School-associated violent deaths in the United States, 1994-1999

Context Despite the public alarm following a series of high-profile school shootings that occurred in the United States during the late 1990s, little is known about the actual incidence and characteristics of school-associate d violent deaths. Objective To describe recent trends and features of school-associated viole nt deaths in the United States. Design, Setting, and Subjects Population-based surveillance study of data c ollected from media databases, state and local agencies, and police and sch ool officials for July 1, 1994, through June 30, 1999. A case was defined a s a homicide, suicide, legal intervention, or unintentional firearm-related death of a student or nonstudent in which the fatal injury occurred (1) on the campus of a public or private elementary or secondary school, (2) whil e the victim was on the way to or from such a school, or (3) while the vict im was attending or traveling to or from an official school-sponsored event . Main Outcome Measures National estimates of risk of school-associated viole nt death; national trends in school-associated violent deaths; common featu res of these events; and potential risk factors for perpetration and victim ization. Results Between 1994 and 1999, 220 events resulting in 253 deaths were iden tified; 202 events involved 1 death and 18 involved multiple deaths (median , 2 deaths per multiple-victim event). Of the 220 events, 172 were homicide s, 30 were suicides, 11 were homicide-suicides, 5 were legal intervention d eaths, and 2 were unintentional firearm-related deaths. Students accounted for 172 (68.0%) of these deaths, resulting in an estimated average annual i ncidence of 0.068 per 100000 students. Between 1992 and 1999, the rate of s ingle-victim student homicides decreased-significantly (P=.03); however, ho micide rates for students killed in multiple-victim events increased (P=.04 7). Most events occurred around the start of the school day, the lunch peri od, or the end of the school day. For 120 (54.5%) of the incidents, respond ents reported that a note, threat, or other action potentially indicating r isk for violence occurred prior to the event. Homicide offenders were more likely than homicide victims to have expressed some form of suicidal behavi or prior to the event (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.96-24.65) and been bullied by their peers (OR, 2.57; 95% CI, 1.12-5.92). Conclusions Although school-associated violent deaths remain rare events, t hey have occurred often enough to allow for the detection of patterns and t he identification of potential risk factors. This information may help scho ols respond to this problem.