Rates of both gun violence and firearm suicide have been increasing year over year, but not all Americans have been impacted equally. Black individuals in the US are nearly 14 times more likely to die from a firearm homicide than their white counterparts, and their inpatient hospitalizations due to firearm injuries are nine times higher. Further, preliminary data indicate that in 2022, for the first time in history, firearm suicide rates among Black individuals exceeded those of white individuals. A new study out in JAMA Network Open explores the relationship between gun violence exposure and suicide among Black adults. In this episode, lead author Daniel Semenza of the New Jersey Gun Violence Research Center and member of the Regional Gun Violence Research Consortium joins Policy Outsider to discuss the study’s findings.
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Joel Tirado 00:03
Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Joel Tirado. Rates of both gun violence and firearm suicide have been increasing year over year, but not all Americans have been impacted equally. Black individuals in the US are nearly 14 times more likely to die from a firearm homicide than their White counterparts, and their inpatient hospitalizations due to firearm injuries are 9 times higher. And in 2022, preliminary data indicate that, for the first time in history, firearm suicide rates among Black individuals exceeded those of White individuals. A new study out in JAMA Network Open explores the relationship between gun violence exposure and suicide among Black adults. Lead author Daniel Semenza of the New Jersey Gun Violence Research Center and member of the Regional Gun Violence Research Consortium joins us today to discuss the study’s findings. That conversation is up next.
Joel Tirado 01:24
Dan, thank you for joining us today. Before we dive into the study, can you tell our listeners a little bit about your research background? And why you chose to look at this particular issue? Sure,
Daniel Semenza 01:38
yeah, thank you so much for having me. When it comes to my research background, so I have a PhD in sociology. And when I was doing my PhD, we had to pick paths and traditions, and I concentrated in criminology, and sociology of health and illness. Um, so as a graduate student, it felt intuitive to me that people who are involved in crime or who are victims of crime, were also likely contending with various issues related to their health. And that particular gun violence victim, it’s a ship and victim division. And exposure might have real implications for people’s mental, physical, behavioral well being. So over the last few years, I’ve been working to really build out the the study of of that problem. Because what the data are increasingly showing us that when we just focus on homicides, and even if we just focus on the direct victims of, of interpersonal violence, and people who are shot, but may not die, we’re really under estimating the toll that gun violence takes on on human health, and particularly the health of people who are much more likely to be exposed, like black Americans, Hispanic Americans, people who live in very disadvantaged neighborhoods throughout a lot of American cities. So that’s kind of been the the motivation behind this is to really characterize and understand what the true burden of gun violence is, so that we can really raise the stakes for understanding what we need to do and the long term solutions that we’d have to put in place to get ourselves to a much better place than currently.
Joel Tirado 03:30
Right, right, we see the figures for firearm deaths, which I think have been hovering in the upper 40 1000s For the past few years. And then I you would know better than me, of course, but the firearm injury rate is maybe three or four times whatever that that number is for deaths. And then you are going a step further, even then, you know, what do we know about like firearm hospitalizations to talk about gun violence exposure? Which, can you talk a little bit about that term and what it means and how it’s sort of operationalized in the research that you did?
Daniel Semenza 04:19
Yeah, so I think it’s really important to kind of sit with this term gun violence exposure for a second because depending on how you think about it can be in many different things. And the analogy that I use was, if you picture a very calm Crystal Lake and you drop a really large rock into that lake, you’ll see these ripples emanating from the center where the rock was dropped into that lake. And you think about every shooting as kind of that, that rock dropping into the lake. There are all these ripples that emanating from a shooting at the center. that you have the individual who is actually shot, whether they live or they die, that person is sustaining a firearm injury. But then you have all of the people who know and love that person, again, whether or not they they die or they live. You have family members, you have friend, you have all these people who are going to secondary survive. And that’s that that next closest ripple. And then beyond that, especially in places where shootings happen on a regular basis, you have people who are witnessing or hearing about students who are living in or embedded in communities where gun violence exposure in all of these different kinds of further away ways, but still very important ways are happening on a regular basis. So if somebody is directly being exposed, somebody secondarily being exposed to having this kind of community exposure. And then there’s even this, this wider, broader flip ripple of people who are seeing this. In social media, we’re seeing this on the news, we’re hearing about shootings, whether they’re mass shootings, or whether they’re shootings that are happening more vocally to them. There is growing research that even that broader exposure, through media has implications for mental well being for feelings of anxiety and stress and things like that. And so you have to characterize this ripple effect, as this much broader, multifaceted thing you really want to understand. What are the implications here for health and well being and human flourishing more broadly? Far beyond just the people who are shot, whether they live or die? And what happened to them?
