Community Gun Violence Linked to Poorer Child Health, ECHO Study Finds

Posted on December 18, 2025December 18, 2025 by Jodi Snare

Children living in neighborhoods with high levels of gun violence were 20% less likely to be reported in excellent or very good health compared with children in areas with lower levels of gun violence, according to a new study from the ECHO Cohort. The association was consistent across age groups and especially pronounced in high-poverty neighborhoods, where children exposed to gun violence were 23% less likely to be reported in excellent health.

The study included more than 13,450 children from birth to age 17 from 56 ECHO Cohort Study Sites across the United States. Researchers linked data on neighborhood gun violence, collected from the Gun Violence Archive, with parent-reported child health measures, while accounting for individual and neighborhood sociodemographic factors.

“This research highlights the profound impact of gun violence on the well-being of children, underscoring the critical importance of community-level violence prevention efforts and policies in fostering safer and healthier communities,” said study author Nandita Somayaji, MHS, MEd, of the Bloomberg School of Public Health at Johns Hopkins University.

These findings point to the importance of gun violence prevention strategies that can create safer environments for children.

This collaborative research titled “Associations between neighborhood-level gun violence and child general health status: An ECHO Cohort analysis” was published in Injury.

Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

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Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

Authors: Aruna Chandran, Emily Knapp, Nandita Somayaji, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Gun violence has been the leading cause of death in children and teens in the United States since 2021. In addition to fatalities, exposure to gun violence in communities has been linked to adverse mental health outcomes in children. However, most prior studies have focused on mental health effects in older children and have not fully examined developmental or physical health impacts in younger children. This study aimed to explore the association between neighborhood-level gun violence and the general health status of children nationwide.

What were the study results?

The study found that parents of children living in areas with high levels of gun violence were 20% less likely to report their child’s health as excellent or very good compared with children who had experienced less gun violence, even after accounting for age and neighborhood economic disadvantage. This association was consistent across age groups, with both younger and older children in high gun violence areas less likely to report excellent or very good health. The effect was strongest in children that lived in neighborhoods with high poverty and high gun violence, where they were 23% less likely to be reported as having excellent or very good health.

What was the study's impact?

The findings underscore the importance of community violence prevention efforts and the need to strengthen our understanding of community risk factors such as gun violence that hinder optimal child growth and development.

Who was involved?

The study included 13,450 children from birth to 17 years old from 56 ECHO Cohort Study Sites.

What happened during the study?

Researchers used data from the Gun Violence Archive to identify how much gun violence occurred in different neighborhoods, categorized into low, medium, and high levels. Then they looked at how parents rated their children’s overall health and compared it across neighborhoods. A statistical model was used to measure the link between children’s health and the amount of gun violence in their neighborhood.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future research following children over time could help researchers better understand how exposure to gun violence affects children's health as they grow. Additional studies could also help researchers separate the impacts of gun violence exposure from other factors and explore how and why this exposure influences children’s health.

Where can I learn more?

Access the full journal article, titled “Associations between neighborhood-level gun violence and child general health status An ECHO Cohort analysis,” in Injury.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published November 2025

Read the associated article.

Download this summary

Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

Social and Neighborhood Factors

ECHO Social and Neighborhood Research

SOCIAL AND NEIGHBORHOOD

ECHO researchers use data from more than 64,000 children and their families across the U.S. to examine associations between neighborhood and social factors and health conditions, including obesity, asthma, pre-term birth, low birthweight, and anxiety and depression.

ECHO Discovery
Webinar Recordings

Aris & Smith: Neighborhood Opportunities and Disparities in Child Health Outcomes & Lung Function Measured by Oscillometry in the Healthy Start and PETALS Cohorts

Resources

Visit these sites to learn more about social and neighborhood factors.

