The Regional Gun Violence Consortium is a coalition of gun violence researchers and practitioners from eight states and territories that aims to inform policymakers and the public by providing evidence-based, data-driven policy recommendations to disrupt the cycle of firearm-involved homicides, suicides, and injuries. Organized by topic area, this year-end report is a compilation of recent research from the Consortium’s members who specialize in public health, criminal justice, political science, economics, public policy, and many other fields. An asterisk (*) denotes members of the Consortium.
Cost of Gun Violence
+ Increases in Actual Health Care Costs and Claims After Firearm Injury. (Megan L. Ranney*; Curtis Herges; Leanne Metcalfe; Jeremiah D. Schuur; Paul Hain; & Ali Rowhani-Rahbar, Annals of Internal Medicine, Dec. 2020.)
Compared with the 6 months before the index firearm injury, in the 6 months after, per-member costs increased by 347 percent (from $3,984 to $17,806 per plan member) for those discharged from the Emergency Department and 2138 percent (from $4,118 to $92,151 per plan member) for those who were hospitalized.
+ The Association between Weather and the Number of Daily Shootings in Chicago (2012–2016). (Paul M. Reeping & David Hemenway*, Injury Epidemiology, Jun. 2020.)
A 10-degree (°C) higher temperature was significantly associated with 34 percent more shootings on weekdays, and 42 percent more shootings on weekends or holidays. A 10-degree higher temperature than average was also associated with 33.8 percent higher rate of shootings.
+ Differences in Racial Disparities in Firearm Homicide across Cities: The Role of Racial Residential Segregation and Gaps in Structural Disadvantage. (Brooke Wong; Serena Bernstein; Jonathan Jay; & Michael Siegel*, Journal of the National Medical Association, Oct. 2020.)
The authors model trends from 2000 to 2017 in the gap in homicide rates between the Black and white populations of 275 US cities. They find that racial residential segregation predicts differences between cities in the magnitude of racial disparities in firearm homicide rates.
This brief examines 36,263 homicides in Chicago over a 53-year study period, 1965 through 2017, at micro-place grid cells of 150 by 150 meters. This study shows not only long-term historical patterns of homicides in Chicago, but also places that historical context of homicides in reference to the dramatic increases in homicides in 2016-2017.
The authors estimate that hundreds of suicides could be prevented annually in the US if the 33 states where 18 year olds can still buy handguns raised the age limit to 21 years. However, for several reasons, policymakers and suicide prevention advocates should be wary of expecting this extent of life saving benefits: laws governing age of purchase can only affect exposure to firearms among 18-20 year olds who do not already have access to a firearm.
+ Access to Firearms, Homicide, and Suicide: Role of the Mortality Multiplier. (Deborah Azrael & Matthew Miller*, American Journal of Public Health, Oct. 2020.)
The mortality multiplier (m) is used to express the effect of firearm-focused legislation as a change in the total number of violent deaths for a unit change in firearm deaths. For example, if m = 0.8 for the effect of a given set of firearm laws on homicide, for every 10 firearm homicides averted by the laws there would be two additional non-firearm homicides that would not have occurred in the absence of the laws, resulting in eight homicides averted.
+ Beyond Gun Laws—Innovative Interventions to Reduce Gun Violence in the United States. (Charles C. Branas*; Paul M. Reeping; & Kara E. Rudolph, JAMA Psychiatry, Aug. 2020.)
Although legislative avenues remain a primary strategy to prevent gun violence, there is a rich emerging scientific literature evaluating the effectiveness of interventions and programs that do not depend on state or federal legislation or law enforcement. A scientific review of programs in 264 cities showed that every 10 additional nonprofit, community-building programs per 100,000 residents were associated with a 9 percent reduction in homicide and a 6 percent reduction in violence.
+ The Impact of State Firearm Laws on Homicide Rates in Suburban and Rural Areas Compared to Large Cities in the United States, 1991-2016. (Michael Siegel*; Benjamin Solomon; Anita Knopov; Emily F. Rothman; Shea W. Cronin; Ziming Xuan; & David Hemenway*, Journal of Rural Health, Mar. 2020.)
