Product-oriented approaches to reducing youth gun violence

Injury prevention experts have suggested that gun manufacturers could reduce youth violence by changing the design of guns. Product safety features could make guns more difficult for children to fire unintentionally and more difficult to use if stolen or obtained illegally. This article gives a brief history of efforts to make safer, smarter guns and assesses the potential of the product safety approach for reducing youth gun violence. Among the article's key findings: Research from the injury prevention field suggests that changing product design may be more effective in preventing injuries than trying to change personal behaviors; Existing product safety technologies for guns could reduce unintentional gun injuries, especially to young children. In addition, emerging technologies will enable gun manufacturers to "personalize" guns, which could prevent unauthorized users of any age from firing the weapons. Personalization could decrease access to guns by adolescents; Gun manufacturers have been slow to incorporate safety features into their products; but legislative, regulatory, and litigation efforts are under way to mandate safer guns. The authors envision a future when the law requires product safety features--including personalization--on all new firearms. These product safety features have the potential to reduce both intentional and unintentional firearm injury and death.     

Are medical societies developing a standard for gun injury prevention?

CONTEXT: Following heightened gun violence in the 1990s, many medical societies in the United States adopted policies on the topic. OBJECTIVE: Identify points of firearm violence policy agreement among large medical organizations. DESIGN: Fourteen national medical societies-clinical focus, demonstrated interest in gun injury prevention, >2000 members-were selected for policy review in 2002. Policies were categorized on areas covered and items within these. Consensus areas were addressed by >/=7/14 societies.Consensus items were included by >/=7/14 societies, shared items by 5-6. RESULTS: There were five consensus areas: access prevention, gun commerce, research, public education, and clinical counseling. There were four consensus items: restricting gun access by enforcing existing laws, restricting access to all guns at the point of sale, restricting access to handguns at the point of sale, and creating a national database on gun injury and death. Shared items promote violence prevention, clinical education on risks of guns in the home, treating guns as consumer products, restricting gun access to children, bans on automatic weapons, and promoting trigger locks. CONCLUSIONS: Large medical societies in the United States agree on key approaches for reducing gun injury mortality and morbidity. Future research will be needed to track the evolution of this emerging standard for physician action, which now includes the consensus areas and items. It promises to be, in effect, a medical standard of care for gun injury prevention. The United States experience may be useful to others working on gun injury prevention.     

Parental attitudes toward BB and pellet guns

As well as describing our pediatric BB and pellet gun injuries and the circumstances surrounding these injuries, we also evaluated parental perceptions of the dangers of BB and pellet guns. A convenience sample of three groups of parents and their children presenting to a Midwest, urban, children's hospital emergency department was prospectively enrolled. The three groups of parents included the injured group, which consisted of the parents whose children had been injured by BB or pellet guns; the gun group, which consisted of the parents who allowed their children to possess BB or pellet guns but had not sustained injury from these guns; and the no gun group, which consisted of the parents who did not allow their children to have these guns. All parents completed a survey concerning their attitudes toward BB and pellet guns. Twenty-eight parents completed questionnaires in each of the three groups. Most BB and pellet gun injuries occurred in adolescent males at home without adult supervision and were inflicted by a friend or by themselves. The injured group and the no gun group viewed BB and pellet guns as significantly more dangerous than the gun group. Parents who allow their children to have BB or pellet guns appear to misperceive their potential for injury by allowing their children to use these guns in an unsafe manner. Clinicians must educate parents about the significant potential for injury of nonpowdered guns.     

Parental misperceptions about children and firearms

OBJECTIVE: To assess the accuracy of parental predictions about their children's self-reported behavior around household guns. DESIGN: Survey. SETTING: Family practice clinic in rural Alabama. PARTICIPANTS: Convenience sample of parents and their children aged 5 to 14 years. INTERVENTION: Questionnaires about firearms administered separately to children and their parents. MAIN OUTCOME MEASURES: Rates of concordance and discordance between parents and their children living in homes with guns about whether the children knew the storage location of household firearms and had ever handled firearms in the home. RESULTS: Of 420 parent-child dyads, 314 agreed to participate; 201 of the 314 homes contained guns. Children younger than 10 years were as likely as older children to report knowing the storage location (73% vs 79%, respectively) and to report having handled a household gun (36% vs 36%, respectively). Thirty-nine percent of parents who reported that their children did not know the storage location of household guns and 22% of parents who reported that their children had never handled a household gun were contradicted by their children's reports. Such discordance between parent and child reports was unrelated to whether parents stored their firearms locked away or had ever discussed firearm safety with their children. CONCLUSIONS: Many parents who were living in homes with firearms and who reported that their children had never handled firearms in their homes were contradicted by their children's self-reports. Parents who locked their guns away and discussed gun safety with their children were as likely to be contradicted as parents who did not take such safety measures.     

