The paper, titled “Universal Strategies to End Appeal of Firearms in America,” is in press in the American Journal of Preventive Medicine and is available as a journal pre-print. Romer’s central claim is that existing approaches to firearm violence, which largely target people believed to be at risk of harming themselves or others, remain important but could be complemented by population-level interventions that change how Americans think about guns in the first place. The model for such an approach, he argues, is the sustained campaign against cigarettes, which combined public education about health consequences with measures that curbed the promotion and glamorization of tobacco in popular culture.

Personal protection is now the most commonly cited reason for owning a firearm in the United States, and that framing matters well beyond marketing. It has shaped constitutional law. In New York State Rifle & Pistol Association v. Bruen, the Supreme Court described handguns as the “quintessential self-defense weapon” and used that characterization as part of its justification for extending Second Amendment protection to carrying handguns in public. In Romer’s view, this makes the self-protection narrative a strategic target: if the perception that firearms are a safe and effective means of protecting oneself and others could be challenged with evidence, the consumer appeal that underpins both the market and the jurisprudence might begin to erode.

One concrete target Romer identifies is the portrayal of guns in movies and television. Entertainment, he writes, frequently depicts firearms as reliable tools for subduing adversaries and defending one’s family, and it does so in ways that sanitize the consequences. “Those shows make it seem that it is easy to hit their targets with effects that appear bloodless,” Romer writes in the paper. “A young person viewing these portrayals could easily get the impression that handguns are a simple and effective way to protect oneself.” The concern echoes a well-documented dynamic from tobacco research: when smoking was routinely glamorized on screen, adolescent exposure to those portrayals was associated with increased smoking initiation.

The evidence base for an analogous effect with guns is still developing, but several findings are suggestive. Earlier research by the policy center’s Annenberg Health and Risk Communication Institute found that the rise in firearm use in popular movies and television crime dramas is associated with an increase in firearm homicides, particularly among young people ages 15 to 24. A separate analysis found that the increase in firearm use in popular movies from 2000 to 2021 closely tracked increased handgun purchases over the same period. Romer is careful to note the limits of these data: they parallel what was once observed for adolescent exposure to movie portrayals of cigarettes, but more research is needed to determine the causal impact of exposure to firearms in movies, in the way that was ultimately done for tobacco.

The tobacco campaign offers a technical template for how that causal case was built and how policy followed. Anti-smoking efforts combined several mutually reinforcing elements: epidemiological evidence linking smoking to disease, mass-media education campaigns that debunked the image of smoking as glamorous or safe, regulation of advertising, and the elimination of paid tobacco product placement in entertainment. As those measures took hold, portrayals of smoking in popular movies declined, and they declined in tandem with population smoking rates. The lesson Romer draws is that changing the cultural environment around a consumer product, not only informing individual consumers, can shift population-level behavior.

Translated to firearms, similar strategies could be studied, Romer argues. These include reducing firearm product placement and portrayals in entertainment, educating the public about the risks associated with firearm ownership, and emphasizing the specific dangers of leaving firearms unsecured in the home. Each element mirrors a component of the tobacco effort: product placement restrictions correspond to the entertainment-side interventions, ownership-risk education corresponds to health-hazard messaging, and unsecured-firearm warnings correspond to targeted safety communication. The paper frames these as research priorities rather than ready-made policies, stressing that their effectiveness for firearms has not yet been demonstrated.

The consumer-product framing is the paper’s most distinctive analytical move. Tobacco control succeeded, in part, because advocates reframed cigarettes from an ordinary commodity into a dangerous product whose marketing deserved scrutiny. Romer suggests that firearms, and handguns in particular, could be examined through the same lens, with attention to how they are advertised, depicted, and normalized. “The public health approach to cigarettes as a consumer product demonstrated how various forms of public education can debunk the claim that owning a firearm is worth the risks that accompany widespread possession,” Romer says. Whether that debunking can succeed in a cultural and legal environment so different from the one tobacco faced is an open empirical question, and the paper does not claim otherwise.

The distinction between universal and targeted strategies carries practical weight. Targeted interventions, such as crisis intervention programs, extreme risk protection orders, and violence interruption efforts aimed at people at elevated risk, address the sharpest harms but leave untouched the broader market dynamics that put handguns in millions of homes. A universal approach, by contrast, operates on the entire population, aiming to lower demand at the source. Romer acknowledges that further research is needed to determine whether such strategies would be effective for firearms, but he points to the historical record as grounds for optimism. “The success of the universal public health approach to cigarettes serves as a model for the reduction of the consumer appeal of firearms,” he writes.

Published as a commentary in the American Journal of Preventive Medicine, with the article dated 23 September 2026, the paper is positioned as an argument for a research agenda rather than a legislative proposal. Its measurable claims are specific: firearm portrayals in entertainment have risen alongside handgun purchases and firearm homicides among young people; the self-defense rationale dominates ownership motivations and has been endorsed by the Supreme Court; and the tobacco precedent shows that education plus cultural de-normalization can reduce a product’s appeal. What remains untested is causality and intervention efficacy, and Romer’s paper explicitly calls for the kind of rigorous studies that eventually justified tobacco’s entertainment restrictions. For researchers, the immediate task is to establish whether screen exposure to firearms shapes attitudes and behavior the way screen exposure to smoking once did. For policymakers, the paper suggests that the tools of public health, evidence, education, and cultural change, may offer a path that complements, rather than replaces, the targeted violence-prevention efforts already in place.