World Health Organization: Social Determinants of Health

CDC: Social Determinants of Health

CDC: Parks, Recreation, and Green Spaces

CDC: Land Use and Community Design

QUESTIONS

For more information, please email the NIH at NIHKidsandEnvironment@od.nih.gov.
For media inquiries or to request an interview, contact Rebekah Yeager at rebekah.yeager@nih.gov.

The ECHO Program investigates social and neighborhood factors—such as access to housing, healthy food, transportation, parks, and education—that can influence child health outcomes. The neighborhoods where children grow up play an important role in their health. Because children are still developing, they may be especially sensitive to their surroundings, which can affect their health not just in childhood but throughout their lives. Tools like the Child Opportunity Index (COI) and the Social Vulnerability Index (SVI) combine dozens of these indicators into a single measure, making it easier for researchers to explore how differences in community resources can affect children’s well-being and future opportunities.

What We're Learning

Since its launch, the ECHO Program has published more than 2,000 research articles on a wide range of child health topics. Within this body of work, many studies have examined how social and neighborhood factors shape children’s health and development.

Here are some research highlights:

Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds
June 2025
Higher risks of developing asthma were seen in children from birth to age 11, and the increased risk was more noticeable in girls and Hispanic children

Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations
March 2025
Non-Hispanic Black children in these neighborhoods had the highest rate of this type of asthma that requires emergency care or medical treatment.

Food Insecurity in Pregnancy & Early Life May Be Linked to Higher Chance of Obesity in Children & Adolescents
September 2024
Children who faced food insecurity during early childhood—or whose mothers experienced it during pregnancy—had a higher BMI and more than 50% increased chance of developing obesity or severe obesity in childhood and adolescence.

ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids
April 2024
Higher levels of green spaces, up to three-fourths of a mile from a child’s home, were linked with lower symptoms of anxiety and depression from ages 2 to 5.

Neighborhood-Level Poverty and Food Insecurity During Pregnancy Associated With Lower Birthweight and Small for Gestational Age Infants, NIH Study Finds
March 2024
Living in neighborhoods where residents have lower incomes, limited food access, or limited vehicle access was associated with lower birthweights and an increased risk of babies born small for gestational age.

Can Neighborhood Conditions Throughout Childhood Shape the Risk of Developing Asthma?

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Neighborhood conditions, such as access to housing, healthy food, transportation, and education centers, can contribute to the development of childhood asthma. Researchers often measure these conditions using the Child Opportunity Index and the Social Vulnerability Index, which link residential addresses at birth, infancy (age 0.5‒1.5 years), and early childhood (age 2.0‒4.8 years) to census-tract data about the opportunities and resources available in the surrounding neighborhood. Previous studies looking into this topic lacked geographic diversity or considered only specific socioeconomic aspects of neighborhood disadvantage, which may not fully capture the role of early-life experiences on health outcomes. This study examines the association of conditions and resources available in neighborhoods during different developmental stages with childhood asthma incidence.

What were the study results?

Living in a neighborhood with higher opportunity at birth, infancy, or early childhood was associated with lower asthma incidence when compared to living in a neighborhood with lower opportunity. Differences in sociodemographic characteristics, parental asthma history, or the number of births a mother had did not explain this effect.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the impact?

Neighborhood conditions could help researchers identify vulnerable children who are at high risk for developing asthma. Policymakers, researchers, and community groups can use this information to guide decisions and interventions to improve the health of children and promote equitable opportunities across neighborhoods.

Who was involved?

This study used data from 10,516 children at 46 research sites participating in ECHO. The participants have at least one residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

What happened during the study?

Researchers linked participants’ residential addresses to the Child Opportunity Index and Social Vulnerability Index. They estimated asthma incidence rates associated with Child Opportunity Index or Social Vulnerability Index data for a child’s neighborhood at each life stage, adjusting for sociodemographic characteristics, maternal and paternal history of asthma, and the number of births a mother had.

What happens next?

