Firearm-Related Injuries Affecting the Pediatric Population
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Organizational Principles to Guide and Define the Child
Health Care System and/or Improve the Health of all Children
POLICY STATEMENT
Firearm-Related Injuries Affecting the Pediatric
Population
The absence of guns from children’s homes and communities is the COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION
most reliable and effective measure to prevent firearm-related inju- EXECUTIVE COMMITTEE
ries in children and adolescents. Adolescent suicide risk is strongly KEY WORDS
associated with firearm availability. Safe gun storage (guns unloaded child, adolescent, violence, homicide, suicide, injury,
epidemiology, policy
and locked, ammunition locked separately) reduces children’s risk of
ABBREVIATIONS
injury. Physician counseling of parents about firearm safety appears AAP—American Academy of Pediatrics
to be effective, but firearm safety education programs directed at NVDRS—National Violent Death Reporting System
children are ineffective. The American Academy of Pediatrics con- This document is copyrighted and is property of the American
tinues to support a number of specific measures to reduce the de- Academy of Pediatrics and its Board of Directors. All authors
structive effects of guns in the lives of children and adolescents, have filed conflict of interest statements with the American
Academy of Pediatrics. Any conflicts have been resolved through
including the regulation of the manufacture, sale, purchase, owner- a process approved by the Board of Directors. The American
ship, and use of firearms; a ban on semiautomatic assault weapons; Academy of Pediatrics has neither solicited nor accepted any
and the strongest possible regulations of handguns for civilian use. commercial involvement in the development of the content of
this publication.
All policy statements from the American Academy of Pediatrics
SCOPE OF THE PROBLEM automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
Although rates have declined since the American Academy of Pediatrics
(AAP) issued the original policy statement in 1992, firearm-related
deaths continue as 1 of the top 3 causes of death in American youth.1 As
shown in Fig 1, the firearm-associated death rate among youth ages
15 to 19 has fallen from its peak of 27.8 deaths per 100 000 in 1994 to
11.4 per 100 000 in 2009, driven by a decline in firearm homicide
rates.1 No single study has adequately explained the decline in firearm-
related homicide rates. Postulated reasons include improved socio-
economic conditions, violence prevention programs, decline in the
crack/cocaine market, changes in legislation, declines in firearms
www.pediatrics.org/cgi/doi/10.1542/peds.2012-2481
availability for other reasons, and community policing. Nevertheless,
firearm-associated death and disability rates remain unacceptably doi:10.1542/peds.2012-2481
high. PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2012 by the American Academy of Pediatrics
Of all injury deaths of individuals 15 through 19 years of age in the
United States in 2009, more than 1 (28.7%) in 4 were firearm related,
and of those younger than 20 years, nearly 1 (19.5%) in 5 were firearm
related.1 These firearm deaths result from homicide, suicide, and
unintentional injury (Fig 2). Black Americans are particularly affected;
injuries from firearms were the leading cause of death among black
males 15 through 34 years of age in 2009.2 Although national data
cannot fully document urban and rural differences in the patterns of
injuries from firearms that involve children, local data indicate that
children in rural areas as well as in urban areas are at risk for
firearm-related mortality.3–5
e1416 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Downloaded from www.aappublications.org/news by guest on March 18, 2019
FROM THE AMERICAN ACADEMY OF PEDIATRICS
the detailed history and circumstances
of the fatal incident. Data concerning
mental health, substance abuse, race,
age group, previous history, method of
injury, and relationship of suspect to
victim are included. Suspects and mul-
tiple victims can be studied together,
allowing for comparisons of victim and
perpetrator characteristics.6–8 The NVDRS
can provide useful information concern-
ing childhood mortality from firearms;
FIGURE 1
Firearm-related death rates per 100 000 people 15 through 19 years of age in the United States, 1995–
limited raw data from this system are
2009. (Adapted from National Center for Injury Prevention and Control, US Centers for Disease now available online.1
Control and Prevention. Web-Based Injury Statistics Query & Reporting System (WISQARS) Injury
Mortality Reports, 1999–2009, for national, regional, and states [May, 2012]. Available at: http://
webappa.cdc.gov/sasweb/ncipc/. Accessed June 8, 2012). INTERNATIONAL COMPARISONS
The United States has the highest rates
of firearm-related deaths (including
homicide, suicide, and unintentional
deaths) among high-income countries.9
For youth 15 to 24 years of age, fire-
arm homicide rates, as documented by
Richardson and Hemenway,9 were 35.7
times higher than in other countries.
For children 5 to 14 years of age,
firearm suicide rates were 8 times
higher, and death rates from un-
intentional firearm injuries were 10
times higher in the United States than
other high-income countries. The dif-
ference in rates may be related to the
ease of availability of guns in the
United States compared with other
high-income countries. This is particu-
larly true for suicides, as guns carry
a high case-fatality rate.10 Suicides
among the young are typically impul-
sive,11 and easy access to lethal
weapons largely determines outcome.
