When kids talk about gun violence, other kids listen

UTMB Health pediatric surgeon Dr. Bindi Naik-Mathuria knows firsthand the devastation that happens when childhood and gun violence cross paths.

"A pediatric surgeon is deeply involved with children injured or killed by gun violence. I have had to operate on children as young as 4 with severe injuries caused by a single bullet, requiring months of recovery," Naik-Mathuria said. "We witness firsthand the pain and trauma they live with from an injury that could have been completely prevented."

A public health researcher at The University of Texas Medical Branch (UTMB), Naik-Mathuria is steadfast about preventing as many of those traumas as possible.

A new approach takes shape

The U.S. Centers for Disease Control and Prevention reports that in 2020, firearm injuries surpassed motor vehicle crashes as the leading cause of death for children and adolescents in the United States - a stark and sobering shift that continues to shape the priorities of public health leaders nationwide.

At UTMB, a multidisciplinary research team led by Naik-Mathuria is part of a federally funded project to confront that reality with a different kind of prevention strategy - one that starts not with adults but with young people themselves.

The Rise Up! Against Gun Violence initiative is a three-year, $1.2 million project funded by the CDC that focuses on middle-school-aged youth in Houston and Memphis, targeting a critical developmental window when exposure to community violence often begins. Rather than relying on traditional top-down messaging from adults, Rise Up is built on the simple but powerful premise that young people are more likely to listen to and be influenced by peers who understand their lived experiences. At the heart of the program is a series of youth-developed videos paired with guided discussions.

Naik-Mathuria's experience in the operating room is backed by years of research examining patterns of pediatric firearm injury, particularly in urban areas like Houston. That research points to a critical insight: While safe firearm storage remains essential, many injuries involving older children occur outside the home and are tied to community violence.

Exploring the realities of community violence

Most public messaging around children and firearms focuses on preventing accidental injuries - locking guns, using safes, and keeping firearms out of reach. While those measures are vital, they don't fully address the risks facing adolescents in neighborhoods where violence is part of daily life.

Through interviews with teenagers who have experienced community violence firsthand, the Rise Up team has identified a consistent pattern: Exposure often begins earlier than many assume, around ages 10 or 11.

The same interviews highlight a combination of risk factors and protective influences. Risk factors include unstable home environments, exposure to domestic violence, and social isolation. Protective factors include a supportive adult figure, involvement in structured activities like sports or church, and stable peer relationships.

Rise Up aims to intervene before patterns of behavior are entrenched by reaching children at the age when they are first navigating these pressures.

Rise Up content is created in collaboration with youth ambassadors - young people from Houston and Memphis who bring firsthand insight into the realities their peers face. The approach draws inspiration from the Truth Initiative and its widely recognized anti-smoking campaigns of the late 1990s, which successfully reduced teen smoking rates by shifting the voice of prevention messaging from adults to youth.

"Only youth can truly relate to other youth," Naik-Mathuria said. "In the Truth anti-tobacco campaign, messaging developed by young people was effective at influencing their peers to stop smoking or never pick up a cigarette. We are hoping for a similar effect in our work by getting the youth perspective on how to convince younger children to avoid gun use, gang involvement, and violence."

The youth ambassadors explore both sides of a critical question: What leads some young people toward violence, and what helps others in the same environment avoid it?

'We can't talk past their reality.'

One theme emerges repeatedly: fear. Many participants describe a persistent sense of paranoia, often fueled by social media conflicts that escalate into real-world threats. For some, carrying a weapon is seen not as aggression but as protection.

Understanding that mindset is key to designing effective prevention.

"We can't talk past their reality," Naik-Mathuria said. "We have to acknowledge it and meet them where they are."

The Rise Up program builds on a strong foundation of epidemiological research. A 2024 study co-authored by Naik-Mathuria found that interpersonal violence accounts for more than three-quarters of pediatric firearm injuries in the Houston area. Additional research has mapped tens of thousands of firearm incidents across Harris County, identifying geographic "hot spots" where targeted interventions could have the greatest impact.

Those findings are guiding where the program is being implemented. In Houston, Rise Up is being introduced in middle schools, health clinics, and youth centers in areas where data indicate a higher risk of community violence.

The project brings together expertise from across UTMB and beyond, reflecting the complexity of the issue.

• Naik-Mathuria serves as principal investigator and anchors the clinical and pediatric trauma perspective.
• From the School of Public and Population Health, Monique Pappadis, PhD, assistant dean for Community-Based Research, leads the project's community engagement work and ensures program materials reflect the lived experience of the families being reached.
• Michael Goodman, MDiv, MPH, DrPH, associate professor in the same department, contributes expertise in community-based digital tools, including the Community Microphone platform that will gather feedback from parents, educators, and community members during program development.
• Dr. Ahmar Hashmi, assistant professor in the School of Health Professions, brings implementation science methods to the focus group and evaluation design.
• The team is rounded out by a parallel rollout in Memphis led by trauma surgeon Dr. Regan Williams at the University of Tennessee and two Houston-based consultants - violence interrupter Victor Gonzales and youth public health expert Jamie Freeny.

Setting the stage for immediate impact and long-term change

Because prevention is inherently long-term, measuring success requires a different approach. The goal of reducing firearm injuries may take years to fully assess. In the meantime, the Rise Up team is tracking changes in attitudes and behaviors that research has linked to future outcomes.

Students participating in the program complete surveys before the intervention, immediately afterward, and again at a three-month follow-up. These surveys measure factors such as attitudes toward conflict, awareness of risk, and perceived access to adult support. Focus groups provide additional qualitative insight into how the program is received and where it can improve.

If the program proves effective, scalability is a central goal. The team plans to make the full curriculum - including videos and facilitator guides - freely available online. This would allow schools, community centers, and health clinics across the country to implement the program, even without access to specialized violence-intervention staff.

"Everyone wants children to be safe," Naik-Mathuria said. "Child and community safety are the core of this study. Vulnerable children living in high-risk urban communities where gun violence is prevalent are often victims or perpetrators of firearm assaults or bystanders caught in the wrong place at the wrong time. They never have the chance to grow up to live safe, normal lives without the fear or consequences of gun violence all around them. We strive to change that."

The three-year project began in October 2025. Youth ambassador interviews are underway in Houston, with Memphis to follow. Video production is scheduled for the second year, and broader implementation and community testing will take place in year three.

At its core, Rise Up represents a shift in how prevention is imagined - not as something done to communities, but something built with them. And in this case, it starts by listening to the voices that are too often overlooked - young people themselves.