Diverse Perspectives, Common Goals

Over the past two decades as a physician, Rebecca Cunningham has treated countless individuals who have entered emergency rooms in Ann Arbor and Flint. As a researcher, she has been working with groups from across the University of Michigan and beyond to generate new knowledge and advance innovative solutions that reduce firearm injuries and deaths. We recently spoke with Dr. Cunningham, the vice president for research at U-M, to learn more about the impact and importance of firearm injury prevention research and scholarship.

Recent mass shootings in Oxford, Michigan, Buffalo, New York and Uvalde, Texas have sparked increased debate around firearms. Is firearm violence increasing in the United States? 

Yes, unfortunately firearm violence is growing more and more intense every year.

The latest numbers from the Centers for Disease Control and Prevention reveal that more than 45,000 people across the U.S. died as the result of firearms in 2020 – 1,454 of which were reported in Michigan. That marks a 14 percent increase from 2019. A deeper dive into the federal data shows that this national increase was driven largely by firearm homicide, which jumped more than 35 percent from 2019 to 2020.

And in partnership with my colleagues Jason Goldstick and Patrick Carter from the U-M Institute for Firearm Injury Prevention, we recently discovered that firearms have now surpassed motor vehicles as the leading cause of death among children and teens in the U.S. More than 4,300 individuals ages 1 to 19 across the U.S. died as the result of firearms in 2020, and that figure includes suicides, homicides and unintentional deaths.

What role can research and scholarship play as it relates to firearm violence?

If we truly want to address this crisis, research and scholarship are absolutely essential. When you start to think about some of the most serious challenges facing our society, our nation has often turned to scientific evidence to prevent injuries.

Michigan is the historic heart of America’s automotive industry, so we can look at motor vehicles as an example. Back in the 1960s, there was public outrage around motor vehicle injuries and deaths. That outrage led to the creation of the National Highway Traffic Safety Administration and the National Center for Injury Prevention and Control, along with a multifaceted, rigorous scientific approach to reducing these injuries that included behavioral, technological and policy interventions.

As a result, we saw a 76% decline in motor vehicle deaths between 1969 and 2017, all while the number of cars and number of miles driven in the U.S. increased – and despite the fact that car manufacturers initially resisted increased safety measures out of concern that consumers would not pay for or utilize these new safety features. This example really illustrates that the science of injury prevention can decrease the burden of injury, and we have an opportunity now to generate a similar impact for reducing firearm deaths through the application of rigorous injury prevention science.

As the country scrambles to find solutions that address this crisis and prevent more children from dying in our schools, we need to scientifically examine these programs to see what works and what doesn’t. Politicians, doctors and educators have a lot of really great ideas, but we have to study those ideas to see if they are having the intended effect or result in unintended consequences.

Research can help our communities find answers to critical questions, like how many Michiganders are dying of firearm violence. What school safety measures actually work? Does school hardening increase the safety of students? How can hospitals and schools identify students that are at risk and are making threats, or are about to become violent and hurt themselves? When laws are passed, like red flag laws or child access prevention laws, do we see a decrease in injury and death? If so, what part of the policy is working, and how are the policies being implemented?

What is being done nationally as it relates to firearm-related research?

The field of firearm injury prevention research is really in its infancy, as intense polarization around this issue has resulted in limited high-quality science, minimal research funding and a dearth of academic scholars.

To put that into context, Dr. Patrick Carter and I partnered with our colleagues at Brown University a couple years ago on a study, and what we found is that, on a per-death basis, funding for pediatric firearm research is 30 times lower than it would have to be to keep pace with research on other child health threats, like motor vehicle crashes and cancer. This was a stark demonstration of the lack of support for research that could help reduce the chances that children will be hurt or killed by firearms.

I am cautiously optimistic, but we are starting to see some momentum in this space. More graduate students and postdocs are beginning to pursue firearm injury prevention work as their primary field of research. And federal agencies are starting to fund more of this research, which is exactly what we need in order to develop and implement solutions.

There is still a long way to go as it relates to generating the type of funding necessary to support this important work, but I can assure you this will remain one of our key focus areas moving forward.

How is the University of Michigan approaching this particular field of research?

As the nation’s largest public research university, we are uniquely positioned to address this crisis for a variety of reasons. For starters, our researchers have secured more federal funding to study firearm injury prevention than any other academic institution nationwide.

We also have vast research expertise across disciplines, and this is truly beneficial because our teams then can explore firearm injuries across the lifespan. That includes everything from suicide, community and school-based violence, domestic violence, peer violence and police violence, as well as disparities in susceptibility to firearm injuries by race, gender, geographic location and socioeconomic status.

Last June, U-M solidified its support toward addressing this crisis by committing $10 million over the next five years to launch the Institute for Firearm Injury Prevention. Led by Professors Marc Zimmerman and Patrick Carter, the institute is able to engage the breadth of expertise across U-M, with input from nonacademic stakeholders, to generate knowledge and advance solutions that will decrease firearm injury across the U.S.

And the mission of the institute aligns nicely with our overall mission here at U-M, which is to serve the people of Michigan and the world. Over the past decade, more Michigan residents have died as a result of firearms than from opioids. As a public research university, we have an obligation to use our expertise and relationships to find solutions to the most pressing challenges facing our communities. Firearms should be no different.

What are some of the ways in which U-M researchers are addressing this crisis at home?

From the Upper Peninsula to urban Michigan communities, there are a number of really incredible researchers here at Michigan who are working to identify solutions and promote firearm safety across our state.

For example, Professor Cynthia Ewell Foster is working with groups from across the U.P. to develop and implement a new firearm safety education program that is tailored for families living in rural communities. Her research and engagement efforts inspired Store Safely, a four-step online program that provides tools and resources so that families can help prevent injuries and firearm misuse among children and teens.

Professor Patrick Carter, who is co-director of the Institute for Firearm Injury Prevention, is studying whether a behavioral intervention program can reduce risky firearm behavior and violence among urban youth who seek emergency care. Professor Marc Zimmerman also is a co-director of the institute, focuses a lot of his work on the “busy streets” theory, which is the idea that improving the physical environment in a neighborhood not only promotes physical safety, but also inspires empowerment and a sense of connection between neighbors.

Professor Lisa Wexler is developing a suicide prevention approach to encourage safe firearm storage in homes across rural and remote Alaska with Alaskan Natives, which has suicide rates far above national averages. And Professor Jason Goldstick is exploring whether machine learning can assess young people’s risk for firearm violence so that prevention resources and emergency interventions work effectively.

Michigan has incredible expertise in this space, and we will continue to use our collective knowledge to create safer and more vibrant communities nationwide.