FIGURE 2 ECONOMIC COSTS OF
Injury intent: US 2009 firearm-related deaths, for all ages (n = 31 593) and in children from birth FIREARM-RELATED INJURY
through 19 years of age (n = 2966). (Adapted from National Center for Injury Prevention and Control,
US Centers for Disease Control and Prevention. Web-Based Injury Statistics Query & Reporting Corso and colleagues12 calculated the
System (WISQARS) Injury Mortality Reports, 1999–2009, for national, regional, and states [May, 2012].
Available at: http://webappa.cdc.gov/sasweb/ncipc/. Accessed June 8, 2012).
financial cost to society resulting from
gun-related assaults and homicides
in 2000. The amount totaled $17.4 bil-
lion, including $0.8 billion in direct
The National Violent Death Reporting all violent deaths in participating states. medical costs and $16.6 billion in lost
System (NVDRS), administered by the The NVDRS system uses sources of data productivity. In the same year, self-
Centers for Disease Control and Pre- to allow analysis of each death (homi- inflicted firearm injuries and suicides
vention, provides detailed surveillance of cides, suicides, and others), including cost society $16.4 billion, including
PEDIATRICS Volume 130, Number 5, November 2012 e1417
Downloaded from www.aappublications.org/news by guest on March 18, 2019
$16.3 billion in lost productivity and
$0.1 billion in direct medical costs. The
analysis found that average direct
medical cost per case for nonfatal fire-
arm assaults and self-inflicted injuries
resulting in hospitalization were $24 353
and $7234 respectively.12 The method for
calculating the medical costs includes
ambulance transport costs, coroner/
medical examiner costs, emergency de-
partment costs, hospital readmission
costs, and inpatient hospitalization and/
or nursing home costs.12 Work loss FIGURE 3
Firearm-related death rates per 100 000 black and white people 15 through 19 years of age in the
costs were calculated by the net present United States, 2009. (Adapted from National Center for Injury Prevention and Control, US Centers for
value of future wage earning and losses Disease Control and Prevention. Web-Based Injury Statistics Query & Reporting System (WISQARS)
in household productivity. Injury Mortality Reports, 1999–2009, for national, regional, and states [May, 2012]. Available at:
http://webappa.cdc.gov/sasweb/ncipc/. Accessed June 8, 2012).
HOMICIDE
In 2009, 84.5% of all homicides of in schools, although rare, deserves percentage of suicides in rural areas,
people 15 through 19 years of age serious study and calls for local and where they are more widely avail-
were firearm-related.1 Deaths of male national responses. able.17,18 Strong evidence suggests
individuals outnumber deaths of fe- that the presence of firearms in the
male individuals (Fig 3). Young black home increases the risk of suicide
men from 15 through 34 years of age SUICIDE among adolescents. A review of exist-
have the highest rates of firearm- Suicide Risk Among Adolescents ing data from case-control studies
related homicide.1 In 2010 in the and Firearm Availability and ecological data found that firearm
United States, 67.5% of all homicides In 2009, suicide was the third leading availability plays a large role in in-
were committed with a firearm, and cause of death for American youth 15 creasing the risk of youth suicide.19
in 68.5% of those cases, a handgun to 19 years of age. Firearms remained Several individual-level and ecologic
was used as the murder weapon.13 the most common method used for studies, including nationally repre-
Firearm homicide rates were higher suicide in this age group, accounting sentative studies, have corroborated
in major urban areas than in the for 736 deaths (3.4 per 100 000).1 Of all these earlier findings.20–24 The asso-
nation as a whole (5.2 per 100 000 vs common methods used for attempting ciation of a gun in the home and
4.2 per 100 000). Within the 50 largest suicide, firearms are the most lethal, increased risk of suicide among ado-
metropolitan areas, they were highest with approximately a 90% mortality lescents has been well documented.