This article aims to examine whether state firearm laws impact homicide rates differently in suburban and rural areas compared to large cities in the United States. Among other findings, two policies—universal background checks and “may issue” laws that required a heightened showing of suitability for concealed carry—were associated with lower firearm homicide rates in large cities but were not associated with firearm homicide rates in suburban and rural areas.
+ Lessons Learned in Conducting Youth Suicide Prevention Research in Emergency Departments. (Carol W. Runyan; Sara Brandspigel; Catherine W. Barber; Marian Betz; Deborah Azrael; & Matthew Miller*, Injury Prevention, Apr. 2020.)
To address youth suicide, the authors recruited seven emergency departments (EDs) for what they believe is the first controlled trial of an intervention to promote safer firearm and medication storage after a child was seen in an ED by a behavioural health clinician. Despite the challenges noted, they found that the behavioural health clinicians in the EDs followed the protocol and found it useful in engaging families in discussions about both firearm and medication storage. Several hospitals intend to continue the intervention on their own as the new usual care, suggesting that the challenges encountered can be and are worth tackling.
+ Neighbors Do Matter: Between-State Firearm Laws and State Firearm-Related Deaths in the US, 2000–2017. (Ye Liu; Michael Siegel*; Bisakha Sen, American Journal of Preventive Medicine, Nov. 2020.)
This study aims to evaluate whether the relationship between state firearm laws and state firearm deaths are affected by comparatively lenient firearm laws in neighboring states. It finds weaker firearm laws in neighboring states may undermine the effectiveness of a state’s own firearm laws in curbing firearm deaths. Coordinated legislative action across neighboring states may be more effective than an individual state taking legislative action.
+ The Relation Between State Gun Laws and the Incidence and Severity of Mass Public Shootings in the United States, 1976–2018. (Michael Siegel*; Max Goder-Reiser; Grant Duwe; Michael Rocque; James Alan Fox; Emma E. Fridel, Law and Human Behavior, Oct. 2020.)
In this study, the authors analyzed the relationship between state firearm laws and the incidence and severity (i.e., number of victims) of mass public shootings in the United States during the period 1976–2018. Laws requiring permits to purchase a gun are associated with a lower incidence of mass public shootings and bans on large capacity magazines are associated with fewer fatalities and nonfatal injuries when such events do occur.
+ State Legislative Strategies to Pass, Enhance, and Obscure Preemption of Local Public Health Policy-Making. (Jennifer L. Pomeranz* & Diana Silver, Preventive Medicine, Sep. 2020.)
Local governments are often innovators of public health policy-making, yet states are increasingly preempting or prohibiting local control over public health issues. To systematically identify strategies to pass, obscure, or enhance preemption, in 2019 the authors conducted a content analysis of the full text of the bills from which preemptive laws in 5 policy areas (tobacco control, firearms, paid sick leave, food and nutrition, and civil rights) passed over a 5-year period (2014–2018) for preemptive laws that remained in effect as of January 2019.
+ Unfinished Business: Gun Violence on the Policy Agenda. (Joseph J. Popcun*; Nicholas J. Simons*; & Leigh Wedenoja, Rockefeller Institute of Government, Jul. 2020.)
The most commonly introduced and most commonly passed type of bill was person-specific firearm prohibitions, which restrict who can have access to firearms including restrictions on individuals convicted of felonies or domestic abuse offenses and individuals with “red flags.” Person-specific firearm prohibitions accounted for almost a quarter of all firearm legislation introduced in 2018 and 2019 and was successfully enacted into law in three cases. Bills focused on seller and owner responsibility were also extremely common.
+ The Scope of the Problem: Gun Violence in the USA. (David Hemenway* & Eliot Nelson, Current Trauma Reports, Jan. 2020.)
The scope of the US gun problem in 2019 is far greater than is indicated merely by medical costs and body counts.
+ State Handgun Purchase Age Minimums in the US and Adolescent Suicide Rates: Regression Discontinuity and Difference-in-Differences Analyses. (Julia Raifman; Elysia Larson; Colleen L. Barry; Michael Siegel*; Michael Ulrich; Anita Knopov; & Sandro Galea, BMJ, Jul. 2020.)
The authors evaluate the association between US state policies that establish age 18 or 21 years as the minimum purchaser age for the sale of handguns and adolescent suicide rate. They found that state policies to limit the sale of handguns to individuals aged 21 or older were associated with a reduction in suicide rates among adolescents.
