Solutions for reducing gun violence should be expanded, says University of Washington-led report

A new report in the Journal of the American Medical Association lays out a range of evidence-based initiatives to reduce firearms deaths in the U.S. by 2040. The article comes out of a large interdisciplinary conference earlier this year that was chaired by researcher Fred Rivara, a pediatrics professor at the University of Washington’s Medical School. He says professionals in the fields of public health, criminology, public policy and gun manufacturing discussed what has worked all over the country to bring gun deaths down. He says the idea was not to do away with guns or the Second Amendment, but to encourage the wider implementation of policies that have already been proven effective — and use emerging technologies — to reduce deaths.

Rivara joins us to tell us more about the research into gun violence as a public health crisis, and what he hopes policymakers and the general public take from it.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. A new report in the Journal of the American Medical Association lays out a range of evidence-based initiatives to reduce gun deaths in the U.S. by 2040. The article came out of a large conference earlier this year that was chaired by Fred Rivara, a researcher and pediatrics professor at the University of Washington’s Medical School. It brought together public health officials, criminologists, public policy experts and gun manufacturers. Rivara says the idea was not to do away with guns in the U.S. or the Second Amendment, but to push for the wider implementation of policies that have already been proven effective and to encourage the use of emerging technologies to reduce gun deaths.

Fred Rivara joins us now. It’s great to have you on the show.

Fred Rivara: Thank you very much for having me.

Miller: I want to take the five broad recommendations put out in this JAMA article one by one. The first is to focus on communities and change fundamental structures that lead to firearm harms. What are those fundamental structures?

Rivara: We have to realize that firearm harms doesn’t happen to a random sample of the population. It happens to individuals, particularly in areas that have been resource poor for many years. It happens to individuals who are often minority groups in low socioeconomic areas, and we really need to think about a broader solution to this issue.

We also have to think about how we can do this in a way that respects those individuals in those areas, at the same time respecting the fact that we have a Second Amendment in the United States which is not going to change. We have 400 million firearms in private hands in the United States and that also is not going to change. So it’s really trying to step back and think about, given those issues, given where violence is occurring, how can we really make an impact?

Violence happens in our society as it happens in most societies. However, what’s different about our society is the presence of firearms. As I said, we have 400 million firearms in the United States and it’s violence plus guns that equals gun violence.

Miller: When you talk about changing the fundamental structure that leads to firearms harms or gun violence, how much are you thinking about addressing poverty – poverty eradication, or at least ameliorating poverty?

Rivara: It’s somewhat about poverty, but I think it’s also more about how we have communities that have been under-resourced for many years and that individuals in those communities oftentimes carry firearms for self-protection, because the communities are in fact unsafe because of various reasons.

We’re not necessarily trying to address the issues of poverty, but how can we help individuals in those communities live more safely, live in a way that they don’t have to resort to carrying firearms for self-protection, live in such a way that they have opportunities that other individuals have now that they have not had traditionally?

Miller: When I read the phrase, “Changing the fundamental structures of society,” I think that seems like a very tall order. So what are the pieces there that you see as most feasible in 15 years?

Rivara: Again, it’s not necessarily trying to tinker with the laws, although we can talk about the laws and they do make a difference. I think it’s really trying … what’s been happening right now with these community intervention programs. These programs have been very successful in a number of communities. They’ve been successful in Baltimore, where firearm deaths have decreased by 40% over the last few years, and it really is a combination of violence interruption. It really is identifying those at greatest risk, offering them counseling, offering them job training, offering them substance abuse counseling and really trying to address those at greatest risk.

Miller: The second set of recommendations is focused on technology and there are a couple of different kinds of technology that have been mentioned. One of them is a biometric personally authorized gun. What does that mean?

Rivara: Some people would label this as a “smart gun” or a “smart firearm.” It’s a firearm that is built in such a way that can only be used by an individual that owns the firearm. Whether it be that there’s biometrics built into the firearm, whether it be fingerprints or whether it be a device that recognizes your face, but in such a way that it can’t be shot by, say, your 15-year-old son who picks it up. They can’t shoot it. It can only be shot by individuals who are authorized and who the gun has been programmed to recognize as an authorized user of the firearm. So that’s an important thing.

This is, I think, a promising technology. It’s not going to be something that takes care of all the problems completely, because again, we have millions of firearms out there in the United States and there is no technology right now that can retrofit those firearms, but there is technology that can be used in new firearms that are purchased. We know that in the pandemic, for example, in 2020, there was a peak of firearm purchasing – 40 million firearms were purchased in 2020. If those firearms were smart firearms, that would lower the risk of those individuals who bring those into their home.

