Surgeon General Dr. Vivek Murthy has declared gun violence a public health crisis that is now the leading cause of death among children and teens, adding that more than half of American adults or their family members have experienced a fire-arm related incident.

The advisory was the first publication from the Office of the Surgeon General dedicated to firearm violence and its consequences for the health and well-being of the American public.

“Firearm violence is an urgent public health crisis that has led to loss of life, unimaginable pain, and profound grief for far too many Americans,” Murthy said in a news release on Tuesday. “We don’t have to continue down this path, and we don’t have to subject our children to the ongoing horror of firearm violence in America. All Americans deserve to live their lives free from firearm violence, as well as from the fear and devastation that it brings. It will take the collective commitment of our nation to turn the tide on firearm violence.”

In his 40-page advisory, Murthy cited research by SHP’s Maya Rossin-Slater, an associate professor of health policy and a senior fellow at the Stanford Institute for Economic Policy Research (SIEPR) who has investigated the long-term impact of gun violence on classmates who survive school shootings. In the most comprehensive analysis to date of American children who have experienced gun violence at schools, Rossin-Slater found that they have higher rates of school absenteeism, lower high school and college graduation rates and will experience an income loss of $115,550 over their lifetimes.

Rossin-Slater praised Murthy for putting a spotlight on the epidemic.

“I recognize that the surgeon general must be very judicious when issuing statements and public advisories, as one does not want to issue too many statements out of concern that people won't take them seriously,” she said. “So, the fact that the surgeon general decided that gun violence is a topic that is worthy of an advisory is a big deal, and my hope is that it prompts policy action that is effective at reducing gun violence in America.”

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Murthy cited Rossin-Slater’s study published in the Proceedings of the National Academy of Sciences (PNAS) which found that exposure to fatal school shootings also increases antidepressant use among youths under age 20 by 21% in the communities where fatal school shootings occur.

“I am grateful to have been able to contribute to the body of research that quantifies the substantial costs of gun violence on children—costs that are not only measured in terms of the number of fatalities and injuries, but also in terms of less immediate but very long-lasting impacts on youth mental health, educational, and economic outcomes,” Rossin-Slater said. “I hope that the American public and policymakers listen to the surgeon general's advisory and take action."

SIEPR published a series of videos about the silent cost of school shootings, including this one in which Rossin-Slater and colleagues discuss the startling trends in the mental health of children who witness the tragedies.