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School shootings, like firearm violence more broadly, have profound health consequences for both directly exposed individuals and their surrounding communities. However, compared to other traumatic events, the long-term health impacts of school shootings remain understudied. While cumulative and chronic trauma has been widely linked to substance use behaviors, the effects of singular, high-intensity traumatic events—such as school shootings—are often overlooked. Yet, adolescents may turn to substances as a means of coping with the psychological distress and physical injuries associated with such tragedies, placing them at increased risk for substance use initiation or escalation. This study addresses this critical gap by examining the relationship between school shooting exposure and adolescent substance use behaviors. Drawing on trauma and behavioral health theories, and supported by empirical evidence from a difference-in-differences analysis, this research highlights the need for trauma-informed policies and prevention strategies aimed at mitigating substance use risk among affected youth. Findings contribute to a growing understanding of how mass violence influences adolescent well-being and underscore the importance of early intervention efforts.