You have to remember also that, while we talk about firearm violence, in the United States the majority of firearm deaths are actually suicides, not homicides. Certainly in the state of Oregon, here in the state of Washington, the majority of the deaths are suicides. And smart firearms may be really important in terms of decreasing the risk of somebody, again, your 15-year-old son, picking up your firearm and committing suicide with it.

Miller: I’m glad you mentioned suicide. The numbers that I saw, based on the most recent CDC data, are that about 58% of total firearm fatalities two years ago – that’s the latest year I saw data for – they were suicides. How much did you and your colleagues focus on suicide prevention specifically in your conversations?

Rivara: We focused on it less than we probably should have. We talk a lot about lethal means counseling. We talk about restrictions on who can own firearms and what are the ways of removing firearms from the hands of those who might harm themselves or others. There are things like Extreme Risk Protection Orders which do that, but we probably should have talked more about suicides than we did.

Miller: Going back to technologies, your team also mentioned using artificial intelligence tools that could help identify or prevent risk. What might that look like?

Rivara: There are beginning to be companies now that have been created that have better screening technology for identifying those who carry firearms. It’s a combination of sort of metal detectors with AI that identifies people that might be having activities that might be at risk. It’s that, plus also using AI now in communities. When we think about, there is a lot of use of media among this younger generation, and partly there is, can AI be used to screen that media to identify those who might be at risk of harming themselves or others?

Miller: Your team included, or invited, gun manufacturers to be at the conference. I’m curious what role they played there?

Rivara: There was one manufacturer there and he has a company that has produced a smart gun. He was there to really talk about what’s the potential of these smart firearms and how these might be used to decrease, particularly, suicide deaths. It was really trying to have an open conversation with him as a representative of the firearm industry. We didn’t include other manufacturers that didn’t have smart guns.

Miller: Before we hear more about the specific recommendations, I’m just curious … You are a pediatrician. In your own clinical practice, have your patients been affected by gun violence?

Rivara: For sure. I work at Harborview Medical Center, which is a regional pediatric and adult trauma center. We see, unfortunately, individuals that are brought here to our hospital that have been the victims of firearm violence. Some suicide attempts, although most people who try to commit suicide with a firearm die at the scene of the injury, but a lot of assault victims as well.

Miller: Let’s turn back to the recommendations. The third –

Rivara: Let me just mention one other thing, which is that children are also victims when there’s a shooting in their family. If a parent is shot – not even killed but shot – that’s certainly going to affect the kids in the family as well, and we certainly see that effect on kids. We also see kids now in the community having to do lockdowns at school. Whether they be lockdown drills – and something like 90% of kids in the United States have been in a lockdown drill – but there’s also a large proportion that have actually been in a lockdown. So there are many, many ways that firearms affect kids.

Miller: The third part of the broad bucket of recommendations is to “change the narrative around firearm harms.” What is the current narrative?

Rivara: The current narrative by a large majority of people is that firearms are protective of people living in the home and that you may need a firearm to keep your family safe. For example, with suicide, people that are going to intend to kill themselves are going to kill themselves regardless of whether or not they have a firearm. If you take away the firearm, they’re going to kill themselves in another way. We really want to do away with those kinds of myths.

Right now, people feel like crime is a bit of a problem in the United States, when actually crime is down, despite what you hear from the Trump administration. You’re out of Portland, and in Portland itself there’s been a 23% reduction in firearm homicides from 2020 to 2024. Here in Seattle, there’s been a 49% reduction in homicides in the last year. In Baltimore, there’s been a 40% reduction in homicides. So in fact, in our society, right now, in this time, crime is actually down. That need to have a firearm for personal protection is actually much less than you might think it is.

The other thing is that many studies have shown that if you have a firearm in the home, that you’re much more likely to have somebody in the home that is shot either through suicide or homicide than shooting an intruder – on the order of 40 or 50 to 1.

Miller: I should say that we, absolutely on this show, have talked about those crime statistics when they went up and then more recently when they have gone way down. We’ve talked about various interventions and interrupters, people who map out social networks and will go and talk to people who are at risk of becoming victims or perpetrators of gun violence. We’ve had those conversations over the years. But we’re just one show. We’ve got some folks who listen to us, some folks who don’t.

I’m curious what your policy prescription or theory of change is here for how you actually spread the message that you want to spread?

Rivara: It’s difficult, because firearms are relatively easy to obtain. But I think that me, as a pediatrician, what I do is I talk with families about having a firearm in the home. And not necessarily say, “You shouldn’t have a firearm in the home,” but to make sure it’s safely locked up and give them some information about that the real risk of having a firearm at home is more to your children and other people in the home than to your ability to shoot an intruder.

