BOSTON, April 24, 2026 – Firearm violence is the leading cause of death among U.S. youth. A new study from Boston Children's Hospital found that youth-perpetrated firearm homicides increased by 41% between 2018 and 2022. Stronger firearm laws were associated with lower homicide rates, with states in the strongest law quintile having a 66% lower homicide rate compared with those in the weakest quintile. This underscores the importance of comprehensive firearm legislation for decreasing youth perpetrated firearm homicide. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2026 Meeting , taking place April 24-27 in Boston.
Prior research has focused on youth as victims, with less known about youth as perpetrators. Understanding how firearm laws shape youth-perpetrated homicides is key to prevention.
“Firearm violence is now the leading cause of death for children in the U.S., yet we know far less about youth as perpetrators than as victims,” said Ayesha Dholakia, fellow at Boston Children's Hospital and lead author of the study. “Our study shows that states with stronger firearm laws have substantially lower rates of youth-perpetrated firearm homicide, underscoring the role of policy environments in prevention and the need to better understand who is driving youth firearm violence--and why.”
Of 94,863 homicides, 37,858 (39.9%) recorded perpetrator age. Of these, 12,501 (33.0%) involved youth perpetrators, of which 10,263 (82.1%) involved firearms. After excluding 11 low data capture states, there were 9,167 youth-perpetrated firearm homicides involving 8,524 unique youth perpetrators. Five-year average state-level rates ranged from 0.3 to 10.3 per 100,000 youth (median 1.8, IQR 1.3-3.7). Perpetrators had a median age of 20 years (IQR 18-22) and were majority male (93.2%) and of Black race (64.5%). Victims had a median age of 24 years (IQR 19-33) and were majority male (85.9%) and of Black race (62.5%).
Additional information is included in the below research abstract. The PAS Meeting connects thousands of leading pediatric researchers, clinicians and educators worldwide. View the full schedule in the PAS 2026 program guide . For more information about the PAS Meeting, please visit www.pas-meeting.org .
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Abstract: State Firearm Law Strength and Youth-Perpetrated Firearm Homicides: A Multivariable State-Level Analysis of Incidents with Known Perpetrator Age
Presenting Author
Ayesha Dholakia, Fellow, Boston Children's Hospital
Organization
Boston Children's Hospital
Topic
Injury Prevention
Background
Firearm violence is the leading cause of death among U.S. youth. Prior research has focused on youth as victims, with less known about youth as perpetrators. Understanding how firearm laws shape youth-perpetrated homicides is key to prevention.
Objective
To characterize youth perpetrators of firearm homicide and assess associations between state firearm law strength and youth-perpetrated firearm homicide rates.
Design/Methods
We conducted a retrospective analysis using 2018-2022 CDC National Violent Death Reporting System data of homicides with known youth perpetrators (24 years). The outcome was the annual state-level youth-perpetrated firearm homicide rate per 100,000 youth. The primary exposure was state firearm law strength, defined using the Giffords Law Center Gun Law Score, categorized into quintiles. We fit generalized estimating equations with a negative binomial link, adjusting for year and state-level covariates (poverty, age, sex, population density), reporting adjusted rate ratios (aIRRs) with 95% CIs. Predicted homicide rates were derived from the adjusted model.
Results
Of 94,863 homicide, 37,858 (39.9%) recorded perpetrator age. Of these, 12,501 (33.0%) involved youth perpetrators, of which 10,263 (82.1%) involved firearms. After excluding 11 low data capture states, there were 9,167 youth-perpetrated firearm homicides involving 8,524 unique youth perpetrators (Table 1). Five-year average state-level rates ranged from 0.3 to 10.3 per 100,000 youth (median 1.8, IQR 1.3-3.7). Perpetrators had median age 20 years (IQR 18-22) and were majority male (93.2%) and of Black race (64.5%). Victims had median age 24 years (IQR 19-33) and were majority male (85.9%) and of Black race (62.5%). In adjusted models, stronger firearm laws were associated with lower state homicide rates in a stepwise pattern compared with weakest-law states (quintile 1): quintile 2 IRR 0.86, 95% CI 0.73-1.02; quintile 3 IRR 0.77, 95% CI 0.61-0.98; quintile 4 IRR 0.55, 95% CI 0.37-0.74; and quintile 5 IRR 0.34, 95% CI 0.19-0.61. Homicide rates rose 41% from 2018 to 2022 (IRR 1.41, 95% CI 1.18-1.69) (Table 2). Predicted rates decreased from 3.7 (95% CI 2.7-4.7) to 1.6 (95% CI 0.9-2.2) per 100,000 youth across quintiles (Figure).
Conclusion(s)
Youth-perpetrated firearm homicides increased by 41% between 2018 and 2022. Stronger firearm laws were associated with lower homicide rates, with states in the strongest law quintile having a 66% lower homicide rate compared with those in the weakest quintile. This underscores the importance of comprehensive firearm legislation for decreasing youth perpetrated firearm homicide.
Co-Authors
Eric Fleegler, MD, MPH, Associate Professor of Emergency Medicine and Pediatrics, MassGeneral Hospital for Children
Michael Monuteaux, ScD, Senior Epidemiologist and Biostatistician, Boston Children's Hospital
Suzanne G. McLone, N/A, MPH, Graduate Research Assistant, Boston University School of Public Health (BUSPH)
Lois Lee, MD, MPH, Associate Professor, Boston Children's Hospital
Tables and Images
Table 1: Demographic and Incident Characteristics of Youth Firearm Homicide Perpetrators and Victims in Incidents with Known Perpetrator Age, NVDRS 2018-2022.
Table 2: Multivariable analysis of state-level predictors of youth-perpetrated firearm homicide among incidents with known perpetrator age
Figure: Adjusted Associations Between State Firearm Law Strength and Youth-Perpetrated Firearm Homicide Rates