Earlier this year, I saw two brothers and their sister for check-ups. I asked each if they felt safe in their neighborhood, as part of the usual teen questions. Even though they lived in the same public housing, only the girl said that she heard gunshots and felt unsafe. Despite her clear concerns, she hopelessly said, “it’s the Bronx,” when I asked what could make her safer.
While girls account for only 14% of firearm-related deaths in children, they may be uniquely vulnerable to the secondhand effects of gun violence. According to a 2023 CDC report, teen girls were more likely to miss school because of feeling unsafe in or on the way to school, and more than twice as likely to report poor mental health, compared to their male counterparts.
Teen girls who lived or went to school near a gun homicide had worse anxiety and depression symptoms than boys, according to a 2020 study published in SSM Population Health. Yet, in the Bronx and other low-income urban areas, violence prevention resources are mainly directed towards male youth. They are more likely to exhibit aggression and other externalizing behavior, when exposed to trauma. In contrast, girls are more likely to internalize, and trauma may go under the radar, disguised as vague medical complaints.
A middle school girl recently came to the school clinic for a headache. I asked about stressors. She was worried about homework from missed school days. When I screened for suicide, she said, “I don’t want to die, but I think about my chances of getting out of school alive. You know, a school shooting.”
Days earlier, and 900 miles away, an elementary school shooting in Nashville took the lives of two young girls, and, likely, frightened many more.
A study published in the Journal of Interpersonal Violence found that, of youth exposed to gun violence, more girls felt fearful, and those who lived in urban areas were more likely to take protective action.
“I need to run as fast as I can… I wouldn’t take my books,” the middle school girl told me. What would you take, I asked. “My phone. But you’re not allowed to keep it…Then, how are we going to call our parents?,” she said. “I’m scared of heights,” she added, and had calculated that the number of windows wouldn’t accommodate all the students for a simultaneous escape.
“They tell you to hide,” She estimated the space beneath her teachers’ desk wouldn’t fit all her classmates. “And all they give you is a pencil.” She pointed to my printer as more effective in fight, the last component of “Run Hide Fight,” an FBI technique commonly taught to schoolchildren during lockdown drills — but not evidence based, or trauma informed.
School shootings account for a small percentage of gun violence but have added to the list of everyday fears for urban girls — forcing them to look at pencils, desks, and books not as tools for learning but as weapons for survival. In New York State, a bill has been proposed requiring a “trauma-informed” approach to lockdown drills. Despite support from the New York State-American Academy of Pediatrics and other advocates, the bill did not pass.
In the absence of support, living in constant fear can cause toxic stress — a disruption in children’s brain and body systems — increasing the risk for health problems into adulthood. Known as adverse childhood experiences, or ACEs, exposure to violence has typically been studied in the context of children’s families, but recently expanded to their communities.
University of Chicago Crime Lab researchers offer promising results of Working on Womanhood, or “WOW,” the first evidence-based trauma informed school counseling program for Black and Latinx teen girls in violent neighborhoods. Delivered in groups, WOW combines multiple therapy modalities with mentoring and resulted in significant reductions in anxiety, depression, and PTSD symptoms, in a randomized trial, involving more than 3,700 Chicago high school girls.
For now, I offered my middle school patient Tylenol for her headache. It’s not going to eradicate her fears, but maybe listening helped. When leaving, she pointed to an exam room window, and said, “That’s not going to work,” noting it wasn’t bullet proof. I told her not to worry about me and that my job was to protect her. She reminded me of adults who have died in mass shootings.
We must do more for our girls. Until we have the needed resources, we can listen, learn, and let them know they matter.
Agrawal, a pediatrician, is a public policy scholar at Rockefeller Institute of Government and is the New York State chair of the Gun Safety Committee of the American Academy of Pediatrics.
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