say, steering the federal agency away from research that might lead to firearms regulation. Young scholars were discouraged from pursuing the field.
“For 25 years, I’ve never told doctoral students that they should become a gun researcher because they couldn’t make a living. So we’ve lost a generation of researchers,” said David Hemenway, a health policy professor and director of the Harvard Injury Control Research Center, who estimates that there are 10-20 full-time gun violence researchers in the U.S.
From 1998 to 2012, the number of publications about gun violence declined 64%, according to a 2017 study by JAMA Internal Medicine. What research was conducted came from cobbled-together grant funding from a smattering of hospitals, universities, states and foundations, the study found.
Gun violence research received far less funding than research on car crashes and cancer.Between 2008 and 2017, firearm injuries were the second-leading cause of death for U.S. children and adolescents, according to a 2019 study by University of Michigan School of Medicine experts.
During that period, an average of $88 million a year was granted to study the number one cause — motor vehicle crashes — and $335 million went to research cancer, the third-leading cause of deaths for young people. Just $12 million went to firearm injury prevention research.
The situation began to thaw in 2018, when lawmakers clarified the Dickey Amendment language, lifting restrictions on gun violence research.
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That same year, physicians nationwide rallied on social media in support of a public health approach to gun violence. The online movement began when the National Rifle Association published a tweet accusing medical professionals of “pushing for gun control.”
“Someone should tell self-important anti-gun doctors to stay in their lane,” the NRA tweeted.
Physicians were furious. “This is our lane,” many responded on Twitter. Hundreds posted images of bloodied scrubs and trauma bays.
“A lot of us in the healthcare community were really incensed by those comments, because we’re the ones on the front lines of taking care of those patients day in and day out, said Joseph Sakran, director of Emergency General Surgery at Johns Hopkins Medicine. “So we made a point to the public that we do have a role to play in coming up with solutions that is based in data.”
The NRA did not respond to several requests from USA TODAY for comment.
Sakran, who dedicated himself to medicine after surviving a bullet wound in Afghanistan, said injury prevention is the best form of medical treatment. Approximately 80% of people die where they are shot, according to estimates by researchers at Northeastern University.
“I was taking care of a 17-year-old kid, and he was shot in the back of the head, execution style. He had a devastating and traumatic brain injury,” Sakran said. “And I had to tell this mother that there was nothing I could do, which is one of the worst things I have to do as a trauma surgeon.”
‘Research is not advocacy’
Dr. Wintemute grew up in Southern California with guns in his home. He learned to shoot from his father, who had been a soldier in World War II, and taught riflery as a camp counselor at the local YMCA. He later joined UC Davis’ firearm and pistol club and became a member of the NRA.
“My problem is not with the firearm, it’s with misuse. I’m an ER doc, and my commitment is to try to intervene upstream in that flow of events that brings people into my ER with holes in their bodies, or, more likely, takes them directly to the morgue,” he said. “My loyalty is to the science, not to an agenda. Research is not advocacy.”
Many researchers compare the complexity of the gun violence issue to that of motor vehicle injuries. In 1966, more than 53,000 people were killed, a fatality rate of 5.5% per 100 million vehicle miles, according to National Highway Traffic Safety Administration data. That year, Congress held a series of hearings and passed the Motor Vehicle Act, which created what would become the NHTSA, headed by a public health physician.
Scientists received funding to develop seatbelts, airbags, steering columns, safety glass and more. Studies revealed the dangers of putting young and alcohol-impaired drivers behind the wheel. By 1992, the fatality rate had dropped to 1.5%, NHTSA said. By 2017, it was 1.2%.
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“Data matters, research mattered in the motor vehicle arena,” Hemenway said. “Drivers are no better than they are when I was a kid, but there are fewer fatalities than there were. There are good ways to reduce the problem without banning the use of these products.”
Finding root causes of the disease
The CDC and NIH have provided few clues about how they intend to dole out their $12.5 million shares.
The NIH released a statement saying it was still reviewing the language of the bill and identifying new research opportunities.
The agency said gun violence prevention studies usually include research on parental roles in preventing injury at home and other places and understanding the relationship between alcohol abuse and gun violence.
The CDC did not respond to a request for an interview, but spokeswoman Courtney Lenard said in an email gun violence is “a pressing public health problem.”
“CDC welcomes the opportunity to study gun violence and identify effective strategies to prevent it,” Lenard wrote.
Rep. Nita Lowey, who chairs the House Appropriations Committee and advocated for the funding, said she wants to see the country’s “best researchers” find out the underlying causes of gun violence, including accidental shootings and suicide.
“There are few causes more important than the safety and security of our communities,” Lowey said.
Researchers have a long wish list for the new funding, and are eagerly awaiting the agencies to issue calls for proposals. Many share a top priority: gathering reliable data on how many people suffer non-fatal firearm injuries each year.
Emergency rooms nationwide are required to report firearm-related deaths to the CDC but not non-fatal firearm injuries, so the agency estimates the number based on information from about 60 hospital ERs.
“CDC was doing what they could do when they didn’t have adequate resources … but the data was non-representative and inaccurate,” said Wintemute, who helped author a 2017 study that showed the data didn’t meet the agency’s own standard of credibility. In July, CDC’s Web-based Injury Statistics Query and Reporting System stopped showing non-fatal injury data, calling the data “unstable.”
