Alcohol and guns are everywhere in American society. Researchers say it's a deadly combo.

A fight broke out in a bar and spilled out onto the street early one Saturday morning last month in Melbourne, Florida, leaving three people injured, windows shattered and a bullet lodged in the child car seat of a nearby vehicle.

“This is unacceptable,” Melbourne Mayor Paul Alfrey said after the shooting. The incident spurred city leaders to consider requiring bars and restaurants to obtain extended-hours permits that emphasize security measures in order to serve alcohol.

The shooting in Melbourne is just one of the many incidents of gun violence happening in the U.S. nearly every day — many with a connection to alcohol.

“Alcohol misuse is a risk factor for gun violence,” said Silvia Villarreal, director of research translation at the Johns Hopkins Center for Gun Violence Solutions and lead author of a new report on the intersecting public health issues.

The report by the Consortium for Risk-Based Firearm Policy, a group of more than 30 gun violence experts, and the Center for Gun Violence Solutions recommends policymakers take action to limit access to firearms by people with a documented history of alcohol misuse and restrict firearms at locations where alcohol is consumed.

“One huge part of why we did this is there’s really not a lot of awareness of the data and how many people are affected by this,” Villarreal said in a panel discussion on the report Thursday.

What to know about alcohol and gun violence in the U.S.

Alcohol kills 140,000 people annually, and guns kill more than 48,000, according to data from the U.S. Centers for Disease Control and Prevention.

The two often intersect: An estimated 1 in 3 gun homicide perpetrators drank heavily before murdering their victims, 30% of gun homicide victims drank heavily before being killed, and a quarter of gun suicide victims were heavily drinking before they died by suicide, researchers found.

Among legal gun owners, alcohol misuse (as measured through DUI and other alcohol-related convictions) increases the risk of interpersonal gun violence, including intimate partner violence, a series of studies from the Violence Prevention Research Program at the University of California, Davis, found.

The COVID-19 pandemic only exacerbated these issues. Excessive drinking increased by 21%, and alcohol-related deaths increased approximately 25%, one study found. Meanwhile, gun sales increased by 40% and gun homicides by 35%, and gun suicides had the largest one-year increase ever recorded, two other studies concluded.

Do U.S. laws regulate the risk of alcohol and guns?

Bringing a gun to a place where alcohol is present is legal in many states but prohibited in others. Some states exempt concealed carry permit holders from laws prohibiting firearm possession in places where alcohol is consumed, the report said.

Most states do not have laws prohibiting people who misuse alcohol from purchasing or possessing firearms, the report said. But even states that do often fail to provide clear definitions of who is disqualified, which makes the policies difficult to enforce and hard to evaluate, the researchers said.

Michelle Spencer, deputy director of equity and community partnerships at the Johns Hopkins Center for Gun Violence Solutions, said alcohol has been socialized into our everyday lives and is an “under-appreciated” risk factor for gun violence. “It’s not seen necessarily as a trigger as other substances are viewed,” Spencer said Thursday.

What researchers recommend on alcohol and guns

Drawing on available data, the report authors outlined a series of recommendations. Chief among them, the researchers say states should pass laws prohibiting the purchase and possession of firearms by people convicted of two or more instances within a five-year period of driving under the influence of alcohol or driving while intoxicated.

Female firearm homicide is 19% lower in the five states with DUI penalties that activate federal firearm prohibitions after one or two DUI convictions, compared to states without such laws, a study last year found.

The authors recommend states adopt concealed carry laws to temporarily prohibit anyone with a court record of alcohol misuse within the past five years from receiving a concealed carry license. They also say states and cities should prohibit the public carry or possession of firearms in locations where alcohol is consumed and prohibit people from carrying or possessing firearms while intoxicated.