Mitigating the effects of gun violence on children and youth

Countless children and youth are exposed to gun violence each year--at home, at school, in their communities, or through the media. Gun violence can leave lasting emotional scars on these children. This article reviews research regarding the psychological effects of gun violence on children and youth, and offers suggestions for how parents, school administrators, and mental health workers can mitigate these negative effects. Children exposed to gun violence may experience negative short- and long-term psychological effects, including anger, withdrawal, posttraumatic stress, and desensitization to violence. All of these outcomes can feed into a continuing cycle of violence. Certain children may be at higher risk for negative outcomes if they are exposed to gun violence. Groups at risk include children injured in gun violence, those who witness violent acts at close proximity, those exposed to high levels of violence in their communities or schools, and those exposed to violent media. Parents, school administrators, and mental health workers all can play key roles in protecting children from gun violence and helping them overcome the effects of gun-related trauma. The authors recommend a number of strategies that adults can adopt to help children cope with gun violence, such as increasing parental monitoring, targeting services to youth at risk of violent activity, and developing therapeutic interventions to help traumatized young people.     

Youth,guns, and violent crime

Young people are overrepresented as both victims and perpetrators of violence. Indeed, some commentators have suggested that recent cohorts of youth have been composed of "superpredators" who have little regard for human life. The evidence, however, suggests that other factors are responsible for recent increases in youth gun violence. This article analyzes the extent and causes of youth violence in the United States, paying particular attention to the late 1980s and early 1990s, when rates of homicide and robbery committed by youth rose to extremely high levels. Examination of trends for these crimes shows that: The increase in violence in the United States during the late 1980s and early 1990s was due primarily to an increase in violent acts committed by people under age 20. Similarly, dramatic declines in homicide and robbery in recent years are attributable primarily to a decline in youth violence. The increase in youth homicide was predominantly due to a significant increase in the use of handguns, which converted ordinary teenage fights and other violent encounters into homicides. Several other interrelated factors also fueled the rise in youth violence, including the rise of illegal drug markets, particularly for crack cocaine, the recruitment of youth into those markets, and an increase in gun carrying among young people. The author points out that youth violence diminished as the crack markets shrank, law enforcement increased efforts to control youth access to guns, youth gun carrying declined, and the robust economy provided legitimate jobs for young people.     

What pediatricians can do to further youth violence prevention—a qualitative study

OBJECTIVE: Youth violence is a public health problem world wide. However, the United States has the worst rate of youth violence among industralized countries. This study was conducted to learn what pediatricians, community leaders, and parents think the doctor's role is in youth violence prevention during the well-child examination for children. METHODS: Interviews were conducted with pediatricians, community leaders, and parents living or working in Los Angeles, California. RESULTS: All three groups interviewed believed that the physician should incorporate violence prevention counseling as part of the well-child examination. The mechanism of action differed for the three groups. Almost half of pediatricians' statements focused on their role as prevention counselor, with respect to such issues as appropriate discipline and gun safety. One third of community leaders' statements, however, related to physician referral to existing community resources. More than half of parents' statements referred to the pediatrician as someone who can directly educate their child about making positive choices. CONCLUSIONS: Although pediatricians cannot solve the problem of youth violence alone, findings from this study suggest that they should address this issue with their patients and should work in tandem with existing community resources to further a solution to this growing epidemic.     

Factors preventing gun acquisition and carrying among incarcerated adolescent males

CONTEXT: Despite the wide availability of guns in the United States, not all delinquent adolescents own guns and not all adolescent gun owners carry them at all times. Research about the factors that prevent high-risk youth from acquiring and carrying guns is limited. OBJECTIVE: To determine, from the perspective of incarcerated adolescent males, factors that prevent acquiring or carrying guns, either on a temporary or permanent basis. DESIGN AND SETTING: In-depth, semistructured interviews were conducted with randomly selected incarcerated adolescent males at a residential juvenile justice facility from January to May 1998. Transcribed interviews were examined for recurrent themes. PARTICIPANTS: Forty-five incarcerated adolescent males. MAIN OUTCOME MEASURES: Reported factors limiting gun acquisition and carrying. RESULTS: Seventy-one percent of the sample had either owned or carried a gun out of their home. We identified 6 recurring themes that, at least on occasion, prevented or delayed delinquent youth from acquiring or carrying guns. The most commonly cited factors were fear of being arrested and incarcerated and lack of perceived need for a gun. Other themes included not wanting to hurt oneself or others, respect for the opinions of others, inability to find a source for a desired gun, and lack of money to acquire a desired gun. CONCLUSIONS: We identified 6 factors that limited gun acquisition and carrying among a sample of incarcerated male adolescents. Knowledge of these factors should inform intervention efforts to reduce youth gun acquisition and carrying.     

