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As an economist, I pay attention to trends. Some are hard to see, and some are obvious.

One trend that’s impossible to miss is the uptick of gun violence in the U.S. Between 2019 and 2020, firearm homicides went up by 34 percent and reached their highest level in more than 25 years.

One especially visible form of gun violence is school shootings. They’re still rare events, but they’re on the rise — the 2020 to 2021 school year saw the greatest number of shootings with casualties since reliable record-keeping began.

LEVINE: 2020 was a phenomenal year in terms of gun sales.

That’s Phil Levine. He’s a professor of economics at Wellesley College, and a lot of his research focuses on the causes and consequences of gun violence. We’ll hear from him today about the link between school shootings and gun sales, and the tough bind it creates for gun-control advocates because school shootings don’t happen in a vacuum.

ROSSIN-SLATER: Gun violence has so many more consequences than just the direct victims.

And that’s Stanford economist Maya Rossin-Slater, who studies the effects of school shootings on kids. Later, she’ll tell us about the indirect victims of gun violence — and what these tragedies are really costing us.

From the Freakonomics Radio Network, this is Freakonomics, M.D. I’m Bapu Jena. I’m an economist and I’m also a medical doctor. Each episode, I dissect an interesting question at the sweet spot between health and economics. Today: The hidden consequences of school shootings.

Mass school shootings like the tragedy in Uvalde, Texas, and earlier ones in Sandy Hook and Parkland, receive a lot of attention. In their aftermath, we’re shocked and angry. Media coverage often lasts weeks or months.

Advocates of gun control hope that coverage will spur change. Sometimes it does, but other times, the effects aren’t what anyone expected. Including people who study these events, like Phil Levine.

LEVINE: One of the things that we noticed when we started thinking about the Sandy Hook school shooting, is the extent to which gun sales skyrocketed in the months afterwards. So, Sandy Hook was in December of 2012. There was an enormous spike in gun sales from the period of December, right after the school shooting, through early April of 2013. And we can identify the timing of it almost perfectly to the political discussions that were taking place at that time. Those discussions ended up being unsuccessful. They did not lead to any new legislation. When they ended, gun sales returned to normal. What we were interested in what is the impact of having 3 million additional guns, purchased in a relatively short period of time. And it turns out that there is a very large spike in accidental gun deaths that lines up perfectly with the surge in gun sales, which unfortunately led to the deaths of essentially the same number of children through these subsequent deaths as occurred in the Sandy Hook shooting itself. Just because there are more guns out there, someone accidentally picked it up and a bad thing happened.

JENA: Does your research then suggest that perhaps keeping these high-profile shootings in the news for a long time, again, with the goal of raising awareness, might actually lead to more gun sales, so maybe it’s more harmful than it is good, or at least that there’s a trade off?

LEVINE: So, I think there’s a trade off, but I also think, for instance, in the most recent, school shooting in Texas, in Uvalde, there was almost no spike in gun sales. We had a little political discussion about gun control legislation that wasn’t terribly controversial. And so, not surprisingly that didn’t generate any gun sales spike, or nothing to speak of at least. What seems to matter is when people feel like they’re at personal risk for one reason or another, gun sales just skyrocket.

JENA: Do you think this phenomenon is generalizable? This is not just a Sandy Hook phenomenon. This could be a Parkland phenomenon. It could be related to things other than school shootings where people feel like the likelihood that they’ll be able to access firearms is going to be limited.

LEVINE: So, for instance, in Parkland, the likelihood of gun control legislation was not very great given the political environment in which we were living in 2018. But if you’ll recall, the students, at Parkland were extremely vocal and extremely successful in keeping the message in the public eye. That actually led to a spike in gun sales. What matters in terms of these spikes is, is there something happening in the world that’s generating a tremendous amount of uncertainty?

