For decades, the biggest threat kids faced growing up came from the automobiles they happily hopped into every day for a trip to school, the store or soccer practice.
Now, it's gunfire.
As the country mourns its latest school shooting victims in Uvalde, Texas, it also has reached a grim milestone: Guns now kill more kids and teens in the U.S. than auto accidents do.
The trend has been building in recent years as automobile deaths have fallen with improved safety measures, while gun violence among the young has taken a growing toll. Figures from the Centers for Disease Control and Prevention show that in 2020, the most recent year available, firearms passed motor vehicles as the leading killer of those ages 1-19.
"It was clear to me that it was just a matter of time," said Dr. Lois Lee, a pediatric emergency medicine physician at Boston Children's Hospital and an associate professor of pediatrics and emergency medicine at Harvard Medical School who has been studying the trend. "I just didn't think it would occur so quickly."
What's spurred the violence? Experts point to many causes — the frustrations of entrenched poverty and discrimination, glorification of gun violence in popular culture and entertainment, and too-easy youth access to guns in many states like Texas — all kicked into overdrive by the stresses of the COVID-19 pandemic.
"We live in a society right now where gun violence is becoming increasingly tolerated," said Rutgers University-Newark psychology professor Paul Boxer. "What I've seen locally, personally, it's a lot of anxiety and depression."
But Boxer cautioned the factors behind the rising youth gun violence are as varied as the patchwork of gun laws and socio-economic circumstances across a politically divided country.
In a New England Journal of Medicine paper published last month, Lee noted that firearms overtook automobiles as the leading killer among those ages 1-24 in 2017, as gun violence became deadlier among older teens and young adults.
For children and adolescents aged 1-17, motor vehicles remain the top killer, the CDC figures show, though guns are closing in.
Motor vehicle deaths among youth ages 1-19 fell from 7,885 in 2002 to 3,512 in 2019 before ticking up to 3,913 in 2020. U.S. gun deaths among kids and teens had hovered around 3,000 annually since 2000, reaching a low of 2,450 in 2013. But they have risen since, spiking to 4,357 in 2020.
"I don't really understand what happened or why we're starting to see that inflection point in 2014," said Lee, who notes in a May 26 article in The Lancet Child & Adolescent Health that while motor vehicle fatalities of youth younger than 20 have fallen 51% since 2000, firearm deaths have risen 83% since 2013.
Dr. Garen Wintemute, director of the UC Davis' Violence Prevention Research Program, said that among those ages 15-24, "the year-over-year relative increase in homicide from 2019 to 2020 was the largest by far that we've seen in 100 years of record-keeping." What caused that, he said is "is what happened to the entire population."
"What else happened in 2020? The COVID pandemic, with all the disruption it brought, and the beginning of an unprecedented surge in firearm purchasing that continues to the present," Wintemute said.
A recent CDC report noted a 35% increase in gun homicides overall in all age groups from 2019 to 2020.
But the national trend is uneven across the states. California — known for its car culture and the nation's most extensive gun laws — is among 21 states where deaths of kids and teens from motor vehicles is higher than from guns. So are Florida, scene of one of the deadliest school shootings at Parkland in 2018, and Connecticut, where the deadliest mass shooting at an elementary school occurred in Newtown in 2012.
All three of those states have tougher gun laws than Texas, where an 18-year-old gunman killed 19 school children and two teachers at an elementary school on Tuesday. The Lone Star State is among those states where guns top cars as the leading killer of kids and teens. Others include Pennsylvania, Ohio and Illinois.
The increase in firearm deaths is largely due to a rise in homicides, Lee said, which account for nearly 60% of the firearm deaths among young people since 2010.
Wintemute noted that there has been a "gradual increase" in suicides among the young that also jumped in 2020, but not as much as homicides.
Both guns and motor vehicles were deadlier in 2020 for boys than for girls, who were killed more than twice as often by cars as by guns.
The figures also showed firearm deaths were higher than those from automobiles in 2020 for Black, Asian and Pacific Islander youths. White youths had higher total firearm deaths, but their automobile deaths were higher still.
Reversing the trend in gun deaths is more complex than it is with automobiles — most automobile deaths are accidents, most gun deaths intentional, and there's no constitutional right to a car. But Lee said an approach similar to that taken with automobiles would still yield results.
For cars, the government established a federal agency, the National Highway Safety Administration, solely focused on reducing motor vehicle deaths. The government funded research to find ways to make the roads safer, from seat belts and airbags to speed limits, driver licensing and tougher drunken-driving laws.
Lee said stricter gun regulations in states like California have been shown to reduce death rates. But she said better research could yield insights into what's driving more young people to commit murder. She noted there's no government agency tasked with reducing gun deaths, and research funding has been limited, though $25 million was approved in 2020 and the current administration is proposing $60 million.
"We need more research funding," she said, "because there's so much we don't know about the causes of gun violence as well as methods to prevent firearm injuries and deaths."
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