in the central cities (9.7 per 100 000).3 rate.15 Adolescents are at a relatively From a clinical perspective, it is im-
An understanding of the characteristics high risk of attempting suicide as portant to note that this association is
of firearm-related homicides is impor- a consequence of their often impul- significant even in those teens without
tant when interventions are being sive behavior. Choosing a highly lethal a previous psychiatric diagnosis.25,26
planned. Most homicides occur during method such as a firearm to attempt The odds of suicide are particularly
interpersonal conflict, typically be- suicide leads to higher suicide fatality high if the gun is kept loaded.25,26
tween relatives, friends, or acquain- rates overall, in part because most Data concerning the effects of laws
tances.13 Recognized risk factors for survivors of serious suicide attempts restricting firearm ownership show
violence involving children and ado- do not die of renewed attempts.16 varying results.27–29 Interestingly, laws
lescents include exposure to family Thus, easy access to firearms con- reducing child access, which primar-
violence, history of antisocial behavior, tributes to an increased risk of sui- ily requires safe storage, appear to
depression, suicidal ideation, drug/ cide among youth this age. Although be associated with lower overall ado-
alcohol use, poor school performance, handguns are used in most youth lescent suicide rates, whereas pur-
bullying, and isolation from peer firearm suicides, long guns (shotguns chase restrictions did not result in
groups.14 The occurrence of shootings and rifles) are also used in a large this reduction.29 Other studies have
e1418 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Downloaded from www.aappublications.org/news by guest on March 18, 2019FROM THE AMERICAN ACADEMY OF PEDIATRICS
established the finding that safe Well-established behavioral risk fac- stored a gun unlocked, and 8.3%
storage of firearms reduces the risk tors for carrying guns include gang stored at least 1 gun unlocked and
of adolescent suicide.30 membership, use of alcohol and other loaded.40 Household firearm owners
drugs, victimization by violence, and with adolescents 13 through 17 years
UNINTENTIONAL perpetration of violence.34–36 As with of age report leaving their firearms
FIREARM-RELATED DEATHS other risk behaviors, adolescents sub- unlocked 41.7% of the time, compared
stantially overestimate the percentage
In 2009, 114 children and adolescents with only 28.8% of household firearm
of their peers who carry guns, and
younger than 20 years died as a result of owners with children 0 through 12
interestingly, gun carrying is highly
unintentional firearm-related injuries.1 associated with that normative per-
years of age.40
Perhaps surprisingly, 66 of these 114 ception.35 Adolescence is marked by Most gun owners report the leading
unintentional deaths occurred in the 15- a search for identity, independence, motivation for ownership is recrea-
to 19-year age group. Fatal shootings and autonomy. Accompanying charac- tional; however, nearly three-quarters
are usually inflicted by other children or teristics may be curiosity, the strong of handgun owners said self-protection
youth, typically friends or siblings.31,32 influence of the peer group, rites of was the primary reason for owning
There are few recent systemically col- passage, belief in invincibility, impul- a gun.41 Research in several US urban
lected data concerning the precise cir- siveness, immaturity, mood swings, areas indicates that a gun stored in
cumstances of unintentional firearm and substance abuse. The perception the home is associated with a three-
injury deaths among these 114 children. of danger by adolescents may be fold increase in the risk of homicide
influenced by many factors, including and a fivefold increase in the risk of
NONFATAL FIREARM-RELATED the media, as well as the reality of suicide.42–44 Evidence from Philadelphia
INJURIES their own lives. A view of the world as suggests that firearm possession
a dangerous place during this partic- increases the risk of being shot in an
According to data from emergency
ularly vulnerable developmental period assault. In a carefully conducted case-
departments in the 66 hospitals in the
may lead to conflict, injury, and death, control study, Branas and colleagues
National Electronic Injury Surveillance
especially when access to guns is easy. found that people possessing a gun
System All-Injury Program, an estimated
were more than 4 times more likely to
73 505 people of all ages were treated
be shot in an assault than those not in
for nonfatal firearm-related injuries in GUNS AND GUN OWNERSHIP possession of a firearm.45
US hospital emergency departments in
It is estimated that 57 million Amer-
2010, among them 15 576 children and
icans owned 283 million firearms
adolescents younger than 20 years.1 Of LEGAL ISSUES
in 2004, representing 38% of all
those, 6236 (40%) required hospitali-
households and 26% of all adults A 2008 Supreme Court decision struck
zation for their injuries. Adolescents 15
having or owning at least 1 gun. Of down the handgun ban in the District of
to 19 years of age had nonfatal firearm
these, 60% were long guns and the Columbia, concluding that the second
injury rates nearly 3 times that of the
remaining 40% were handguns.37 Of amendment to the US Constitution
general population (62.9 vs 23.9 per
the handguns, 50% were revolvers, establishes individual rights to gun
100 000).1 Most (79%) of the nonfatal
35% were semiautomatic pistols, ownership.46 In the subsequent 2010
injuries to adolescents were attribut-
and 15% were other types.37 More Supreme Court case of McDonald v the
able to assault, and assault-related
recently, there has been a troubling City of Chicago, the Court ruled that
injuries were responsible for 84.5% of
increase in serious and disabling the 14th Amendment extends the 2nd
hospitalizations.1
injuries resulting from high-velocity Amendment protections of the federal
nonpowder guns.38 government to states and localities
ADOLESCENT CHARACTERISTICS Prevalence of gun ownership by against laws that infringe on “the right
AND ACCESS TO GUNS household varies significantly geo- to keep and bear arms.”47
The 2011 National Youth Risk Behavior graphically, with an estimated low of Because Chicago was the only locality
Surveillance reported that 5.1% of 5.2% in the District of Columbia to in the country to possess an outright
students in grades 9 through 12 had 62.8% of all households in Wyoming.39 handgun ban, the McDonald ruling
carried guns during the past month, In a study of gun-owning Americans did not have an immediate effect on
with boys more likely to report car- with children under 18 years of age, state and local gun laws outside the
rying guns than girls (8.6% vs 1.4%).33 21.7% stored a gun loaded, 31.5% Chicago area. The ruling set the stage
PEDIATRICS Volume 130, Number 5, November 2012 e1419
