Abstract
Firearm violence is the leading cause of death in children and adolescents in the United States, impacting children of all socioeconomic status, race, and ethnicity, though with significant burden in minority populations. Pediatricians have a unique role in prevention of firearm injury and mortality through intervention, education, and advocacy. Specifically, pediatricians can screen to identify those at risk, counsel patients and families to prevent firearm injuries, work within local communities to improve targeted intervention strategies, and participate in national advocacy groups. By taking a personal responsibility and a public health approach, pediatric health care providers play a pivotal in decreasing the burden of firearm injury, mortality, and adherence to gun safety.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Cunningham RM, Goldstick J, Carter PM. The major causes of death in children. Reply. N Engl J Med. 2019;380(14):1385. https://doi.org/10.1056/NEJMc1901264.
Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003. J Trauma. 2011;70(1):238–43. https://doi.org/10.1097/TA.0b013e3181dbaddf.
Fowler KA, Dahlberg LL, Haileyesus T, Gutierrez C, Bacon S. Childhood firearm injuries in the United States. Pediatrics. 2017;140(1):3486. https://doi.org/10.1542/peds.2016-3486.
Roberts B, James D, Haft J, Balakrishnan N, Prince J, Sathya C. Wounding patterns in pediatric firearm fatalities. Injury. 2023;54(1):154–9. https://doi.org/10.1016/j.injury.2022.11.072.
Azrael D, Cohen J, Salhi C, Miller M. Firearm storage in gun-owning households with children: results of a 2015 national survey. J Urban Health. 2018;95(3):295–304. https://doi.org/10.1007/s11524-018-0261-7.
Salhi C, Azrael D, Miller M. Parent and adolescent reports of adolescent access to household firearms in the United States. JAMA Netw Open. 2021;4(3):e210989. https://doi.org/10.1001/jamanetworkopen.2021.0989.
Iantorno SE, Swendiman RA, Bucher BT, Russell KW. Surge in pediatric firearm injuries presenting to US Children’s Hospitals during the COVID-19 pandemic. JAMA Pediatr. 2023;177(2):204–6. https://doi.org/10.1001/jamapediatrics.2022.4881.
Sakran JV, Nance M, Riall T, Asmar S, Chehab M, Joseph B. Pediatric firearm injuries and fatalities: do racial disparities exist? Ann Surg. 2020;272(4):556–61. https://doi.org/10.1097/sla.0000000000004390.
Turner HA, Mitchell KJ, Jones LM, Hamby S, Wade R Jr, Beseler CL. Gun violence exposure and posttraumatic symptoms among children and youth. J Trauma Stress. 2019;32(6):881–9. https://doi.org/10.1002/jts.22466.
Lowe SR, Galea S. The mental health consequences of mass shootings. Trauma Violence Abuse. 2017;18(1):62–82. https://doi.org/10.1177/1524838015591572.
Pulcini CD, Goyal MK, Hall M, et al. Mental health utilization and expenditures for children pre-post firearm injury. Am J Prev Med. 2021;61(1):133–5. https://doi.org/10.1016/j.amepre.2021.01.024.
Riehm KE, Mojtabai R, Adams LB, et al. Adolescents’ concerns about school violence or shootings and association with depressive, anxiety, and panic symptoms. JAMA Netw Open. 2021;4(11):e2132131. https://doi.org/10.1001/jamanetworkopen.2021.32131.
Dowd MD, Sege RD. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):1416–23. https://doi.org/10.1542/peds.2012-2481.
Petty JK, Henry MCW, Nance ML, Ford HR. Firearm injuries and children: position statement of the American Pediatric Surgical Association. J Pediatr Surg. 2019;54(7):1269–76. https://doi.org/10.1016/j.jpedsurg.2019.03.001.
Ranney ML, Betz ME, Dark C. #ThisIsOurLane - firearm safety as health care’s highway. N Engl J Med. 2019;380(5):405–7. https://doi.org/10.1056/NEJMp1815462.