Future studies can explore the impact of investing in early life health and environmental, social, and economic resources on improving health outcomes for children in disadvantaged neighborhoods. Follow-up studies can also focus on how these neighborhood-level factors are affecting asthma rates and how moving may alter asthma development.

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” in JAMA Pediatrics.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 28, 2023

Access the associated article.

Download this summary

ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Informed Mothers More Likely to Engage in Collective Action, Reduce Family- and Community-Level Chemical Exposures

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Informed Mothers More Likely to Engage in Collective Action, Reduce Family- and Community-Level Chemical Exposures

Authors: Amy Padula, Rachel Morello-Frosch, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, and the National Institutes of Health.

What were the study results?

This study found that participants knew about the dangers of chemical exposures and were motivated to act to protect the health of their families and communities, although they have busy family lives, and the pandemic has further prevented them from participating in collective action. Participants requested strategies that were time-efficient and included straightforward, accessible information on how to reduce exposures at the personal and community level.

What was the study's impact?

Researchers have an opportunity to directly learn from participants about how to improve the way in which chemical exposure results are reported in future studies. Report-back systems, or ways that study results are returned to participants, can present valuable information for participants about environmental health and how to lower chemical exposures in their homes and communities, and hold policy makers responsible for protecting parents and children from harmful chemical exposures. Researchers can use tools like the Digital Exposure Report Back Interface (DERBI) to give their participants access to individualized chemical results with information about how to take individual and collective action to reduce exposures.

Why was this study needed?

Participants in chemical exposure studies who receive reports on their personal exposures often look for information to reduce those exposures. Many chemical exposures are the result of policies, regulations, and practices, not individual behaviors and lifestyles. Individuals can address those policies and regulations through collective action, which is working with others to reach a common goal. Researchers wanted to understand the role of personal exposure reports in a participant’s interest in engagement in collective action.

Who was involved?

In summer 2020, the researchers held three online focus groups in English and Spanish with a diverse group of 18 participants from pregnancy cohorts in Illinois and California.

What happened during the study?

This study aimed to understand how much participants know about sources of potentially harmful chemical exposures and their experience and interest in participating in collective action. Focus group participants talked about some of the barriers and strategies to participating in collective action, and their preferences for receiving and using their personalized reports about environmental chemical exposures. Input from these focus groups can be used to help design tools and content to report results of exposure research to ECHO participants.

What happens next?

The researchers are currently studying participant surveys from before and after participants received their chemical exposure reports to learn more about how participants use DERBI. These surveys may also reveal how DERBI reports may influence participant efforts to reduce exposure in their homes and communities through collective action.

Where can I learn more?

More information about the Digital Exposure Report Back Interface (DERBI) can be found on the Silent Spring Institute website.

Access the full journal article, titled “Perspectives of peripartum people on opportunities for personal and collective action to reduce exposure to everyday chemicals: Focus groups to inform exposure report-back” in Environmental Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 26, 2022

Access the associated article.

Download this summary

Informed Mothers More Likely to Engage in Collective Action, Reduce Family- and Community-Level Chemical Exposures

Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

Who sponsored this study?

Why was this study needed?

What were the study results?

What was the study's impact?

Who was involved?

What happened during the study?

What happens next?

Where can I learn more?

Download this summary

ECHO Social and Neighborhood Research

ECHO Discovery Webinar Recordings

Resources

QUESTIONS

What We're Learning

ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Who sponsored this study?

Why was this study needed?

What were the study results?

What was the impact?

Who was involved?

What happened during the study?

What happens next?

Where can I learn more?

Download this summary

Read More Research Summaries

Informed Mothers More Likely to Engage in Collective Action, Reduce Family- and Community-Level Chemical Exposures

Who sponsored this study?

What were the study results?

What was the study's impact?

Why was this study needed?

Who was involved?

What happened during the study?

What happens next?

Where can I learn more?

Download this summary

Read More Research Summaries about Chemical Exposures and Pregnancy

ECHO Discovery
Webinar Recordings