Downloaded from www.aappublications.org/news by guest on March 18, 2019for Second Amendment legal chal- as well as limiting access by un- education result in reductions in de-
lenges to local and state gun laws, authorized users. These include trig- linquency56; however, one study has
however, including laws requiring the ger locks, lock boxes, personalized shown that, for seventh-grade chil-
safe storage of firearms and trigger safety mechanisms, and trigger pres- dren exposed to high levels of violence
locks, as well as laws aimed at pro- sures that are too high for young as victims or witnesses, a conflict-
tecting children from firearms. There children.48 A multisite study found that resolution class produced more anxi-
have been and will likely continue to be keeping a gun locked and keeping ety, depression, and aggression.57
a number of state and local legal a gun unloaded have protective effects School curricula aimed at reducing
challenges to restrictions on firearm of 73% and 70%, respectively, with violence should be specific to the
acquisition and use in the United regard to risk of both unintentional population and include evaluation
States. These include challenges to injury and suicide for children and components to determine their effec-
measures specifically pertaining to teenagers. These findings were con- tiveness.58
access to firearms by children. Pedia- sistent for both handguns and long The AAP statement on youth violence
tricians should, nonetheless, continue guns (rifles and shotguns).30 prevention suggests many ways in
to provide anticipatory guidance to Gun avoidance programs are designed which pediatricians and communities
children and their families regarding to educate children as a way of can respond to violence.59 This policy
keeping children safe from injury, reducing firearm injury (eg, Eddie endorses use of the Connected Kids:
including restriction of access to guns. Safe, Strong, Secure violence-prevention
Eagle, STAR); however, several evalua-
tion studies have demonstrated that program. This program provides coun-
such programs do not prevent risk seling suggestions concerning a num-
IMPLICATIONS OF DATA FOR behaviors49–51 and may even increase ber of violence-related topics and
PREVENTION STRATEGIES gun handling among children.45 In parent information brochures specifi-
The following summary of data sug- contrast, results of a large national cally related to reducing unintentional
gests a number of intervention strat- randomized controlled trial demon- injuries to young children and suicide
egies: strated that brief physician counsel- risk among adolescents. The Connected
Firearm-related injuries are often ing directed at parents, combined Kids program was developed on the
fatal; primary prevention is essen- with distribution of gunlocks, may be basis of expert opinion and focus
tial. effective in promoting safer storage of groups of parents around the United
guns in homes with children.52 A re-
Suicide fatality rates increase if States.60–62 The clinical guide and
cent randomized controlled trial parent information material provides
guns are present in the home.
found that a safe storage campaign parents with factual information from
Access to guns increases the num- with gun safe distribution was both which they can make their own deci-
ber of conflict-related deaths and feasible and effective at limiting sions. For parents of young children,
injuries. household exposure to unlocked and handgun storage is placed in the con-
Access to guns and unsafe storage loaded guns.53 text of preventing child access to other
practices creates risk of serious A number of factors may be important dangerous household products. Parents
unintentional injury and death. in reducing exposure to violence and of adolescents have counseling and
Most firearm-related injuries and the results of that exposure in children written materials that describe the re-
deaths of children and adolescents and adolescents. Some curricula tar- lationship between the availability of
involve a handgun, but long guns geting younger children and those at lethal weapons and fatal teen suicide
are involved a large number of low risk of violence have been eval- attempts. These concepts have been
unintentional injuries and suicides, uated and have shown positive incorporated in the new Bright Futures
especially in rural areas. results.54 Resiliency-based violence- toolkit, and pediatricians will find items
prevention strategies in preschool concerning gun safety incorporated in-
children have shown improvement in to relevant previsit questionnaires.63
Preventing Firearm Injuries teacher interactional skills supporting The AAP also advocates for reduction of
in Children children’s resiliency and improvement television viewing by children, because
A number of design options have been in children’s prosocial behaviors.55 media exposure results in increases in
proposed to decrease the likelihood Other studies have shown that both childhood and youth violence. In par-
of unintentional injury by a firearm, family support and early childhood ticular, media tends to romanticize the
e1420 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Downloaded from www.aappublications.org/news by guest on March 18, 2019FROM THE AMERICAN ACADEMY OF PEDIATRICS
use of firearms as a means of resolving 2. Health information for parents: b. The AAP supports efforts to re-
conflicts. The AAP policy statement on a. Pediatricians and other child duce the destructive power of
media violence provides specific back- health care professionals are handguns and handgun ammu-
ground information and recommenda- urged to counsel parents about nition via regulation of the man-
tions for pediatricians.64 the dangers of allowing children ufacture and importation of
Pediatricians can benefit from know- and adolescents to have access classes of guns. Engineering
ing local community resources that to guns inside and outside the efforts (eg, personalized safety
assist with guidance when patients home. The AAP recommends that mechanisms and trigger locks)
and families are at high risk of firearm- pediatricians incorporate ques- may be of benefit and need fur-
related injury. Pediatricians may tions about the presence and ther study. Trigger locks, lock
partner with other community mem- availability of firearms into their boxes, gun safes, and safe stor-
bers and community-based organi- patient history taking and urge age legislation are encouraged
zations to identify and publicize these parents who possess guns to by the AAP. Other measures
resources. prevent access to these guns aimed at regulating access of
by children. Safer storage of guns should include legislative
SUMMARY AND guns reduces injuries, and phy- actions, such as mandatory
RECOMMENDATIONS sician counseling linked with dis- waiting periods, closure of the
tribution of cable locks appear gun show loophole, mental
Firearm-related injury to children is
to increase safer storage. Never- health restrictions for gun pur-
associated with death and severe
chases, and background checks.