Some shooting ranges have adopted policies to prevent suicides at their facilities. Little data have been available to guide them. A total of 118 suicides (or 0.18 percent) occurred at a shooting range, or 0.12 per million population. If that rate held for the nation as a whole, there would have been roughly 35 shooting range suicides per year during the study period.
+ Firearm Ownership and Acquisition in California: Findings from the 2018 California Safety and Well-being Survey. (Nicole Kravitz-Wirtz; Rocco Pallin; Matthew Miller*; Deborah Azrael; & Garen J. Wintemute, Injury Prevention, Dec. 2020.)
Roughly one in four (25 percent, 95 percent confidence interval [CI], 22 percent to 28 percent) California adults live in a home with a firearm, including 4.2 million adults—14 percent (95 percent CI 13 percent to 16 percent) of the adult population—who personally own a firearm. These owners collectively own an estimated 19.9 million firearms (8.9 million handguns).
+ Firearm Access and Adolescent Suicide Risk: Toward a Clearer Understanding of Effect Size. (Sonja A. Swanson; Mara Eyllon; Yi-Han Sheu; & Matthew Miller*, Injury Prevention, May 2020.)
Almost one-third (30.7 percent) of adolescents reported living in a home with firearms. Although unmeasured confounding and other biases may nonetheless remain, the authors’ updated estimates reinforce the suggestion that adolescents’ risk of suicide was increased threefold to fourfold if they had lived in homes with a firearm compared with if they had not.
Twelve percent (95 percent confidence interval [CI], 10.6 percent to 13.6 percent) of women and 33.3 percent of men (95 percent CI 30.3 percent to 36.5 percent) personally owned guns. Male and female gun owners are demographically similar and cite similar reasons for owning firearms, but female gun owners own fewer guns (3.6 vs 5.6).
+ Handgun Ownership and Suicide in California. (David M. Studdert; Yifan Zhang; Sonja A. Swanson; Lea Prince; Jonathan A. Rodden; Erin E. Holsinger; Matthew J. Spittal; Garen J. Wintemute; & Matthew Miller*, New England Journal of Medicine, Jun. 2020.)
Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male non-owners (95 percent confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female non-owners (95 percent CI, 6.22 to 8.24).
+ The Meaning of Guns to Gun Owners in the US: The 2019 National Lawful Use of Guns Survey. (Michael B. Siegel* & Claire C. Boine, American Journal of Preventive Medicine, Jul, 2020.)
This study seeks a better understanding of the lawful use of guns and the symbolic meaning of guns to gun owners. Understanding these attitudes is essential to bridge the divide in public opinion regarding policies to reduce gun violence in the US. The survey shows that, for most of the gun owners, gun ownership plays a practical role as a method of self-protection and has a symbolic association with freedom. It also finds that there exists a fair amount of support, privately not publicly, among gun owners for some gun violence prevention policies.
+ Older Firearm Owners and Advance Planning: Results of a National Survey. (Marian E. Betz; Matthew Miller*; Daniel D. Matlock; Garen J. Wintemute; Rachel L. Johnson; Conor Grogan; Hillary D. Lum; Christopher E. Knoepke; Megan L. Ranney*; Krithika Suresh; & Deborah Azrael, Annals of Internal Medicine, Oct. 2020.)
The National Firearms Survey included 1001 respondents aged 65 years and older who were living in homes with firearms and were firearm owners themselves. These respondents had a median age of 71.0 years and owned a median of 3 firearms. Most were married (74.6 percent), white (81.4 percent), and male (73.7 percent). Although nearly half had handled a firearm once or less in the past year, 18.0 percent reported carrying a loaded handgun in the past month.
+ Patterns of Gun Owner Beliefs about Firearm Risk in Relation to Firearm Storage: A Latent Class Analysis Using the 2019 National Firearms Survey. (Carmel Salhi; Deborah Azrael; & Matthew Miller*, BMJ, Jul. 2020.)
The authors’ latent class analysis is a first step towards better understanding variation in patterns of beliefs among gun owners regarding the risks and benefits of firearms. Their results suggest that messaging aimed at promoting safer firearms storage might benefit from the empirically derived typologies we identify.