Joel Tirado 06:51
So, Dan, you talked a little bit about this. In your response there, you know, what exactly do we mean by gun violence exposure? In this study, you listed a few of those. But do you mind just sharing for the sake of the study? What specific gun violence exposures were you looking at?
Daniel Semenza 07:17
Sure, so in this study, and a few others, like what our goal was, was to collect data on a few of those initial ripples. And so we looked at direct victimization, which is being threatened with a gun and a separate question for Have you ever been with a gun? We also looked at this idea of secondary survivorship or secondary victimization. Do you know a family member? Or do you have a friend that you know that has been shot? And we look at that third level, which is community exposure? Have you witnessed or heard about a shooting in your local community in your local neighborhood, but somebody that you don’t know super close, personally, like a family member, or friend, so we didn’t look at social media exposure or media exposure more broadly, we kind of kept it at those three direct secondary and community levels. And we looked at this data is nationally representative among black Americans for this study. But in others, we also collected data nationally representative of American Indian and Alaskan Natives, are we focused on these groups because they are disproportionately exposed, and more likely to experience homicide, and suicide with a firearm? So really wanted to get a sense of that amongst these two groups?
Joel Tirado 08:43
Is this research into gun violence exposure? Sort of new? Is this something researchers have been looking at for a long time? I guess? How robust is the body of research that you’re building on here?
Daniel Semenza 09:00
Yeah, it’s so for something like gun violence, exposure and suicide. There’s, there’s very little, there’s a couple of papers that have approximated what we tried to do that had asked one question here or there, but they haven’t been able to character characterize? What do these different types of exposure mean for potential suicide ideation or behavior? And nor did it look at that in combination with one another, right? How do these exposures accumulate with one another? So I think that that is a relatively novel approach that that we take in this body of work this study and a few others is, is trying to look at them stand alongside one another and keep it in a plea to really get a sense of of how these things build up on one another and how they cut across not just suicidal ideation and behavioral outcomes, but we look at everything from sleep to Physical health and functional disability and other studies. And I think that is going much further than fire research has really done in thinking about this as broad exposure, not just what does it look like when you yourself get shot, sort
Joel Tirado 10:15
of a natural segue into, you’ve talked a little bit about the background here talked about what we mean by gun violence exposure. And we have a sense that this is a relatively novel, area of research. So talk a little bit about how the study was conducted. And then some of the big findings
Daniel Semenza 10:40
are so in this study, we worked with a huge survey group, they’re called themselves. And we collaborated with them to do this national study of black adults living in the United States. And so this is, you know, when you do all the waiting and make sure that data looks good, you are looking at a nationally representative sample of people who self identify as Black or African American that are he plus. And so that resulted in a little more than 3000 individuals in this survey. And our goal was to we asked a lot of different questions about firearms and use of guns. And one part of the survey was to understand these different types of gun violence exposure. But like I was saying before, we wanted to look at not just how does the individual type of exposure like being shot or being threatened or knowing somebody who has been shot, what does that mean for suicidal outcome, but also how these things add up to one another. And so we looked at them individually, but we also did this cumulative analysis where we added them up 012, and three plus types of exposures. So you could really get a sense of like, the more that people are exposed, is this affecting their ideation, and there’s suicidal outcomes. And, you know, we can talk about the results and what we find more in depth. But ultimately, what we see is in the fourth sample, the way that it’s typically done is first you look at the full sample suicidal ideation, right? Are people having thoughts about suicide, and we saw that certain individual exposures like actually being threatened with a gun, or knowing a family member, or a friend that had been shot was linked to an increase of suicide ideation over the life time. So we looked at past year past month, but we really only saw this kind of in general over somebody’s lifetime. And then from there, we looked at a sub sample, it said, Okay, who are the people who have had suicide ideation? Let’s just ask those individuals. Have you ever prepared a suicide attempt? Or have you ever actually attempted suicide, and again, we saw that being shot. So that really direct and efficient was linked to suicide attempt preparation, when the person has said that they have had suicidal thoughts, and being threatened or knowing a family member or a friend that had been shot with link to actual attempts of suicide. So you saw it, you know, I think it was a little surprising that we didn’t see all the different individual exposures. It was more about knowing somebody that secondary victimization, or these different types of direct victimization, being threatened or being shot that really matter. And then when we looked at the cumulative exposure, we saw that for both suicidal ideation, and the actual computer, or outcomes of preparing an attempt or attempting suicide, that in general, as the number of exposures increase, we saw a real increase in that risk of ideation and behavior has been particularly the strongest and I think the results are our most concerning of brown actual attempted suicide, where people who are exposed to three or more types of these different types of gun violence exposure are almost four times more likely than people not exposed to say that they had attempted suicide at some point in their lives.