morbidity and is a significant public theless, the safest home for
health problem. Child health care a child or adolescent is one with- c. The AAP recommends restora-
professionals can and should provide out firearms. tion of the ban on the sale of
effective leadership in efforts to pre- assault weapons to the gen-
b. The presence of guns in the
vent gun violence, injury, and death. eral public.
home increases the risk of le-
The AAP recognizes the importance thal suicidal acts among adoles- 4. The AAP supports the funding of
of a variety of countermeasures (ed- cents. Health care professionals research related to the preven-
ucational, environmental, engineering, should counsel the parents of tion of firearm injury, including
enactment, enforcement, economic all adolescents to remove guns surveillance through the NVDRS;
incentives, and evaluation) to dra- from the home or restrict ac- accurate evaluation of health
matically curb the number of firearm- cess to them. This advice should care–based screening and inter-
related injuries to children. The AAP be reiterated and reinforced for vention; and local, regional, and
makes the following recommenda- national efforts to identify and
patients with mood disorders,
tions, which reaffirm and expand on the disseminate violence prevention
substance abuse problems (in-
1992 and 2000 policy statements65,66: resources.
cluding alcohol), or a history of
1. The AAP affirms that the most ef- suicide attempts. 5. The AAP supports the education of
fective measure to prevent suicide, 3. The AAP urges that guns be sub- physicians and other professionals
homicide, and unintentional firearm- ject to consumer product regu- interested in understanding the
related injuries to children and lations regarding child access, effects of firearms and how to re-
adolescents is the absence of guns safety, and design. In addition, duce the morbidity and mortality
from homes and communities. Al- the AAP continues to support law associated with their use.
though the US Supreme Court rul- enforcement activities that trace
LEAD AUTHORS
ing in the case of McDonald v City the origins of firearms used in M. Denise Dowd, MD, MPH
of Chicago struck down compre- the commission of crimes and Robert D. Sege, MD, PhD
hensive local and statewide fire- that these data be used to enforce
arm bans, pediatricians should regulations aimed at preventing COUNCIL ON INJURY, VIOLENCE, AND
continue to advocate for the stron- illegal sales to minors. POISON PREVENTION EXECUTIVE
COMMITTEE, 2012–2013
gest possible legislative and regu- a. Evidence supports the effective- H. Garry Gardner, MD, Chairperson
latory approaches to prevent firearm ness of regulation that limits Kyran P. Quinlan, MD, MPH, Chairperson-elect
injuries and deaths. child access to firearms. Michele Burns Ewald, MD
PEDIATRICS Volume 130, Number 5, November 2012 e1421
Downloaded from www.aappublications.org/news by guest on March 18, 2019Beth E. Ebel, MD, MSc, MPH PAST COUNCIL EXECUTIVE Michael S. Turner, MD
Richard Lichenstein, MD COMMITTEE MEMBERS Jeffrey Weiss, MD
Marlene D. Melzer-Lange, MD Mary E. Aitken, MD, MPH
LIAISON
Joseph O’Neil, MD, MPH Carl R. Baum, MD Natalie Yanchar, MD — Canadian Paediatric
Wendy J. Pomerantz, MD, MS
M. Denise Dowd, MD, MPH Society
Elizabeth C. Powell, MD
Seth J. Scholer, MD, MPH Dennis R. Durbin, MD, MSCE STAFF
Gary A. Smith, MD, DrPH Benjamin D. Hoffman, MD Bonnie Kozial
REFERENCES
1. National Center for Injury Prevention and injuries in the United States population. 22. Wiebe DJ. Homicide and suicide risks as-
Control, US Centers for Disease Control and Ann Emerg Med. 2000;35(3):258–266 sociated with firearms in the home: a na-
Prevention. Web-Based Injury Statistics Query 11. Gould MS, Greenberg T, Velting DM, Shaffer tional case-control study. Ann Emerg Med.