And the prime example of that was COVID. 2020 was a phenomenal year in terms of gun sales. The COVID pandemic hit in March of 2020, gun sales skyrocketed, the end of May, beginning of June, you get George Floyd and the racial unrest that resulted from that led to, again, a very large spike in gun sales. 2020 was sort of for the gun industry, you know, the perfect storm for them. I mean, gun sales, just, massively increased. And actually, that spike kind of lasted into 2021 as well, it’s really sort of ridden the wave with COVID.

JENA: One of the political talking points about guns is sort of this question of whether or not more guns lead to more crime or more guns lead to less crime. When I read your Sandy Hook study, I thought to myself, all right, well, this is sort of an example where you exogenously have more guns infused into the environment. I don’t recall if you looked at crime specifically, but you certainly find injuries.

LEVINE: From an economic perspective, you can think about the world almost with two equilibriums. In one equilibrium nobody has a gun, and so there would be no gun-related crime. in another world, everybody has a gun and the risk of damage that would occur, if anyone tried to use the gun — because there would be tit for tat — would lead to no crime. The problem is we live in a world in the middle. And so, what happens in the middle if we have a few more guns or a few less guns is not theoretically clear. So, figuring out what’s the impact in a world where we’re in the middle of fewer or more guns is very hard.

JENA: I’m curious as to whether or not you perceive gun violence to be a health issue as well?

LEVINE: I definitely think it’s a health issue. If we have goals of protecting public health, and people are being injured and dying through the use of guns, that’s a public health issue. And figuring out ways how we can reduce that is something that we need to think carefully about.

JENA: What are the things that schools have tried to do in light of school shootings and any evidence that they work and any indication that they might not work or kind of pose unintended consequences?

LEVINE: So, I think in many instances, a school shooting occurs and then there’s sort of a knee jerk response where we feel like we have to do something. And that includes reconstructing school entryways to make sure that it’s difficult, if not impossible, to enter the school if your entry hasn’t been approved. Active shooter drills. All these things are very expensive. All of these things have not such strong proven track records of being effective. And it’s possible that one of the things that they do do is take away money from things that we can be doing to, for instance, provide greater psychological assistance to the kids who were exposed, where we know there was direct harm done to those children. I think of Uvalde was a perfect example of the training, the school construction. All of the things that we think we’re doing, trying to help our children didn’t seem like they were all that effective in that particular instance.

JENA: But there are measurable ways in which the school shootings affect the psychological health, the physical health, educational outcomes, all of those Areas where investing would make more sense.

LEVINE: And maybe we should be focusing more on that.

JENA: People will sometimes talk about federal policies that have kind of constrained the amount of funding that can go towards gun-related research. Is the problem that we have with guns an issue of lack of research? What is it that we don’t know that we need answers to from a research perspective?

LEVINE: I think as an economist, we answer questions for potentially different reasons. One of them is because there’s things that we might expect to happen that other people wouldn’t expect to happen because we think about the world a little bit differently and that’s important and valuable. On the other hand, I think some of the things that we study isn’t so much that we’re surprised by the results. We’re kind of expecting the results. But A, documenting the fact that these things are occurring and B, quantifying the extent of damage that’s occurring is also something that we have the ability to do. In what ways does it show up? What’s the magnitude of the effect? Those are things that we don’t necessarily know off the tops of our heads. The big picture question I think that we are trying to address is what impact do school shootings have on the kids who were exposed to the shootings, who obviously weren’t the victims themselves.

It’s a critical question, and in some of his other work, Phil has tried to answer it. My next guest has too. Coming up: how does surviving a school shooting shape your life?

ROSSIN-SLATER: We really wanted to understand the impact of any type of gun violence. Basically, anytime a gun goes off at a school setting during school hours — what happens?

I’m Bapu Jena, and this is Freakonomics, MD.

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A report published this past June by the National Center for Education Statistics found that during the 2020 to 2021 school year, there were 93 school shootings with casualties, which means someone was injured or killed. It’s the highest number in two decades. There were also 53 reported school shootings with no injuries.

ROSSIN-SLATER: Just because a shooting is non-fatal doesn’t mean that it doesn’t have consequences.