Joel Tirado 14:36
Your study focused on black Americans. What are you using as a sort of baseline of comparison for other demographic groups? And forgive me if that’s an ignorant question, but I just maybe you can talk about that.
Daniel Semenza 14:54
No, it’s not ignorant at all, and it’s, it’s a big part of the next step. This receptions. So we really are just focused on black Americans in the sense of a sample is, we did an initial survey asking, do you how do you self identify your race black, or African American was one category. And people said that they identified as that they were included in the sample. So we’re not comparing to white Americans, we’re not comparing to Hispanic Americans or any other group. This is just what does it look like to be a black American? And how are the results different for people who have been exposed? Versus who happened, then next step is and this is rolling out probably in the next month, I think, is we will be doing a national survey across racial groups. So then we will be able to see what is exposure looking like for white Americans versus black Americans versus spanic? Americans, right? And what are the implications of those different levels of exposure for suicide ideation and behaviors, but also many other health outcomes? So let’s talk and maybe a year or so we’ll do this podcast again. And we’ll have a much clearer sense of what the comparisons look like. And in that survey, we’re also going to be able to look at how recently people have been exposed. Right. So you know, if you were shot, was it 20 years ago? Or was it last week? And how much does that matter for, for a lot of things, different health outcomes, as well as how frequently these type of exposures have happened? We think those things really matter. And so that’s going to help us build off this initial knowledge that we’ve gotten with the sample. blackbelts. Right.
Joel Tirado 16:36
Right. Yeah. Is there? Is there an enduring trauma to being shot? You know, can you see those effects still 20 years later? Yeah. You know, the question that I have is, why are these findings important? I think there’s probably a better way to ask this question. You know, it’s, it’s like, well, it’s people’s lives. It’s gun violence in America, and the likelihood that a person is thinking about taking their own life. So, you know, it’s obviously important in that way, it’s building our knowledge about the connection between gun violence, exposure and suicide. But can you go beyond that and saying why these findings are important?
Daniel Semenza 17:26
Absolutely. The financials are important, you know, because I think they matter. And it’s kind of self evident ways that you just described, it’s important to understand how exposure to violence actually might increase this risk for for self directed buttons that there is this potential relationship between people hurting one another and people hurting themselves. And I think what that does is it really questions the narrative with a focus just on homicides, or just on numbers of shooting going up, going down. And when they go down, we feel better. And we pat ourselves on the back and we say, okay, something is being done. And, you know, we’re addressing gun violence, that narrative is happening a lot right now. In that in a lot of major cities, we saw in 2023, that homicides went down. And and that is extremely good. Importantly, less people are dying, as a result of gun violence, and less people are getting shot. But the numbers are still exorbitantly high compared to pretty much any other country that’s like us and all throughout the rest of the world. And you’ve been your homicide is still the many that are likely having all of these ripple effects that have not really been classified. So what I think this paper helps to do is really give a reality check that when we talk about gun violence, the stakes are a lot broader, and they’re a lot higher than we often give it credit for. And, and they’re already very high. And they’re already very broad when we’ve just talked about homicide and non fatal shootings. But it often feels to me somebody who’s doing this work on a regular day to day basis. But there just is not enough urgency that that that the goalposts we need to set farther, really reducing shootings and really improving and really changing policy to the point where we can get to a more sane level of violence compared to a lot of other countries. And we need some of this research to snap us back to reality and help us understand the true state. So to me, that is why I see characterizing this across many different health outcomes, including what we talked about today as being so
Joel Tirado 19:49
right, instead of getting stuck on that big number of annual deaths from firearms, recognizing that the impact of firearms is Much more pervasive and having that be part of our, our media conversations and our conversations with policymakers. Which leads me to the next thing I wanted to ask you about these findings in this research more generally on gun violence exposure. How can policymakers use this research in their efforts to both reduce firearm involved violence broadly? And then also specifically, firearm suicides? And then I’m violating the fundamental do not do of asking multipart questions, but maybe, maybe I think you’re you’re adept enough to handle that. So that’s it onto you?