& Reporting System (WISQARS) Injury Mor- D. Youth suicide risk and preventive inter- 2003;41(6):771–782
tality Reports, 1999–2009, for national, ventions: a review of the past 10 years. 23. Miller M, Azrael D, Hepburn L, Hemenway D,
regional, and states (May, 2012). Available J Am Acad Child Adolesc Psychiatry. 2003; Lippmann SJ. The association between
at: http://www.cdc.gov/injury/wisqars/fatal_ 42(4):386–405 changes in household firearm ownership
injury_reports.html. Accessed June 8, 2012 12. Corso PS, Mercy JA, Simon TR, Finkelstein and rates of suicide in the United States,
2. Centers for Disease Control and Pre- EA, Miller TR. Medical costs and pro- 1981-2002. Inj Prev. 2006;12(3):178–182
vention, National Center for Health Sta- ductivity losses due to interpersonal and 24. Miller M, Hemenway D, Azrael D. Firearms
tistics. About Underlying Cause of Death self-directed violence in the United States. and suicide in the northeast. J Trauma.
1999–2009. Available at: http://wonder. Am J Prev Med. 2007;32(6):474–482 2004;57(3):626–632
cdc.gov/ucd-icd10.html. Accessed July 25, 13. Federal Bureau of Investigation. Crime in the 25. Brent DA, Perper JA, Moritz G, Baugher M,
2012 United States. Washington, DC. Available at: Schweers J, Roth C. Firearms and adolescent
3. Centers for Disease Control and Prevention. www.fbi.gov/about-us/cjis/ucr/crime-in-the-u. suicide. A community case-control study. Am
Violence-related firearm deaths among s/2010/crime-in-the-u.s.-2010/violent-crime/ J Dis Child. 1993;147(10):1066–1071
residents of metropolitan areas and cities – murdermain. Accessed January 10, 2012 26. Brent DAPJ, Perper J, Moritz G, Baugher M,
United States, 2006-2007. MMWR Morb 14. Dwyer K, Osher D, Wanger C. Early Warning, Allman C. Suicide in adolescents with no
Mortal Wkly Rep. 2011;60(18):573–578 Timely Response: A Guide to Safe Schools. apparent psychopathology. J Am Acad Child
4. Annest JL, Mercy JA, Gibson DR, Ryan GW. Washington, DC: US Department of Educa- Adolesc Psychiatry. 1993;32(3):494–500
National estimates of nonfatal firearm- tion; 1998 27. Caron J, Julien M, Huang JH. Changes in
related injuries. Beyond the tip of the 15. Elnour AA, Harrison J. Lethality of suicide suicide methods in Quebec between 1987
iceberg. JAMA. 1995;273(22):1749–1754 methods. Inj Prev. 2008;14(1):39–45 and 2000: the possible impact of bill C-17
5. Nance ML, Carr BG, Kallan MJ, Branas CC, 16. Owens D, Horrocks J, House A. Fatal and requiring safe storage of firearms. Suicide
Wiebe DJ. Variation in pediatric and ado- non-fatal repetition of self-harm. Systematic Life Threat Behav. 2008;38(2):195–208
lescent firearm mortality rates in rural review. Br J Psychiatry. 2002;181:193–199 28. Kapusta ND, Etzersdorfer E, Krall C, Sonneck
and urban US counties. Pediatrics. 2010; 17. Zwerling C, Lynch CF, Burmeister LF, Goertz G. Firearm legislation reform in the
125(6):1112–1118 U. The choice of weapons in firearm sui- European Union: impact on firearm avail-
6. Centers for Disease Control and Prevention cides in Iowa. Am J Public Health. 1993;83 ability, firearm suicide and homicide rates
(CDC). Homicide and suicide rates— (11):1630–1632 in Austria. Br J Psychiatry. 2007;191:253–257
national violent death reporting system, six 18. Dresang LT. Gun deaths in rural and urban 29. Webster DW, Vernick JS, Zeoli AM, Manganello
states, 2003. MMWR Morb Mortal Wkly Rep. settings: recommendations for prevention. JA. Association between youth-focused fire-
2005;54(15):377–380 J Am Board Fam Pract. 2001;14(2):107–115 arm laws and youth suicides. JAMA. 2004;292
7. Butchart A. The National Violent Death 19. Miller M, Hemenway D. The relationship (5):594–601
Reporting System: a new gold standard for between firearms and suicide: a review of 30. Grossman DC, Mueller BA, Riedy C, et al.
the surveillance of violence related deaths? the literature. Aggress Violent Behav. 1999; Gun storage practices and risk of youth
Inj Prev. 2006;12(suppl 2):ii63–ii64 4(1):59–75 suicide and unintentional firearm injuries.