Maya Rossin-Slater is an economist and professor of health policy at Stanford University. Her research has mostly focused on early childhood. She’s studied the long-term impacts of childhood exposure to pollution, and how attending preschool can influence a young child’s education and earnings as they get older, and even their life expectancy. But recently, Maya has been thinking more about later childhood, what we call adolescence, and she’s started to notice a certain, very dangerous elephant in the room.

ROSSIN-SLATER: It is impossible to ignore the big issue in this country, which is gun violence. And so, that’s what led me to studying the impacts of shootings at schools on youth in the United States.

JENA: Why are schools especially bad places for shootings to occur?

ROSSIN-SLATER: So, first, there’s all kinds of ways in which kids’ learning might be disrupted, right? You have to shut down the school for a while. Or the teachers have to take some time off or maybe there’s going to be more teacher turnover. The other thing is you have sort of this peer-effect amplification. So, you have one child that experiences let’s say violence in their community and they come to school. and maybe they’re going to be more disruptive. But now, if the shooting takes place in the school setting, then you have all of these kids that experience some kind of trauma that it gets amplified. And then there’s this idea that schools are supposed to be these safe places where kids can come and kids learn and kids have friends. And you kind of shake that trust, in what a school is and so it’s sort of a particularly kind of traumatic place — potentially — to have gun violence.

JENA: I’ve followed your work for a long time, and I’ve had a lot of interest in the work that you’ve done on gun violence, and you’ve done a couple of really important and creative studies on the issue. Maybe you could start by telling me about your work on the mental-health consequences of school shootings.

ROSSIN-SLATER: You know, mental health is notoriously hard to measure and hard to study. However, I ended up, teaming up with several other use this big, prescription-drug database from 2008 to 2013. And we ended up studying 44 shootings. And we looked at what happened to prescriptions for antidepressants, for youth under the age of 20 in the five-mile radius around, schools that experienced shootings over this time period. And what we found was that in the aftermath of a shooting that had at least one death. There was a large and persistent increase of over 20 percent in the antidepressant prescription rate for youth under the age of 20. And when I say persistent, it means that it increased and it lasted, it stayed at a heightened level for at least the next three years. So, there’s this elevated and high rate of antidepressant prescription drug use in the local area surrounding the shooting. Kids don’t just go back to normal quickly. It appears that the mental-health impacts last for quite a while.

JENA: But your point actually suggests it is important to quantify the impacts to sort of think about how to allocate resources. So, if you find — as you did — that, there’s a 20 percent increase in antidepressant use at a minimum there’s that much of an increase in depression, and probably other mental health problems, that would speak to the amount of resources that should be dedicated after these sorts of shootings. Did you look at whether or not the impacts of school shootings on antidepressant use varied by sort of the medical climate, the availability of, mental health providers or some measure of support infrastructure in the community?

ROSSIN-SLATER: One of the interesting things that we found was that we saw an increase in antidepressant use everywhere, except in places that have a high rate of mental-health professionals, like psychologists, who cannot prescribe drugs. To us it suggests that in those places, maybe the affected kids are actually benefiting from other types of mental health support, like access to therapy, as opposed to just getting antidepressant prescription drugs.

JENA: School shootings can take on a number of different forms, from many children who were killed, to one child who’s killed, to even the shooting that’s not fatal. Did you break down the analysis according to the types of shootings in terms of the mental health consequences?

ROSSIN-SLATER: At least for the mental health impact, it appeared that severity does matter. and we see the impacts that are concentrated really on the fatal school shootings.

JENA: I don’t think that we’d reached the conclusion that a nonfatal shooting doesn’t have consequences, but do you see an uptick in, antidepressant use after non-fatal shootings at all?

ROSSIN-SLATER: In terms of antidepressant use, we were not able to detect any significant increases following non-fatal shootings. However — and this brings me to our other study where we looked at shootings in the state of Texas and looked at educational and long-term economic outcomes. And there, we really learned that just because a shooting is non-fatal doesn’t mean that it doesn’t have consequences

JENA: So, that that’s probably a good transition to your study with a number of excellent co-authors looking at data from Texas. Could you maybe walk me through the data that you put together, because it’s really an enormous undertaking that you did?