Ojo A, Guntuku SC, Zheng M, Beidas RS, Ranney ML. How health care workers wield influence through Twitter hashtags: retrospective cross-sectional study of the gun violence and COVID-19 public health crises. JMIR Public Health Surveill. 2021;7(1):e24562. https://doi.org/10.2196/24562.
Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health: violence: a global public health problem. Lancet. 2002;360(9339):1083–8. https://doi.org/10.1016/s0140-6736(02)11133-0.
Hughes BD, Cummins CB, Shan Y, Mehta HB, Radhakrishnan RS, Bowen-Jallow KA. Pediatric firearm injuries: racial disparities and predictors of healthcare outcomes. J Pediatr Surg. 2020;55(8):1596–603. https://doi.org/10.1016/j.jpedsurg.2020.02.021.
Naik-Mathuria BJ, Cain CM, Alore EA, Chen L, Pompeii LA. Defining the full spectrum of pediatric firearm injury and death in the United States: it’s even worse than we think. Ann Surg. 2023;278(1):10–6. https://doi.org/10.1097/sla.0000000000005833.
Nordin A, Coleman A, Shi J, Wheeler K, **ang H, Kenney B. In harm’s way: unintentional firearm injuries in young children. J Pediatr Surg. 2018;53(5):1020–3. https://doi.org/10.1016/j.jpedsurg.2018.02.036.
Ranney M, Karb R, Ehrlich P, Bromwich K, Cunningham R, Beidas RS. What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A sco** review. J Behav Med. 2019;42(4):724–40. https://doi.org/10.1007/s10865-019-00035-2.
Coyne-Beasley T, Schoenbach VJ, Johnson RM. “Love our kids, lock your guns”: a community-based firearm safety counseling and gun lock distribution program. Arch Pediatr Adolesc Med. 2001;155(6):659–64. https://doi.org/10.1001/archpedi.155.6.659.
Schmidt CJ, Rupp L, Pizarro JM, Lee DB, Branas CC, Zimmerman MA. Risk and protective factors related to youth firearm violence: a sco** review and directions for future research. J Behav Med. 2019;42(4):706–23. https://doi.org/10.1007/s10865-019-00076-7.
Beam DR, Szabo A, Olson J, Hoffman L, Beyer KM. Vacant lot to community garden conversion and crime in Milwaukee: a difference-in-differences analysis. Inj Prev. 2021;27(5):403–8.
Guitart D, Pickering C, Byrne J. Past results and future directions in urban community gardens research. Urban For Urban Green. 2012;11(4):364–73.
American Academy of Pediatrics, editor. Bright futures. 4th ed. Elk Grove Village: American Academy of Pediatrics; 2017.
Rowhani-Rahbar A, Simonetti JA, Rivara FP. Effectiveness of interventions to promote safe firearm storage. Epidemiol Rev. 2016;38(1):111–24. https://doi.org/10.1093/epirev/mxv006.
Wintemute GJ, Betz ME, Ranney ML. Yes, you can: physicians, patients, and firearms. Ann Intern Med. 2016;165(3):205–13. https://doi.org/10.7326/m15-2905.
Roberts B, Masiakos PT, Vacek J, Sathya C. Firearm injury and mortality prevention in pediatric health-care settings. Pediatr Rev. 2022;43(4):212–21. https://doi.org/10.1542/pir.2020-001305.
Sathya C, Kapoor S. Universal screening for firearm injury risk could reduce healthcare’s hesistancy in talking to patients about firearm safety. Ann Surg Open. 2022;3(1):e121. https://doi.org/10.1097/as9.0000000000000121.
Levy SJ, Williams JF. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016;138(1):1211. https://doi.org/10.1542/peds.2016-1211.
Lyons MS, Lindsell CJ, Ruffner AH, et al. Randomized comparison of universal and targeted HIV screening in the emergency department. J Acquir Immune Defic Syndr. 2013;64(3):315–23. https://doi.org/10.1097/QAI.0b013e3182a21611.