+ The Relationship between Alcohol Consumption and the Desire to Own a Firearm: An Empirical Study on Citizens of São Paulo City, Brazil. (Marcelo Justus; David Hemenway*; & Matthew Miller*, Public Health, Feb. 2020.)
In 2013, although only 1.5 percent of the population surveyed reported living in a household with a firearm, 15.7 percent report that they would possess a firearm if they could, and 13.0 percent believed they would be safer/more protected from violence if they had a firearm. The desire to own a firearm is higher among people who consume alcoholic beverages than among those who do not and is higher as alcohol binge frequency increases.
+ Views on Firearm Safety Among Caregivers of People With Alzheimer Disease and Related Dementias. (Marian E. Betz; Deborah Azrael; Rachel L. Johnson; Christopher E. Knoepke; Megan L. Ranney*; Garen J. Wintemute; Daniel D. Matlock; Krithika Suresh; & Matthew Miller*, Geriatrics, Jul. 2020.)
In this survey study of US adults (aged ≥35 years) living in homes with firearms, 2.6 percent reported being caregivers of a person with Alzheimer disease and related dementias, and 41 percent of these caregivers lived with that person. Although most caregivers were open to health care professional counseling about firearm safety for persons with Alzheimer disease and related dementias, few caregivers had ever received any such counseling.
+ Firearm Industry Groups are Using COVID-19 to Expand Gun Rights. (Jennifer L. Pomeranz*, Journal of Public Health Management & Practice, Aug. 2020.)
While New York, New Jersey, and California do not include firearm retailers as essential businesses, other states such as Connecticut have allowed firearm retailers to remain open as essential operations. As a result, the National Rifle Association (NRA) and other firearm advocacy organizations sued New York, New Jersey, and California for not listing firearm retailers as essential businesses, arguing their failure to do so violates the Second Amendment of the US Constitution.
+ Gun Accessories and the Second Amendment: Assault Weapons, Magazines, and Silencers. (Robert Spitzer*, Law and Contemporary Problems, 2020.)
Legal challenges to gun laws are nothing new, including laws restricting access to assault weapons. Such challenges have often included objections to restrictions regarding bullet magazines. In general, ammo magazine restrictions have been consistently upheld, with a couple of recent exceptions.
+ “Gun Policy and Politics in America,” Developments in American Politics (IN PRESS). (Robert Spitzer*, edited by Danielle Coombs & Jon Herbert, Palgrave/St. Martin’s, 2021.)
+ “Looking Down the Barrel of the 2020 Elections,” The 2020 Presidential Election: Key Issues and Regional Dynamics (IN PRESS). (Robert Spitzer*, edited by Luke Perry, Palgrave McMillan, 2021.)
The new edition of this classic text covers the latest developments in American gun policy including the most recent shooting incidents that persist in plaguing the American landscape. Two seismic political events are highlighted in the eighth edition. The first is the ascendance of the gun safety movement, and the second is the financial, political, and legal crises that beset the nation’s oldest and most powerful gun group, the National Rifle Association.
+ “To Brandish or Not to Brandish: The Consequences of Gun Display,” New Histories of Gun Rights and Regulation: Essays on the Place of Guns in American Law and Society (IN PRESS). (Robert Spitzer*, edited by Jacob Charles, under review, 2021.)
+ Emotional and Physical Symptoms after Gun Victimization in the United States, 2009–2019. (Eugenio Weigend Vargas & David Hemenway*, Preventive Medicine, Feb. 2021.)
The objective of this study was to determine the effects of gun victimization on the likelihood of post emotional and physical symptoms as reported by victims. The authors’ findings suggest that the presence of a firearm during a violent crime results in an increased likelihood of subsequent emotional and physical repercussions.
+ The Impact of COVID-19 on Community-Based Violence Interventions. (Irshad Altheimer*; Janelle Duda-Banwar; & Christopher J. Schreck, American Journal of Criminal Justice, Jun. 2020.)
Guided by their work in Rochester, New York, the authors explore how the emergence of COVID-19 and the subsequent social restrictions have hampered the ability of community-based organizations to respond to violence. They also examine ways that community-based organizations can adapt to the challenges associated with COVID-19 and continue providing services to the community.
