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School shootings perpetrated by adolescents have mainly used handguns, typically obtained from family members, a cross-sectional study showed.

Among 253 adolescent school shootings from 1990 through 2016, 85.5% of firearms discharged were handguns (95% CI 80.6-89.4), reported Brent Klein, PhD, of the University of South Carolina in Columbia, and colleagues. Just 9.6% of firearms were rifles, and only 5.9% were shotguns.

High-powered firearms accounted for less than a quarter of shootings, they .

"Although today's media coverage primarily focuses on high-profile school shootings in which assault-style rifles are used," they wrote, "our findings suggest these cases do not historically represent the broader issue, despite the emergence of this new trend in recent years," beyond the period studied.

Of 262 shooters age 19 years or younger, 51.8% procured firearms from their family members or relatives, primarily their parents, Klein and colleagues added.

The findings match the proportions seen in community violence more generally, "suggesting a potential overlap in the factors driving these violent incidents collectively," Klein and colleagues wrote. They also "stress the critical public health message concerning the secure storage of firearms, especially in households with adolescents."

They added in part that, "hospital-based initiatives centered on screening for firearm accessibility and exposure for inpatients could be fruitful in preventing gun violence, both inside and outside schools."

Klein and colleagues used data from The American School Shooting Study (TASSS), which has gathered information from open sources, such as media and academic reports, court records, and police files.

Among the 262 adolescent shooters, 256 were male, and their mean age was 16.2 years. Of these individuals, 57.8% were Black, 8.6% were Hispanic, 27.9% were white, and 5.7% represented other racial or ethnic groups.

Slightly more than half of the adolescent shooters were enrolled as students at the school they targeted.

Guns used in these school shootings were obtained from friends or acquaintances in 22% of cases, while 29.6% obtained guns from the illegal market. Just 4.7% of adolescent school shooters obtained firearms from strangers or individuals who were shot. And a mere 1.9% used personally owned guns that were bought legally.

Overall, most guns used were moderately or lower powered (39.7% and 37%, respectively), such as 0.22-caliber and 9-mm firearms, rather than higher powered (23.3%).

During the study period, the use of lower- to moderately-powered guns in adolescent schools shootings decreased from the early 1990s to the 2010s whereas use of higher-powered firearms increased only modestly since the mid-1990s. What increased sharply was the number of incidents in which firearm power was not disclosed in open sources.

As for procurement method, most firearms discharged during adolescent school shootings from 1990 to 2016 were obtained via theft, predominately from family members or relatives (82.1%).

Nearly half of the shootings (47%) involved at least one fatality, and 2.8% resulted in four or more deaths.

Limitations of the study included that open sources, such as those used by TASSS, can include "vague, imprecise, and conflicting," information, Klein and colleagues noted. Additionally, data were missing for some variables, though the research team adjusted for missing values, and TASSS data were only current through 2016.

"Analyzing more recent data in future research could reveal new and evolving trends," Klein and colleagues wrote.

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