ROSSIN-SLATER: So, we were able to access an amazing database from the state of Texas. It starts with individual-level, public-school records for all kids in Texas public schools, covering from the early 90s to the present day. So, we can follow them over their time in the Texas public-school system and see things like, their absences, and whether they repeat a grade, any disciplinary actions, and all kinds of, sort of demographic information, on them. So, then we linked this data to data on shootings at schools in Texas over this time period.

JENA: And what did you find?

ROSSIN-SLATER: We really wanted to understand the impact of any type of gun violence. Basically, anytime a gun goes off at a school setting, during school hours — what happens? And so, we looked at what happened to the kids who were at these schools at the time of the shooting. We looked at what was going on with them in the two years before the shooting, and then we followed them for two years after. And we compared that to the trajectories of students at very similar schools. In the aftermath of a shooting, we see a much higher rate of absences amongst kids that were at the schools where shootings took place.

And this is really driven by an increase in chronic absenteeism. So, that is, when a child is absent more than 10 percent of the school days in an academic year. We also see a much higher rate of the likelihood of grade repetition. And then in the longer run, what we found was that kids who were exposed to shootings, especially during 10th or 11th grade, they were much less likely to graduate high school. They were much less likely to enroll in a four-year college. They were much less likely to graduate with a bachelor’s degree. And then they had lower employment rates and had lower earnings at ages 24 to 26. And the magnitudes of these effects were not trivial.

JENA: What I liked about this study was the fact that you could look at very long-term outcomes across — not just health but non-health, kind of cognitive, labor-market outcomes as well. Why do you think it’s important to understand the impact of shootings where no one gets hurt? Because those shootings don’t often make it into the news.

ROSSIN-SLATER: Gun violence has so many more consequences than just the direct victims. And in fact, again, in our Texas study, the vast majority of shootings that we study had no deaths. Less than half had one death. We did not have any shootings in our analysis that had more than one death in Texas over this time period. And so— these effects are there even for the shootings that did not have any deaths, and I think that speaks to this question about ways in which we try to address school shootings. And for example, by having drills.

JENA: Yeah, I was going to about that. I can absolutely imagine a shooting drill could be incredibly traumatizing to individuals. Are you going to look at that specific issue? Like whether or not these drills work in any way?

ROSSIN-SLATER: School-shooting drills are tougher to study because there’s no, systematic data on them. So, we’ve actually been going like school district by school district trying to collect some information on how often and when these school shooting drills are taking place. One of the things that we’ve already been seeing is that for example, in the state of Florida, in the aftermath of the Parkland shooting, you just see this really rapid increase in the frequency of school-shooting drills. Our evidence on the shootings that don’t have any, fatalities or even don’t have any injuries, suggest that these drills could actually have their own negative effects on the kids that are going through them.

JENA: One thing that researchers will often say when we’re talking about issues related to gun violence and gun policy is that we need more research. You know, what is it that we don’t know?

ROSSIN-SLATER: We have limited resources that we’re willing to devote to this issue. And if that’s the case, then we really need to identify who needs help the most. Gun violence is much more likely to take place in less-advanced schools, in schools that have more minority kids, and schools that are poor, that have more kids on free or reduced-price lunch, for example. So, those are also the schools that are the most under-resourced that have the fewest school psychologists, and that have the least access to mental-health services. And I think that’s where research is really critical.

JENA: The question that always comes to my mind is how much do these tragedies cost us and society? I mean, the school shootings but most importantly, the vast number of shootings that are not mass shootings and school shootings. They cost society a lot in terms of lost life, lost relationships, lost economic productivity. And yet, the reason that we have so many guns in this country — is because presumably that’s being offset by something else that people value. You know, if something as dramatic as, a school shooting or exposure to a mass shooting, doesn’t change one’s views of the world, a paper in Nature, or Science, or the New England Journal of Medicine won’t do it. So, it makes me wonder, you know, what does it take?

