{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:44:32Z","timestamp":1777448672507,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mass shooting events (MSEs) continue to rise in the United States, posing significant public health concerns. The link between accessibility to these treatments and MSEs remains unclear. This study investigates this relationship in major U.S. metropolitan statistical areas (MSAs), accounting for socioeconomic variables. We hypothesized that limited access to mental health and substance use treatment would be associated with increased MSE incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study analyzed data from 2015 to 2019 from the Gun Violence Archive (GVA) and the Opioid Environment Policy Scan for 48 major U.S. MSAs. MSEs were defined as incidents with 4 or more victims by GVA. Access to treatment services was assessed by proximity to the nearest mental health and substance use treatment providers. Linear regression analyses controlled for sociodemographic factors, including segregation index, unemployment, and poverty rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between 2015 and 2019, 1200 MSEs resulted in 1219 fatalities and 5208 injuries. No significant correlations were found between MSE incidence and distance to mental health (\u03c1 = \u22120.17,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.249) or substance use treatment providers (\u03c1 = \u22120.05,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.749). However, segregation index (\u03b2 = 0.41,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.004) and unemployment rate (\u03b2 = 0.67,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01) were significantly associated with MSE incidence in multivariate analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Access to mental health or substance use treatment alone may not significantly impact MSE incidence. Structural factors, particularly segregation and unemployment, may play a more critical role in MSE. Future research should focus on broader social and structural determinants to reduce MSEs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251385102","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T13:01:24Z","timestamp":1760619684000},"page":"1153-1161","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mass Shootings in Major U.S. Cities: The Limited Role of Mental Health and Substance Use Treatment Access Compared to Structural Factors"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2984-8852","authenticated-orcid":false,"given":"Zihuang","family":"Zhang","sequence":"first","affiliation":[{"name":"Tulane University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0823-7611","authenticated-orcid":false,"given":"Seowoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingruo","family":"Zhang","sequence":"additional","affiliation":[{"name":"The University of Chicago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia M.","family":"Fleckman","sequence":"additional","affiliation":[{"name":"Tulane University Weatherhead School of Public Health and Tropical Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7679-0892","authenticated-orcid":false,"given":"Kevin N.","family":"Harrell","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle M.","family":"Tatum","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clifton L.","family":"McGinness","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8548-0466","authenticated-orcid":false,"given":"Jeanette","family":"Zhang","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine P.","family":"Theall","sequence":"additional","affiliation":[{"name":"Tulane University Weatherhead School of Public Health and Tropical Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharven","family":"Taghavi","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Past Summary Ledgers","author":"Gun Violence Archive","year":"2024","unstructured":"Gun Violence Archive. Past Summary Ledgers. 2024. https:\/\/www.gunviolencearchive.org\/past-tolls. Accessed November 28, 2024."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.2846"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1521\/pdps.2022.50.3.513"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/1745-9133.12473"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1037\/vio0000106"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2014.03.004"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2017.05.038"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0003122419858731"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/320275"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00753"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/09638237.2017.1340608"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","unstructured":"Paykin S Halpern D Lin Q et al. GeoDaCenter\/opioid-policy-scan: Opioid Environment Policy Scan (OEPS) data warehouse. Published online January 12 2022. doi:10.5281\/zenodo.5842465.","DOI":"10.5281\/zenodo.5842465"},{"key":"e_1_3_3_14_2","volume-title":"American Community Survey 5-Year Data (2009-2023)","author":"US Census Bureau","year":"2019","unstructured":"US Census Bureau. American Community Survey 5-Year Data (2009-2023). Census.gov; 2019. https:\/\/www.census.gov\/data\/developers\/data-sets\/acs-5year.html. Accessed December 13, 2024."},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.0685"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.966434"},{"key":"e_1_3_3_17_2","volume-title":"Neighborhood Segregation Persists for Black, Latino or Hispanic, and Asian Americans","author":"Frey WH","year":"2021","unstructured":"Frey WH. Neighborhood Segregation Persists for Black, Latino or Hispanic, and Asian Americans. Brookings; 2021. https:\/\/www.brookings.edu\/articles\/neighborhood-segregation-persists-for-black-latino-or-hispanic-and-asian-americans\/. Accessed December 13, 2024."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7490-x"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1162\/rest_a_01241"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0840470416679413"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1037\/lhb0000327"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251385102","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348251385102","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251385102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:38:36Z","timestamp":1777379916000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348251385102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1177\/00031348251385102"],"URL":"https:\/\/doi.org\/10.1177\/00031348251385102","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]}}}