Baxley F, Miller M. Parental misperceptions about children and firearms. Arch Pediatr Adolesc Med. 2006;160(5):542–7. https://doi.org/10.1001/archpedi.160.5.542.
King A, Simonetti J, Bennett E, et al. Firearm storage practices in households with children: a survey of community-based firearm safety event participants. Prev Med. 2020;131:105952. https://doi.org/10.1016/j.ypmed.2019.105952.
Barkin SL, Finch SA, Ip EH, et al. Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial. Pediatrics. 2008;122(1):e15–25. https://doi.org/10.1542/peds.2007-2611.
Carbone PS, Clemens CJ, Ball TM. Effectiveness of gun-safety counseling and a gun lock giveaway in a Hispanic community. Arch Pediatr Adolesc Med. 2005;159(11):1049–54. https://doi.org/10.1001/archpedi.159.11.1049.
Pediatrics AA. Screening for suicide risk in clinical practice. https://www.aap.org/en/patient-care/blueprint-for-youth-suicide-prevention/strategies-for-clinical-settings-for-youth-suicide-prevention/screening-for-suicide-risk-in-clinical-practice/.
McCarty CA, Russo J, Grossman DC, et al. Adolescents with suicidal ideation: health care use and functioning. Acad Pediatr. 2011;11(5):422–6. https://doi.org/10.1016/j.acap.2011.01.004.
Davis M, Johnson C, Pettit AR, et al. Adapting safety check as a universal suicide prevention strategy in pediatric primary care. Acad Pediatr. 2021;21(7):1161–70. https://doi.org/10.1016/j.acap.2021.04.012.
Yip PS, Caine E, Yousuf S, Chang SS, Wu KC, Chen YY. Means restriction for suicide prevention. Lancet. 2012;379(9834):2393–9. https://doi.org/10.1016/s0140-6736(12)60521-2.
Mueller KL, Naganathan S, Griffey RT. Counseling on access to lethal means-emergency department (CALM-ED): a quality improvement program for firearm injury prevention. West J Emerg Med. 2020;21(5):1123–30. https://doi.org/10.5811/westjem.2020.5.46952.
Miller M, Salhi C, Barber C, et al. Changes in firearm and medication storage practices in homes of youths at risk for suicide: results of the SAFETY study, a clustered, emergency department-based, multisite, stepped-wedge trial. Ann Emerg Med. 2020;76(2):194–205. https://doi.org/10.1016/j.annemergmed.2020.02.007.
Barkin S, Duan N, Fink A, Brook RH, Gelberg L. The smoking gun: do clinicians follow guidelines on firearm safety counseling? Arch Pediatr Adolesc Med. 1998;152(8):749–56. https://doi.org/10.1001/archpedi.152.8.749.
Hoops K, Crifasi C. Pediatric resident firearm-related anticipatory guidance: why are we still not talking about guns? Prev Med. 2019;124:29–32. https://doi.org/10.1016/j.ypmed.2019.04.020.
Olson LM, Christoffel KK, O’Connor KG. Pediatricians’ involvement in gun injury prevention. Inj Prev. 2007;13(2):99–104. https://doi.org/10.1136/ip.2006.012401.
Garbutt JM, Bobenhouse N, Dodd S, Sterkel R, Strunk RC. What are parents willing to discuss with their pediatrician about firearm safety? A parental survey. J Pediatr. 2016;179:166–71. https://doi.org/10.1016/j.jpeds.2016.08.019.
Sege RD, Hatmaker-Flanigan E, De Vos E, Levin-Goodman R, Spivak H. Anticipatory guidance and violence prevention: results from family and pediatrician focus groups. Pediatrics. 2006;117(2):455–63. https://doi.org/10.1542/peds.2005-0377.
Crifasi CK, Doucette ML, McGinty EE, Webster DW, Barry CL. Storage practices of US gun owners in 2016. Am J Public Health. 2018;108(4):532–7. https://doi.org/10.2105/ajph.2017.304262.