Gun Violence Interests and Identities
+ Once in Parkland, a Year in Hartford, a Weekend in Chicago: Race and Resistance in the Gun Violence Prevention Movement. (Mary Bernstein*; Jordan McMillan; & Elizabeth Charash, Sociological Forum, Dec. 2019.)
Generally ignoring firearm‐deaths by suicide, “common sense” divides gun violence into two distinct types of phenomena: urban gun violence and mass shootings. In this article, the authors draw on ethnographic observation to compare protest vigils in urban communities comprised predominantly of people of color, in suburban areas that are mostly white, and at the national level in order to uncover the racialized processes of symbolic classification by which this “common sense” view is produced and how it is challenged by activists.
Given that gun violence is the second leading cause of death of children and adolescents in the United States, accounting for 15 percent of all child deaths nationwide, pediatricians must join the public debate. The authors discuss three concepts that help explain why the US has the highest levels of gun violence among high-income countries and how we might begin fixing the problem.
+ What is Gun Culture? Cultural Variations and Trends across the United States. (Claire Boine; Michael Siegel*; Craig Ross; Eric W. Fleegler; & Ted Alcorn, Humanities and Social Sciences Communications, Jul. 2020.)
The authors developed empirical methods to identify variations in elements of gun culture across states. They found (1) gun culture is not monolithic; (2) there are multiple elements of gun culture that vary substantially between states; (3) over time, the recreational gun subculture has been falling in prominence whereas the self-defense subculture has been rising; and (4) there is another subculture, distinct from the self-defense one, which consists in mobilization around the Second Amendment and was strongest in places where state firearm laws are most extensive.
Guns and Youth
+ Child Access Prevention Firearm Laws and Firearm Fatalities Among Children Aged 0 to 14 Years, 1991-2016. (Hooman Alexander Azad; Michael C. Monuteaux; Chris A. Rees;
Are state-level laws requiring safe storage of firearms associated with a reduction in firearm fatalities in children aged 0 to 14 years? In this state-level, cross-sectional study throughout the United States, negligence-specific child access prevention firearm laws were associated with a 13 percent reduction in all-intent firearm fatalities, a 15 percent reduction in firearm homicides, a 12 percent reduction in firearm suicides, and a 13 percent reduction in unintentional firearm fatalities among children aged 0 to 14 years.
+ Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department–Based, Multisite, Stepped-Wedge Trial. (Matthew Miller*; Carmel Salhi; Catherine Barber; Deborah Azrael; Elizabeth Beatriz; John Berrigan; Sara Brandspigel; Marian E. Betz; & Carol Runyan, Annals of Emergency Medicine, Aug. 2020.)
The authors evaluate whether a counseling intervention implemented at the hospital level resulted in safer firearm and medication storage by caregivers of youths aged 10 to 17 years after their child’s evaluation in the emergency department (ED) for a behavioral health concern. They found evidence that caregivers’ medication storage improved after their child’s ED visit, with evidence suggestive of improvement for firearm storage.
+ An Eye on Disparities, Health Equity, and Racism: The Case of Firearm Injuries in Urban Youth in the US and Globally (IN PRESS). (Margaret K. Formica*, Pediatric Clinics of North America, 2021.)
+ Suicidality and Exposure to School-based Violence among a Nationally Representative Sample of Asian American and Pacific Islander Adolescents (IN PRESS). (Sonali Rajan*; P. Arora; B. Cheng; O. Khoo; & H. Verdeli, School Psychology Review, 2021.)
+ Youth Exposure to Violence Involving a Gun: Evidence for Adverse Childhood Experience Classification. (Sonali Rajan*; Charles C. Branas*; Dawn Myers; & Nina Agrawal, Journal of Behavioral Medicine, Sep. 2020.)
Adverse childhood experiences (ACEs) have historically included child maltreatment, household dysfunction, and other critical issues known to impact children negatively. The authors’ findings provide evidence that youth gun violence exposure should be classified as an ACE.
In 1984, injury pioneer Sue Baker wrote that ‘the biggest surprise for my students is the scarcity of good data’. Unfortunately, not nearly enough has changed in the succeeding 35 years. Why? In large part because the injury field hasn’t done enough to prioritize and push for improvements in the data.
+ Deconstructing Mass Shootings: Exploring Opportunities for Intervention. (Joel A. Capellan* & Allan Y. Jiao*, Rockefeller Institute of Government, Oct. 2019.)
