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-associated violent deaths.

Objective  To describe recent trends and features of school-associated violent deaths in the United States.

Design, Setting, and Subjects  Population-based surveillance study of data collected from media databases, state and local agencies, and police and school officials for July 1, 1994, through June 30, 1999. A case was defined as 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) while the victim was on the way to or from such a school, or (3) while the victim was attending or traveling to or from an official school-sponsored event.

Main Outcome Measures  National estimates of risk of school-associated violent death; national trends in school-associated violent deaths; common features of these events; and potential risk factors for perpetration and victimization.

Results  Between 1994 and 1999, 220 events resulting in 253 deaths were identified; 202 events involved 1 death and 18 involved multiple deaths (median, 2 deaths per multiple-victim event). Of the 220 events, 172 were homicides, 30 were suicides, 11 were homicide-suicides, 5 were legal intervention deaths, and 2 were unintentional firearm-related deaths. Students accounted for 172 (68.0%) of these deaths, resulting in an estimated average annual incidence of 0.068 per 100 000 students. Between 1992 and 1999, the rate of single-victim student homicides decreased significantly (P = .03); however, homicide rates for students killed in multiple-victim events increased (P = .047). Most events occurred around the start of the school day, the lunch period, or the end of the school day. For 120 (54.5%) of the incidents, respondents reported that a note, threat, or other action potentially indicating risk for violence occurred prior to the event. Homicide offenders were more likely than homicide victims to have expressed some form of suicidal behavior 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, they have occurred often enough to allow for the detection of patterns and the identification of potential risk factors. This information may help schools respond to this problem.

JAMA. 2001;286:2695-2702

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Author Contributions: Study concept and design: Anderson, Kaufman, Simon, Reza, Barrios, Modzeleski, Potter.

Acquisition of data: Anderson, Kaufman, School-Associated Violent Deaths Study Group.

Analysis and interpretation of data: Anderson, Kaufman, Ryan, Simon. Drafting of the manuscript: Anderson, Kaufman, Simon.

Critical Revision of the manuscript for important intellectual content: Anderson, Barrios, Feucht, Hammond, Kaufman, Modzeleski, Paulozzi, Potter, Ryan, Simon, School-Associated Violent Deaths Study Group.

Statistical expertise: Kaufman, Ryan, Kegler.

Administrative, technical, or material support: Anderson, Barrios, Feucht, Kaufman, Modzeleski, Paulozzi, Potter, Ryan, Simon, School-Associated Violent Deaths Study Group.

Study supervision: Anderson, Kaufman.

The School-Associated Violent Deaths Study Group includes Bernadette Ford Lattimore, MPH, Ezra Jones, MPH, LaMar Hasbrouck, MD, MPH, Scott Kegler, PhD, Avid Reza, MPH, and Anita Teague Ruff, MPH.