Johnson-Young EA, McDonald D, Burrell T, et al. Understanding pediatric residents’ communication decisions regarding anticipatory guidance about firearms. J Health Commun. 2020;25(3):243–50. https://doi.org/10.1080/10810730.2020.1745961.
Roszko PJ, Ameli J, Carter PM, Cunningham RM, Ranney ML. Clinician attitudes, screening practices, and interventions to reduce firearm-related injury. Epidemiol Rev. 2016;38(1):87–110. https://doi.org/10.1093/epirev/mxv005.
Grossman DC, Cummings P, Koepsell TD, et al. Firearm safety counseling in primary care pediatrics: a randomized, controlled trial. Pediatrics. 2000;106(1):22–6. https://doi.org/10.1542/peds.106.1.22.
Puttagunta R, Coverdale TR, Coverdale J. What is taught on firearm safety in undergraduate, graduate, and continuing medical education? A review of educational programs. Acad Psychiatry. 2016;40(5):821–4. https://doi.org/10.1007/s40596-016-0490-6.
McKay S, Bagg M, Patnaik A, et al. Addressing firearm safety counseling: integration of a multidisciplinary workshop in a pediatric residency program. J Grad Med Educ. 2020;12(5):591–7. https://doi.org/10.4300/jgme-d-19-00947.1.
Clary C, Lambarth L, Kaushik R. Locked and (un)-loaded discussions: a pediatric resident safe firearm storage counseling curriculum. MedEdPORTAL. 2020;16:11028. https://doi.org/10.15766/mep_2374-8265.11028.
Naureckas Li C, Sacks CA, Cummings BM, Samuels-Kalow M, Masiakos PT, Flaherty MR. Improving pediatric residents’ screening for access to firearms in high-risk patients presenting to the emergency department. Acad Pediatr. 2021;21(4):710–5. https://doi.org/10.1016/j.acap.2021.01.002.
Gastineau KAB, Stegall CL, Lowrey LK, Giourgas BK, Andrews AL. Improving the frequency and documentation of gun safety counseling in a resident primary care clinic. Acad Pediatr. 2021;21(1):117–23. https://doi.org/10.1016/j.acap.2020.07.013.
Betz ME, Wintemute GJ. Physician counseling on firearm safety: a new kind of cultural competence. JAMA. 2015;314(5):449–50. https://doi.org/10.1001/jama.2015.7055.
Purtle J, Dicker R, Cooper C, et al. Hospital-based violence intervention programs save lives and money. J Trauma Acute Care Surg. 2013;75(2):331–3. https://doi.org/10.1097/TA.0b013e318294f518.
Johnson SB, Bradshaw CP, Wright JL, Haynie DL, Simons-Morton BG, Cheng TL. Characterizing the teachable moment: is an emergency department visit a teachable moment for intervention among assault-injured youth and their parents? Pediatr Emerg Care. 2007;23(8):553–9. https://doi.org/10.1097/PEC.0b013e31812c6687.
Nofi CP, Roberts BK, Cornell E, et al. Hospital-based violence intervention programs to reduce firearm injuries in children: a sco** review. J Pediatr Surg. 2023;58(11):2212–21.
Brooke BS, Efron DT, Chang DC, Haut ER, Cornwell EE. Patterns and outcomes among penetrating trauma recidivists: it only gets worse. J Trauma. 2006;61(1):16–9; discussion 20. https://doi.org/10.1097/01.ta.0000224143.15498.bb.
Smith R, Dobbins S, Evans A, Balhotra K, Dicker RA. Hospital-based violence intervention: risk reduction resources that are essential for success. J Trauma Acute Care Surg. 2013;74(4):976–80; discussion 980-2. https://doi.org/10.1097/TA.0b013e31828586c9.
Strong BL, Shipper AG, Downton KD, Lane WG. The effects of health care–based violence intervention programs on injury recidivism and costs: a systematic review. J Trauma Acute Care Surg. 2016;81(5):961–70.