Rather than require all hospitals report non-fatal injuries — which would be expensive and unsustainable — it would be more efficient to survey people about their injuries, according to Wintemute.
“The federal government already supports some large-scale surveys related to public health, and firearms violence questions should be incorporated into those surveys immediately,” he said. “We need to make use of the existing federal research infrastructure to gather reliable national data on firearm ownership, use and violence.”
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Sarah Burd-Sharps, director of research at Everytown for Gun Safety, an anti-gun violence nonprofit, wants to know exactly how many children suffer non-fatal firearm-related injuries, and what role safe storage plays in those incidents.
“In about half of U.S. states, there are some form of child protection laws about guns. Do they work?” Burd-Sharps asked. “Which form of law works best?”
She also wants to know more about background checks, red flag laws and what works to prevent school shootings. Does arming teachers work?
“One thing that tends to happen in this country after a school shooting or mass shooting, one of the causes that is often talked about is video games. But researchers across the country have found no relationship,” she said. “At the federal level, a rigorous scientific study would help us understand if there’s a relationship there.”
‘Epidemic control methods’
Other researchers have proposed studies on the effectiveness of violence prevention programs, scores of which have cropped up in communities across the country. But some of those leading such efforts say money should be spent supporting what has already been proven to work.
“The research is being under-implemented,” said Gary Slutkin, former head of the World Health Organization’s Intervention Development Unit and founder of Cure Violence, a Chicago-based nonprofit that treats violence with disease control and behavior change methods.
“Sometimes you have a lot of research on, say, polio vaccine, but certain countries aren’t being vaccinated. The big gap now in the field is the implementation of public health approaches, and the shifting in their thinking toward public health.”
Cure Violence takes a three-step approach to treating violence: detecting and interrupting potentially violent conflicts, identifying and treating those at risk, and mobilizing communities to change norms.
The organization has trained more than 1,000 “violence interrupters,” who work in their communities to mediate conflicts, prevent retaliations and keep conflicts “cool.” The interrupters work closely with those at risk of committing violence to get the services they need and collaborate with their neighbors.
“One case of flu causes another case. Same for TB, for AIDs, for violence. That requires epidemic control methods,” Sluktin said. “So we have to find a case that might be happening – like someone who might be doing a shooting – and then interrupt that.”
The program is working in about a hundred communities across 15 countries. But the greatest success has been seen in New York, Sluktin said, where the legislature has provided consistent funding for the program since 2009.
An ongoing evaluation by John Jay College of Criminal Justice found one neighborhood experienced a 63% drop in monthly shooting victims from 2009 to 2016, based on New York Police Department data.
New York spends approximately $40 million a year on Cure Violence programs. Slutkin estimates that big cities require about $15-30 million to run an effective program, and small cities need $5-$10 million.
“That’s why $25M for research is so small. And what’s needed is program dollars,” he said. “And these are cities that have police budgets in the hundreds of millions.”
‘Vaccines for violence’
Years after she lost two of her children, Crystal Turner has found a new purpose. The 55-year-old is raising her two grandchildren and volunteering with Columbus Public Health’s Community, Action, Resilience and Empowerment Coalition, which helps reeling residents and communities to heal from violence.
Much like “interrupters,” workers and volunteers with the group go into neighborhoods and knock on doors within a week of a murder, said Marian Stuckey, a Columbus Public Health social worker who oversees CARE, which formed in 2016 in response to a triple homicide in the city’s Hilltop neighborhood.
“It opens the door to communication,” said Stuckey. “I really firmly believe in bringing services to the community, and I think that’s a missing aspect of mental health.”
Turner knows well the power of that personal approach. CARE workers usually start canvassing neighborhoods within 48 hours of an incident and were there for Turner after her children were murdered.
Now, Turner’s the one knocking on the doors of grieving mothers.
“I understand their vulnerability,” she said. “I am a totally different person.”
While the direct impact of CARE on the city’s gun violence is hard to quantify, last year Columbus saw a nearly 30% decline in homicides, with 104 compared to a record high 143 in 2017.
Columbus Public Health Commissioner Dr. Mysheika Roberts supports a public health approach, but noted curing violence is trickier than preventing something like the flu.
“There’s a lot of thought out there that there are vaccines to violence. It can be safe housing, it could be a strong education system,” Roberts said. “So there are multiple vaccines for violence. We just don’t package it in a nice little syringe and needle and make it so easy to get.”
I Grow Chicago founder Robbin Carroll said a lack of education, fair housing, economic opportunity and racism all contribute to the systemic violence playing out on the streets. She said federal funding should be invested in communities suffering from poverty and warned that gun violence research perpetuates an “us versus them” dynamic.
“When we talk about research, or gun violence in general, we’re talking about it in the sense of numbers. We’re not talking about it in the sense of, that’s my 5-year-old,” Carroll said. “We can do a whole lot of research, but until we want to say ‘We care about you’ .. who we’re choosing to be is to probably have another year of extremely high gun violence.”
Researchers like Wintemute said treating the gun violence epidemic shouldn’t be an either-or proposition.
“We should have sufficient funding to support programs that have been effective while we develop and research programs that look at different elements of the problem,” he said. “We shouldn’t have to choose.”
USA TODAY’s Grace Hauck reported from Chicago and Nicquel Terry Ellis from Atlanta. Max Filby reported from Columbus, Ohio for the Columbus Dispatch.