So having a loaded fire in the bedside table at night is really very dangerous for the people in your home, and it’s going to be much more dangerous for them than the idea of an intruder coming in and harming your family.

Miller: To get back to the list of recommendations, the fourth one is to take a “whole government and whole society” approach. You had said earlier that you’re not looking to get rid of the Second Amendment and you’re not really looking to get rid of the 400 million civilian-owned guns right now. But what are the actual policy changes, new laws that you would like to see?

Rivara: We have 50 states and each of the states has their own laws related to firearms. There are federal laws as well. Those have really not changed a whole lot in the last 40 years, but there’s been a lot of action at the state level.

You can divide these state laws into laws that are generally restrictive of who can own a firearm and states that have permissive laws that allow few restrictions on who can own a firearm. What that is translated into is that states that are more restrictive on who can own a firearm have fewer firearms in homes and they have fewer firearm deaths – homicides and suicides.

If you look at states like Hawaii, Massachusetts, Rhode Island, which have more restrictive firearm laws, they have much lower firearm ownership and much lower firearm homicides and suicides than states like Mississippi, Alabama, Louisiana, Georgia and Texas, which have more permissive ownership of firearms. We have this natural experiment across the country in these 50 states, and I think states can learn from one another about what works and what doesn’t.

The other thing is that President Biden started the White House Office of Gun Violence Prevention in September of 2023. Unfortunately, it was closed by President Trump on January 21, 2025. This was a group of individuals that really started looking at community violence intervention programs, getting information out to communities, helping communities to tackle the firearm problem. We really need to think about, how can we use leaders throughout our community and in our government to take an approach that’s really going to reduce firearm deaths?

When I say restrictive, I’m not talking about restricting Second Amendment rights. It’s really restricting access to those who might use the firearms to harm themselves or others. A good example of this would be red flag laws or so-called Extreme Risk Protection Orders. Red flag laws are laws that allow a family to go to a judge and say, “My son, my husband, my father has a firearm, but he also is having a mental health crisis right now, and I’m worried he’s going to harm himself or others.” Then that judge can review the case and ask for the guns to be removed for up to a year. Those laws have been shown to be effective in reducing mass shootings and reducing firearm suicides. It’s really not the idea you’re taking away somebody’s rights, but you’re allowing individuals to remove firearms from those individuals who are going to harm themselves or others, on a temporary basis.

Miller: Three years ago, the U.S. Supreme Court found that gun laws have to be in line with our nation’s history and tradition. What effect has that ruling had?

Rivara: Well, it’s been a mixed effect. That was a New Yorker case and it really seemed to be less restrictive on who can own a firearm. But on the other hand, last year the Supreme Court held a Rahimi Case, which was a case where somebody that was a domestic violence abuser wanted to regain his right to own a firearm. The Supreme Court upheld the law and did not change it, that again prevented that individual from owning firearms.

So it’s been sort of mixed. I know there are other cases to be coming up with the Supreme Court this year, and we’re waiting to see. But again, most of these state laws have been held to be constitutional and they have been effective.

Miller: The last piece in the strategy that you and this coalition put together is to “spark a research revolution on preventing firearm harms.” Can you get federal funding for firearm harm prevention?

Rivara: The answer is yes. Now, we did some studies back in the late ‘80s with money that came to us from the CDC, federal money, and we did some studies that showed having a firearm in your home increased the risk of homicide and suicide compared to homes that didn’t have firearms. The NRA and other firearm rights groups didn’t like this, and they successfully lobbied Congress to pass something called the Dickey Amendment. Jay Dickey was a House of Representatives Congressman, and starting in 1996 until just really about four years ago, there was no federal funding for firearm research. It had a really long tail there to its effect.

Then under President Obama, and then followed by President Biden, those restrictions have been lifted, and there is now money for firearm research. Even now with the Trump Administration, there is still money for firearm research. As a result of this, the number of individuals who are involved with firearms research has blossomed from a handful of maybe 10 or 20 to now hundreds of individuals.

I’m going to be going to Arizona next week and we have a Research Society for Firearm Violence Prevention and we expect there’ll be 600 or 700 people there doing firearm research. So the research is going on. The research is really important because it tells us which of these state laws are effective, which state laws aren’t effective, how can we better implement these programs that will prevent firearm violence? How can we better implement the community violence intervention programs that reduce firearm violence?

Miller: Fred Rivara, thanks very much.

Rivara: Thank you very much, Dave, for having me on your show.

Miller: Fred Rivara is a researcher and a pediatrics professor at the University of Washington’s Medical School.

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