Daniel Semenza 20:57
Well see, let’s let’s not let’s not pat myself on the back for being in depth of anything until we get an answer. But yeah, I definitely have some thoughts on it. So you know, one thing I think that is an important implication of this study, is that often when we talk about homicide and suicide, we talk about it as a black and a white problem. And they are right that when we talk about homicide, predominantly an issue for black Americans living in cities, particularly on the coasts, and that suicide is a problem reserved, particularly about older white men who are most likely to die by suicide, especially when it comes to firearms, and often much more rural places in the center of the country. And never the twain shall meet, as you know, and these are separate problems that have separate intervention. And we we have literally separate academics and whole academic fields that work on this stuff. And this paper, you know, was written by me who’s criminologist, and then three people who work predominantly in the field of suicide ology, right. And so we realized that there’s much greater overlap, and then people don’t get attention for and Jasmine Brooke, Steven, sort of on the paper, she she often talks about, and focuses on this issue that suicide among black Americans like this is a very real concerning problem. And Suicide is not just a white problem, not just a problem of a border for all men in the United States. And so I think one major implication from a policy standpoint is that we really need to be talking about these things together, especially given the concern, a statistic that you brought up at the beginning, which is that for the first time ever, black firearm suicide rates amongst teenagers, Eclipse white breaks for the first time ever. And so this tells me, you know, from a few different data points, and at this study being one of them, that that they are not separate, and that the relationship between self directed violence and interpersonal violence could potentially be closer than we’ve really given credit for. And so policy wide, I think, again, this raises the stakes and the importance of primary prevention, right. And that means out of state by state level, really thinking about what are the ways that we can use gun laws to reduce shoot, right, because if they had implications for self directed departments, well, people being exposed, then that adds additional weight to the importance of these laws. But I also recognize that, you know, gun laws are not the end all to beyond in terms of reducing shooting. So this also means to me that there needs to be ongoing work. And this work is happening on continuing to improve the interventions like community violence, you know, interrupter based intervention and where people are on the streets trying to use shooting focus utterance interventions that involve the police and community members, and a hospital based program. So all of these different arms of violence reduction, to be more inclusive of people that are not just the ones who are doing the shooting were being shot. Also the family members, also the people who live in local communities that are seeing all of this stuff, providing sources with the NBS programs that we’ve already established, to say, hey, we know that these implications are much broader that these ripple effects are hitting a lot more people, right that is meaningfully influencing their health and well being and really to make sure that we are including them in a lot of the services that are provided and the outreach that it’s done, especially in the communities that are going to be hardest with because right now our focus is understandably more myopic. And really to expand that out, if we’re going to a Get Out hold on producing, shooting, but also reducing the collateral damage that stems from these rates of shootings in that first place. I
Joel Tirado 25:20
think that’s a really encouraging message in there that gun laws are not the only way to address these issues that this, you know, that this research brings to the forefront. And there are, there’s existing infrastructure that can be used. So policymakers have multiple avenues for working to address these problems. So that’s, I would say, that’s an encouraging note in a conversation about some, you know, pretty heavy stuff that, you know, we can move forward across multiple areas. Yeah,
Daniel Semenza 26:09
it’s, I mean, optimism is my default setting. And that can be a little challenging, sometimes doing all this work. But I think that optimism really has to be the way to operate, otherwise, it gets really hard to persist. And it can be discouraging to if you think that improving gun laws and, you know, closing background check loopholes and reducing guns in public through concealed carry licenses, like all this stuff, is really hard to change. Because states have control over that, right. And it states aren’t going to change that in certain parts of the country, then you’re going to continue to see that not really shift, but violence, intervention, focused deterrence, hospital based programs, those happen, not at the state level, they happen at local levels, they happen by the work of 1000s of people who are working for individual organizations, some of them are connected, but some are not. And there’s some real impact that a lot of these organizations have. And at the same time, gun violence research is moving at a speed faster than it ever has before. There are now 1000s of people are doing this work in a new organization in groups like Rockefeller, and things like that. And so I am optimistic that we can pull many different levels. And it’s not an either or approach to to try to make things better. It needs to be all in. I tried to make all of these changes while everybody’s working in tandem to the same goal. And I’ve seen that happen more so than I have ever seen in the last five years that I’ve been doing this work.
Joel Tirado 27:57
I can’t think of a better way to end the conversation then on that positive note. So Dan, thank you so much.
Daniel Semenza 28:04
Thank you so much for having me.
Joel Tirado 28:11
Thanks again to Dan Semenza, Director of interpersonal violence research at Rutgers University’s Gun Violence Research Center for helping us understand the findings and significance of this new research. A link to the study discussed in this episode is available in the episode description. Special thanks to Regional Gun Violence Research Consortium Executive Director Jaclyn Schildkraut for her help coordinating this conversation.
Joel Tirado 28:45
Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York state and the nation. Learn more at rockinst.org or by following RockefellerInst. That’s i n s t on social media. Have a question, comment, or idea? Email us at [email protected].
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