8. Steenkamp M, Frazier L, Lipskiy N, et al. The 20. Miller M, Lippmann SJ, Azrael D, Hemenway JAMA. 2005;293(6):707–714
National Violent Death Reporting System: an D. Household firearm ownership and rates 31. Hemenway D, Barber C, Miller M. Un-
exciting new tool for public health surveil- of suicide across the 50 United States. intentional firearm deaths: a comparison
lance. Inj Prev. 2006;12(suppl 2):ii3–ii5 J Trauma. 2007;62(4):1029–1034; discus- of other-inflicted and self-inflicted shoot-
9. Richardson EG, Hemenway D. Homicide, sion 1034-1035 ings. Accid Anal Prev. 2010;42(4):1184–1188
suicide, and unintentional firearm fatality: 21. Kung HC, Pearson JL, Wei R. Substance use, 32. Smith DR, Cohen J, Lautman B. Child’s Play:
comparing the United States with other firearm availability, depressive symptoms, A Study of 266 Unintentional Handgun
high-income countries, 2003. J Trauma. and mental health service utilization Shootings of Children. Washington, DC:
2011;70(1):238–243 among white and African American suicide Center to Prevent Handgun Violence; 1992
10. Beaman V, Annest JL, Mercy JA, Kresnow M, decedents aged 15 to 64 years. Ann Epi- 33. Eaton DK, Kann L, Kinchen S, et al; Centers
Pollock DA. Lethality of firearm-related demiol. 2005;15(8):614–621 for Disease Control and Prevention (CDC).
e1422 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Downloaded from www.aappublications.org/news by guest on March 18, 2019FROM THE AMERICAN ACADEMY OF PEDIATRICS
Youth risk behavior surveillance - United 44. Bailey JE, Kellermann AL, Somes GW, Banton 56. Yoshikawa H. Prevention as cumulative
States, 2011. MMWR Surveill Summ. 2012;61 JG, Rivara FP, Rushforth NP. Risk factors for protection: effects of early family support
(4):1–162 violent death of women in the home. Arch and education on chronic delinquency and
34. DuRant RH, Kahn J, Beckford PH, Woods ER. Intern Med. 1997;157(7):777–782 its risks. Psychol Bull. 1994;115(1):28–54
The association of weapon carrying and 45. Branas CC, Richmond TS, Culhane DP, Ten 57. Colyer E, Thompkins T, Durkin M, Barlow B.
fighting on school property and other Have TR, Wiebe DJ. Investigating the link Can conflict resolution training increase
health risk and problem behaviors among between gun possession and gun assault. aggressive behavior in young adolescents?
high school students. Arch Pediatr Adolesc Am J Public Health. 2009;99(11):2034– Am J Public Health. 1996;86(7):1028–1029
Med. 1997;151(4):360–366 2040 58. American Academy of Pediatrics Task Force
35. Hemenway D, Vriniotis M, Johnson RM, 46. District of Columbia v Heller, 554 US 570, on Violence. The role of the pediatrician in
Miller M, Azrael D. Gun carrying by high 128 SCt 2783 (2008) youth violence prevention in clinical prac-
school students in Boston, MA: does over- 47. McDonald v Chicago, 561 US 3025, 130 SCt tice and at the community level. Pediatrics.
estimation of peer gun carrying matter? 3020 (2010) 1999;103(1):173–181
J Adolesc. 2011;34(5):997–1003 48. Naureckas SM, Galanter C, Naureckas ET, 59. Committee on Injury, Violence, and Poison
36. Hayes DN, Sege R. FiGHTS: a preliminary Donovan M, Christoffel KK; The Pediatric Prevention. Policy statement—Role of the
screening tool for adolescent firearms- Practice Research Group. Children’s and pediatrician in youth violence prevention.
carrying. Ann Emerg Med. 2003;42(6):798– women’s ability to fire handguns. Arch Pediatrics. 2009;124(1):393–402
807 Pediatr Adolesc Med. 1995;149(12):1318–1322 60. Sege RD, Flanigan E, Levin-Goodman R,
37. Hepburn L, Miller M, Azrael D, Hemenway D. 49. Hardy MS. Teaching firearm safety to chil- Licenziato VG, De Vos E, Spivak H; American
The US gun stock: results from the 2004 dren: failure of a program. J Dev Behav Academy of Pediatrics. American Academy
national firearms survey. Inj Prev. 2007;13 Pediatr. 2002;23(2):71–76 of Pediatrics’ Connected Kids program: case
(1):15–19 50. Jackman GA, Farah MM, Kellermann AL, study. Am J Prev Med. 2005;29(5 suppl 2):
38. Laraque D; American Academy of Pediatrics Simon HK. Seeing is believing: what do boys 215–219
Committee on Injury, Violence, and Poison do when they find a real gun? Pediatrics. 61. De Vos E, Spivak H, Hatmaker-Flanigan E,
Prevention. Injury risk of nonpowder guns. 2001;107(6):1247–1250 Sege RD. A Delphi approach to reach con-
Pediatrics. 2004;114(5):1357–1361 51. Himle MBM, Miltenberger RG, Gatheridge sensus on primary care guidelines regarding
39. Okoro CA, Nelson DE, Mercy JA, Balluz LS, BJM, Flessner CA. An evaluation of two youth violence prevention. Pediatrics. 2006;
Crosby AE, Mokdad AH. Prevalence of procedures for training skills to prevent 118(4). Available at: www.pediatrics.org/cgi/
household firearms and firearm-storage gun play in children. Pediatrics. 2004;113(1 content/full/118/4/e1109
practices in the 50 states and the District pt 1):70–77 62. Sege RD, Hatmaker-Flanigan E, De Vos E,
of Columbia: findings from the Behavioral 52. Barkin SL, Finch SA, Ip EH, et al. Is office- Levin-Goodman R, Spivak H. Anticipatory
Risk Factor Surveillance System, 2002. based counseling about media use, time- guidance and violence prevention: results
Pediatrics. 2005;116(3). Available at: www. outs, and firearm storage effective? Results from family and pediatrician focus groups.