ROSSIN-SLATER: Clearly, whatever it is that we’re doing is not enough. Kids are still suffering. Communities are still suffering. I’ve spent a lot of my career so far focusing on the lasting impacts of various early-childhood factors on people’s life trajectories. But the problem is that if we continue to have violence in our schools, we can really undo a lot of those productive investments that we do for kids in the early-childhood period, by like having these big, adverse shocks in adolescence. And so, kind of understanding, what can we do to buffer against that?

All gun violence has consequences, and as Phil Levine told us, 2020 was quite a year for gun sales. It was also quite a year for staying home. My colleague Pablo Pena and I recently wondered how COVID-related school closures and lockdowns that led kids to spend more time at home, where guns are kept, could have impacted gun death rates among children.

Our findings, which were published this week in JAMA Network Open, suggest that around 730 more children than usual were killed because of gun violence between January of 2020 and December of 2021. To put this number in perspective, it’s almost identical to the amount of COVID-related deaths in kids during that same period. Maybe because kids were home more, and guns in the home aren’t always stored safely. Or maybe because of stress or economic hardship at home due to the pandemic. Or both. We don’t know the exact reasons for the spike, but we do know it’s real.

There’s a lot of research out there on gun violence and almost all of it confirms what we already know: guns are one of the most significant threats to health in the United States. But I’d argue that the missing piece of this puzzle isn’t more studies. Research isn’t terribly valuable when one large, vocal group has already decided that the tradeoff — access to guns — is worth it to them. It’s an uncomfortable reality. Either the science is wrong, and gun violence isn’t a massive public health problem, or the science is correct, and for some people, their rights are worth the tradeoff. They’re worth the tragedies. But it can’t be both. It’s a hard way to end an episode, but to me, the debate about gun violence isn’t a debate about the science. It’s a debate about what people value. And right now, as a country, I don’t think we value human life enough.

Thanks to you all for listening this week and thanks to Phil Levine and Maya Rossin-Slater for joining me on the show and for sharing their work and perspectives. Coming up next week:

More than six million people in the U.S. currently live with Alzheimer’s disease, and that number is expected to more than double by 2050. Effective treatments that could address symptoms or slow disease progression have eluded researchers for over a century.

TARIOT: You know, the time to put out the fire is when it’s on the stove, not when the whole house is on fire.

Many experts, like Dr. Pierre Tariot, now believe intervening before symptoms even start could keep the disease at bay. But are they right? And after decades of disappointing results, is it time to consider new approaches?

TARIOT: There are lots of other shots on goal for the treatment or prevention of Alzheimer’s disease.

That’s all coming up next week on Freakonomics, M.D.

As always, if you have any thoughts about the show, email me at, or leave a review on Apple podcasts or wherever you get your podcasts. It helps new people find the show. Thanks again and talk to you soon.

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Freakonomics, M.D. is part of the Freakonomics Radio Network, which also includes Freakonomics Radio, No Stupid Questions, and People I (Mostly) Admire. All our shows are produced by Stitcher and Renbud Radio. You can find us on Twitter and Instagram at @drbapupod. This episode was produced by Julie Kanfer and mixed by Eleanor Osborne, with help from Jasmin Klinger. We also had help this week from Jacob Clemente. Our staff also includes Neal Carruth, Gabriel Roth, Greg Rippin, Rebecca Lee Douglas, Morgan Levey, Zack Lapinski, Ryan Kelley, Jeremy Johnston, Emma Tyrrell, Lyric Bowditch, Alina Kulman, and Stephen Dubner. Original music composed by Luis Guerra. If you like this show, or any other show in the Freakonomics Radio Network, please recommend it to your family and friends. That’s the best way to support the podcasts you love. As always, thanks for listening.

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LEVINE: As economists, we hope to be able to contribute to that discussion, and when policy X gets implemented, what impact does it have an outcome Y? Uh, that’s what we’re good at

JENA: Yeah, we’re not good at it. We’re great at it, though.

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