Background: Since 2019, firearm violence has remained the leading cause of death for U.S. children and adolescents ages 1–19. This crisis has spurred action from policymakers, health professionals, and advocates. However, political polarization has contributed to divergent views on the causes and appropriate responses to firearm violence. Communication by elected officials, especially on social media, plays a critical role in shaping public opinion and policy agendas. Understanding how state policymakers discuss firearm violence, including the use of causal blame, calls to action, and health-related narratives, can inform more effective public health strategies. Objective: To examine how Pennsylvania state legislators discuss firearms and firearm violence on social media and assess the extent to which their messaging aligns with public health perspectives. Methods: We conducted a two-phase mixed-methods analysis of X (formerly Twitter) posts by Pennsylvania state legislators from 05/27/2017 to 07/26/2022. Posts were grouped into three time periods surrounding the Tree of Life Synagogue mass shooting in Pittsburgh. Using a Boolean search strategy, we identified 4,573 posts related to firearms and firearm violence. After removing reposts and non-English content, we randomly sampled 1,491 original posts (32.6%) authored by 152 unique legislators. Posts were coded using a structured codebook based on the Multiple Streams Framework to capture rhetorical framing, causal blame, and policy content. Interrater reliability was high (Holsti’s coefficient > 0.8). We used chi-squared tests and multivariable logistic regression to assess associations between rhetorical elements and policy mentions, adjusting for time period. Results: Mass shootings were the most frequently referenced category of firearm violence, peaking after the Tree of Life shooting (51% vs 77.1% vs 63.6%, P=.004), while firearm suicide was rarely discussed. Posts using advocacy frames were nearly five times more likely to mention policy (aOR 4.67, 95% CI: 3.55–6.16), whereas those referencing mass shootings (aOR 0.54, CI: 0.37–0.77) or emotional appeals (aOR 0.53, CI: 0.40–0.69) were significantly less likely to do so. Most posts employed general advocacy (aOR 2.97) and vague blame (aOR 8.26), resulting in non-specific policy suggestions. Posts that attributed blame to firearm access were strongly associated with specific policy proposals (aOR 6.37) and inversely associated with general policy mentions (aOR 0.26). Only 9.4% of posts used health frames; when present, they more often referenced physical consequences (43.6% vs 15.9%, P

This Viewpoint discusses clinicians as legal petitioners of extreme risk protection orders to promote the safety and well-being of patients and communities.

This Viewpoint discusses clinicians as legal petitioners of extreme risk protection orders to promote the safety and well-being of patients and communities.

An abstract is unavailable.

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Craig Pollack is the Katey Ayers Endowed Professor at the Johns Hopkins School of Nursing and in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

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