Subject of Research: Applying tobacco-control-style public health strategies to reduce the consumer appeal and use of firearms in the United States

Article Title: Public health strategies used against cigarettes could help reduce appeal of firearms, paper argues

Article References: Public health strategies used against cigarettes could help reduce appeal of firearms, paper argues. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: firearms, gun violence, public health, tobacco control, cigarette smoking, handguns, self-defense, entertainment media, movie portrayals, Annenberg Public Policy Center, American Journal of Preventive Medicine, consumer products

The research team drew on data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System, a surveillance program that links death certificates, medical examiner findings, and law enforcement reports to build a richer picture of violent deaths than any single source can provide. From 2018 to 2023, the system captured 115,873 homicide deaths. The investigators sorted these into three categories: single-victim homicides, multi-victim homicides involving two or three victims, and mass homicides defined as events with four or more victims killed, excluding the perpetrator. This classification allowed them to compare the three groups across victim demographics, suspect characteristics, weapons used, locations, and the circumstances that precipitated each event.

The scale of the numbers alone is sobering. The overwhelming majority of victims, 90.5 percent or 104,858 people, died in single-victim homicides. Yet nearly one in twelve victims lost their lives in multi-victim events: 10,123 people were killed across 4,789 incidents, representing 8.7 percent of all homicide deaths in the dataset. That proportion is higher than what an earlier study using the same reporting system found for 2003 to 2017. The authors caution that the increase may reflect the expanded geographic coverage of the reporting system as more states joined over time, or it may signal genuine shifts in national homicide patterns, which rose during the corresponding period. Mass homicides, defined as events with four or more fatalities, accounted for less than 1 percent of deaths but claimed 892 lives across 178 incidents, with individual cases ranging from 4 to 51 victims.

Where these killings happened varied in striking ways. Mass and multi-victim homicides frequently occurred in homes, while single-victim homicides most often took place in public settings such as streets or vehicles. This geographic split carries practical implications: residential violence may be less visible to bystanders and less accessible to conventional street-level interventions, while public-location killings may demand different environmental and policing strategies. The finding that multi-victim events cluster in domestic settings aligns with the study’s central observation about intimate partner violence as a precipitating circumstance.

Demographic patterns were largely consistent with previous research, but the contrasts between categories were pronounced. Mass homicides more often involved non-Hispanic White victims and children, whereas single- and multi-victim homicides more often involved non-Hispanic Black victims and suspects who were acquaintances or friends of those killed. Nearly half of the victims in both multi-victim and single-victim homicides were aged 18 to 34 years, compared with 29.8 percent of mass homicide victims in that age range. Across all three categories, both victims and suspects were primarily male, underscoring the persistent gendered character of lethal violence in the United States.

The racial and ethnic distributions of victims and suspects differed notably by category. The highest proportion of mass homicide victims were non-Hispanic White, at 39.7 percent, while the highest proportions of multi-victim and single-victim homicide victims were non-Hispanic Black, at 47.8 percent and 54.8 percent respectively. Among suspects, non-Hispanic White individuals accounted for 32.2 percent and non-Hispanic Black individuals for 30.1 percent of mass homicide suspects, while in multi-victim and single-victim homicides the highest proportions of suspects were non-Hispanic Black, at 37.6 percent and 36.8 percent respectively. These distributions, the study suggests, reflect the distinct social contexts in which different types of homicide unfold rather than a single uniform phenomenon.

Firearms dominated as the method of injury across every category, reinforcing the central role of guns in American lethal violence. Firearms were involved in 75.8 percent of mass homicides, 86.3 percent of multi-victim homicides, and 76.4 percent of single-victim homicides. The consistency of this finding across victim counts suggests that any firearm-related prevention measure could theoretically affect all categories of homicide, although the study’s authors emphasize that tailored approaches remain essential given the differing circumstances surrounding each type of event.

The precipitating circumstances revealed perhaps the most actionable patterns. Intimate partner violence was a common precipitator in nearly one-third of mass homicides, at 31.0 percent, and was also frequently associated with multi-victim homicides at 16.9 percent and single-victim homicides at 15.0 percent. Family relationship problems and a recent or impending crisis within the preceding two weeks were common circumstances in mass and multi-victim killings. For multi-victim and single-victim homicides, arguments and criminal activity were frequent precipitators. Taken together, these findings indicate that relationship conflict and acute personal crises are not marginal factors but central drivers of lethal violence across the spectrum, from a single death to the deadliest mass events.

The study’s authors argue that these differences are key to developing tailored prevention strategies. A policy aimed at reducing argument-driven street violence, for example, may require community-based conflict mediation and violence interruption programs, while addressing intimate partner violence as a precursor to mass casualty events may call for stronger risk assessment, lethal violence screening in domestic violence services, and coordinated responses when families show signs of acute crisis. The identification of a two-week crisis window before many mass and multi-victim killings suggests a potential point of intervention, though the study stops short of prescribing specific policies.

Patrick S. Sullivan, DVM, PhD, of Emory University, Editor-in-Chief of Annals of Epidemiology, underscored the value of the underlying data infrastructure in a statement accompanying the publication. “This analysis is a reminder of what public data systems make possible,” he said. “By linking death certificates, medical examiner findings, and law enforcement reports, the National Violent Death Reporting System lets us see that homicide is not one problem but several — each with its own affected populations and precipitating circumstances. The findings of this study offer important guideposts for the policies and interventions most likely to reduce these tragic and preventable outcomes.” As US homicide rates continue to fluctuate, the study provides a granular evidence base suggesting that treating homicide as a single public health problem obscures the very distinctions that effective prevention depends on.

Subject of Research: Patterns and precipitating circumstances of single-victim, multi-victim, and mass homicides in the United States

Article Title: Study reveals distinct patterns across single-, multi-, and mass homicides

Article References: Study reveals distinct patterns across single-, multi-, and mass homicides. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: homicide, mass homicide, intimate partner violence, public health, National Violent Death Reporting System, firearms, epidemiology, violence prevention, CDC, Annals of Epidemiology, victim demographics, precipitating circumstances