Stokes SC, McFadden NR, Salcedo ES, Beres AL. Firearm injuries in children: a missed opportunity for firearm safety education. Inj Prev. 2021;27(6):554–9. https://doi.org/10.1136/injuryprev-2020-044051.
Goldstick JE, Carter PM, Walton MA, et al. Development of the SaFETy score: a clinical screening tool for predicting future firearm violence risk. Ann Intern Med. 2017;166(10):707–14. https://doi.org/10.7326/m16-1927.
Butkus R, Doherty R, Bornstein SS, et al. Reducing firearm injuries and deaths in the United States: a position paper from the American College of Physicians. Ann Intern Med. 2018;169(10):704–7. https://doi.org/10.7326/m18-1530.
Miller M, Zhang W, Azrael D. Firearm purchasing during the COVID-19 pandemic: results from the 2021 national firearms survey. Ann Intern Med. 2022;175(2):219–25. https://doi.org/10.7326/m21-3423.
Weinberger SE, Hoyt DB, Lawrence HC, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015;162(7):513–6. https://doi.org/10.7326/m15-0337.
Talley CL, Campbell BT, Jenkins DH, et al. Recommendations from the American College of Surgeons Committee on Trauma’s Firearm Strategy Team (FAST) Workgroup: Chicago consensus I. J Am Coll Surg. 2019;228(2):198–206. https://doi.org/10.1016/j.jamcollsurg.2018.11.002.
Surgeons AC. Firearm injury prevention activities. https://www.facs.org/quality-programs/trauma/advocacy-and-injury-prevention/firearm-injury-prevention-activities/.
Pediatrics AA. Gun violence prevention. https://www.aap.org/en/advocacy/gun-violence-prevention/.
Barber C, Cook PJ, Parker ST. The emerging infrastructure of US firearms injury data. Prev Med. 2022;165(Pt A):107129. https://doi.org/10.1016/j.ypmed.2022.107129.
Cunningham RM, Carter PM, Zimmerman M. The Firearm Safety Among Children and Teens (FACTS) Consortium: defining the current state of the science on pediatric firearm injury prevention. J Behav Med. 2019;42(4):702–5. https://doi.org/10.1007/s10865-019-00077-6.
Funded Surveillance. 2023. https://www.cdc.gov/violenceprevention/firearms/funded-surveillance.html.
What is the Cardiff Violence Prevention Model? 2023. https://www.cdc.gov/violenceprevention/about/fundedprograms/cardiffmodel/whatis.html.
Morrall A. The science of gun policy: a critical synthesis of research evidence on the effects of gun policies in the United States. Rand Health Q. 2018;8(1):5.
Madhavan S, Taylor JS, Chandler JM, Staudenmayer KL, Chao SD. Firearm legislation stringency and firearm-related fatalities among children in the US. J Am Coll Surg. 2019;229(2):150–7. https://doi.org/10.1016/j.jamcollsurg.2019.02.055.
Kivisto AJ, Phalen PL. Effects of Risk-Based Firearm Seizure Laws in Connecticut and Indiana on Suicide Rates, 1981-2015. Psychiatr Serv. 2018;69(8):855–62. https://doi.org/10.1176/appi.ps.201700250.
Stevens J, Pickett K, Reppucci ML, Nolan M, Moulton SL. National trends in pediatric firearm and automobile fatalities. J Pediatr Surg. 2023;58(1):130–5. https://doi.org/10.1016/j.jpedsurg.2022.09.028.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Roberts, B., Nofi, C., Cornell, E., Sathya, C. (2024). Pediatric Healthcare Providers are the Cornerstone of Firearm Injury Prevention. In: Fornari, V., Dancyger, I., Silver, P. (eds) Pediatric Nonadherence. Springer, Cham. https://doi.org/10.1007/978-3-031-58141-0_10
Download citation
DOI: https://doi.org/10.1007/978-3-031-58141-0_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-58140-3
Online ISBN: 978-3-031-58141-0
eBook Packages: MedicineMedicine (R0)