In this policy report, the authors argue that prevention requires us to refocus our attention from why to how mass public shootings happen. To this end, the authors deconstruct mass public shootings into a series of stages and decisions and explore various opportunities for intervention.
+ Mass Shootings, Legislative Responses, and Public Policy: An Endless Cycle of Inaction. (Jaclyn Schildkraut* & Collin M. Carr, Emory Law Journal, 2020.)
The authors explore previous attempts by the federal and state governments to regulate assault weapons and implement background checks for all firearm purchases, particularly in response to high-profile (and highly lethal) mass shootings. They also consider the role of lobbying and interest groups in overshadowing bipartisan support for these proposals.
The author explores how a prolific academic became an advocate for some of the strangest and most odious ideas of our time including Sandy Hook shooting conspiracy theories.
According to the authors’ findings, when mass shootings occur in the United States, several evidence‐informed steps can be taken from the moment the first bullet is fired until the last injured individual is transported to the hospital to promote a rapid response that can reduce death and disability. Ten recommendations are made ranging from recognition of the need for rapid response and bystander training to triage and transport training of police and avoidance of over‐response.
+ Self-Protection versus Fear of Stricter Firearm Regulations: Examining the Drivers of Firearm Acquisitions in the Aftermath of a Mass Shooting. (Maurizio Porfiri*; Roni Barak-Ventura; & Manuel Ruiz Marín, Patterns, Aug. 2020.)
The authors establish an information-theoretic framework to address the long-disputed dichotomy between self-protection and fear of firearm regulations as potential drivers of firearm acquisition in the aftermath of a mass shooting. The analysis suggests that fear of stricter firearm regulations is a stronger driver than the desire of self-protection for firearm acquisitions.
+ The Survivor Network: The Role of Shared Experiences in Mass Shootings Recovery. (Jaclyn Schildkraut*; Evelyn S. Sokolowski; & John Nicoletti, Victims & Offenders, May 2020.)
This study relies on in-depth interviews with 16 survivors of the April 20, 1999 shooting at Columbine High School to explore the way in which they viewed various forms of social support during their trauma recovery process in both the short- and long-term. The findings indicate that the most effective support came from “similar others,” or those who had experienced the shooting in an analogous manner.
In the United States, firearm homicides disproportionately occur in urban areas. The authors examine whether the same is true for fatal police shootings. Their results suggest that efforts to reduce police shootings of civilians should include rural and suburban as well as urban areas.
+ The Interaction of Race and Place: Predictors of Fatal Police Shootings of Black Victims at the Incident, Census Tract, City, and State Levels, 2013-2018 (IN PRESS). (Michael Siegel*; Michael Poulson; R. Sangar; Jonathan Jay, Race and Social Problems, 2021.)
The authors find that, across several circumstances of police killings and their objective reasonableness, Black suspects are more than twice as likely to be killed by police than are persons of other racial or ethnic groups; even when there are no other obvious circumstances during the encounter that would make the use of deadly force reasonable.
+ Racial Disparities in Fatal Police Shootings: An Empirical Analysis Informed by Critical Race Theory. (Michael Siegel*, Boston University Law Review, May 2020.)
This essay uses critical race theory and the Public Health Critical Race Praxis in an attempt to explain the striking differences in the magnitude of racial disparities in fatal police shootings across states and major US cities. It concludes that individual-level interventions cannot adequately address these disparities.
+ A Typology of Civilians Shot and Killed by US Police: a Latent Class Analysis of Firearm Legal Intervention Homicide in the 2014–2015 National Violent Death Reporting System. (Joseph Wertz; Deborah Azrael; John Berrigan; Catherine Barber; Eliot Nelson; David Hemenway*; Carmel Salhi; & Matthew Miller*, Journal of Urban Health, Mar. 2020.)
The study extends prior work on police-involved lethal shootings in three important ways. First, the authors use latent class analysis to construct a data-driven, exhaustive, mutually exclusive typology of these events, using NVDRS data 2014–2015. Second, rather than fitting some, but not all, cases into predefined sub-types, every case is assigned membership to a particular emergent class. Third, the authors use a validated case identification process in NVDRS to identify incidents of lethal police-involved shootings.