pediatrics.org/cgi/content/full/116/3/e370 from a cluster-randomized, controlled trial. Pediatrics. 2006;117(2):455–463
40. Johnson RM, Miller M, Vriniotis M, Azrael D, Pediatrics. 2008;122(1). Available at: www. 63. American Academy of Pediatrics. Bright
Hemenway D. Are household firearms pediatrics.org/cgi/content/full/122/1/e15 Futures Previsit Questionnaires. In: Duncan
stored less safely in homes with adoles- 53. Grossman DC, Stafford HA, Koepsell TD, Hill PM, Shaw JS, Gottesman MM, Swanson J,
cents? Analysis of a national random R, Retzer KD, Jones W. Improving firearm Hagan JF, eds. Bright Futures Tool and Re-
sample of parents. Arch Pediatr Adolesc storage in Alaska native villages: a ran- source Kit. Elk Grove Village, IL: American
Med. 2006;160(8):788–792 domized trial of household gun cabinets. Academy of Pediatrics; 2010 [CD-ROM]
41. Cook PJ, Ludwig J. Guns in America: A Na- Am J Public Health. 2012;102(suppl 2): 64. Council on Communications and Media.
tional Survey on Private Ownership and S291–S297 Media violence. Pediatrics. 2009;124(5):
Use of Firearms. Bethesda, MD: National 54. Grossman DC, Neckerman HJ, Koepsell TD, 1495–1503
Institute of Justice; 1997:1–12. Research in et al. Effectiveness of a violence prevention 65. American Academy of Pediatrics, Committee
brief, document fax number 1026 curriculum among children in elementary on Injury and Poison Prevention. Firearm
42. Kellermann AL, Rivara FP, Rushforth NB, school. A randomized controlled trial. injuries affecting the pediatric population.
et al. Gun ownership as a risk factor for JAMA. 1997;277(20):1605–1611 Pediatrics. 1992; 89(4 pt 2):788–790
homicide in the home. N Engl J Med. 1993; 55. Dubas JS, Lynch KB, Galano J, Geller S, Hunt 66. Committee on Injury and Poison Pre-
329(15):1084–1091 D. Preliminary evaluation of a resiliency- vention. American Academy of Pediatrics.
43. Kellermann AL, Rivara FP, Somes G, et al. based preschool substance abuse and vi- Firearm-related injuries affecting the
Suicide in the home in relation to gun own- olence prevention project. J Drug Educ. pediatric population. Pediatrics. 2000;105
ership. N Engl J Med. 1992;327(7):467–472 1998;28(3):235–255 (4 pt 1):888–895
PEDIATRICS Volume 130, Number 5, November 2012 e1423
Downloaded from www.aappublications.org/news by guest on March 18, 2019Firearm-Related Injuries Affecting the Pediatric Population
COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION EXECUTIVE
COMMITTEE
Pediatrics 2012;130;e1416
DOI: 10.1542/peds.2012-2481 originally published online October 18, 2012;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/130/5/e1416
References This article cites 55 articles, 20 of which you can access for free at:
http://pediatrics.aappublications.org/content/130/5/e1416#BIBL
Subspecialty Collections This article, along with others on similar topics, appears in the
following collection(s):
Current Policy
http://www.aappublications.org/cgi/collection/current_policy
Council on Injury, Violence, and Poison Prevention
http://www.aappublications.org/cgi/collection/committee_on_injury_
violence_and_poison_prevention
Injury, Violence & Poison Prevention
http://www.aappublications.org/cgi/collection/injury_violence_-_poi
son_prevention_sub
Firearms
http://www.aappublications.org/cgi/collection/firearms_sub
Permissions & Licensing Information about reproducing this article in parts (figures, tables) or
in its entirety can be found online at:
http://www.aappublications.org/site/misc/Permissions.xhtml
Reprints Information about ordering reprints can be found online:
http://www.aappublications.org/site/misc/reprints.xhtml
Downloaded from www.aappublications.org/news by guest on March 18, 2019Firearm-Related Injuries Affecting the Pediatric Population
COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION EXECUTIVE
COMMITTEE
Pediatrics 2012;130;e1416
DOI: 10.1542/peds.2012-2481 originally published online October 18, 2012;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/130/5/e1416
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2012 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 1073-0397.
Downloaded from www.aappublications.org/news by guest on March 18, 2019You can also read