National survey of pediatricians' violence prevention counseling.

BACKGROUND: Recommendations for child health care providers to counsel patients and their families on violence prevention have been issued by a number of major health care organizations. OBJECTIVE: To assess the knowledge, attitudes, training, and practices of pediatricians concerning violence prevention counseling in the areas of family violence, discipline, television viewing, peer violence, and guns in the home. DESIGN: Survey. PARTICIPANTS: A national random sample of 1350 pediatricians, divided equally among residents in their final year of training, practitioners who had completed their residency training within the last 5 years, and those who had completed their training more than 5 years ago. MAIN OUTCOME MEASURES: Knowledge, attitudes, training, and current practices regarding violence prevention counseling. RESULTS: The overall response rate was 41%. When providing health supervision to patients, most pediatricians never or rarely screen for family and community violence, peer violence, and weapons. For example, 68% of residents and 73% of practitioners never or rarely screen for domestic violence, 56% of residents and 67% of practitioners never or rarely ask adolescents about their involvement in physical fighting, and 54% of residents and 56% of practitioners never or rarely identify families who have guns in the home. Regarding preparation for providing violence prevention counseling, 76% of residents and 83% of practitioners rated their training as inadequate. Receiving training in the prevention of child/adolescent violence in medical school (P<.001), residency (P<.001), or fellowship/continuing medical education (P=.002) were major determinants of more frequent violence prevention counseling. Pediatricians who believed that parents rarely or never follow through on a physician's advice about safe gun storage, switching to nonviolent disciplining techniques, or limiting their child's television viewing were less likely to ask or advise patients in these areas. CONCLUSIONS: Pediatricians are not adequately prepared to provide violence prevention counseling, and few currently screen for exposure to family and community violence, peer violence, and access to weapons. Comprehensive information about violence prevention should be integrated into medical education, and the efficacy of violence prevention counseling strategies should be evaluated.     

Characteristics of a gun exchange program, and an assessment of potential benefits

Objectives—To describe a gun exchange program and assess potential benefits for participants and host communities.

Methods—Mail survey of participants in a Sacramento, California gun exchange program, August 1993; the response rate was 79%. Comparative data were obtained from nationwide polls of gun owners.

Results—Most (62%) respondents were men; 40% were more than 55 years old; none was less than 25. Concern that children might find and use the gun was the most frequently cited reason for participating (46% of respondents). Of 141 firearms exchanged, 72% were handguns; 23% of respondents indicated that the guns they turned in were not in working order. Of respondents who owned a gun at the time of the program (rather than those who owned no guns and turned in a gun owned by someone else), 41% owned no guns after participating; the prevalence of handgun ownership declined from 79% to 32%. Those who continued to own guns were as likely as gun owners nationwide to keep a gun loaded in the house (odds ratio (OR) 0.9, 95% confidence interval (CI) 0.4 to 1.7) or to carry a gun with them (OR 1.5, 95% CI 0.6 to 3.8).

Conclusions—Gun exchange programs may reduce risk for firearm violence among some participants, but a number of factors limit their overall benefits to host communities.

     

The role of schools in combating illicit substance abuse

Disturbingly high levels of illicit drug use remain a problem among American teenagers. As the physical, social, and psychological "home away from home" for most youth, schools naturally assume a primary role in substance abuse education, prevention, and early identification. However, the use of random drug testing on students as a component of drug prevention programs requires additional, more rigorous scientific evaluation. Widespread implementation should await the result of ongoing studies to address the effectiveness of testing and evaluate possible inadvertent harm. If drug testing on students is conducted, it should never be implemented in isolation. A comprehensive assessment and therapeutic management program for the student who tests positive should be in place before any testing is performed. Schools have the opportunity to work with parents, health care professionals, and community officials to use programs with proven effectiveness, to identify students who show behavioral risks for drug-related problems, and to make referrals to a student's medical home. When use of an illicit substance is detected, schools can foster relationships with established health care experts to assist them. A student undergoing individualized intervention for using illicit substances merits privacy. This requires that awareness of the student's situation be limited to parents, the student's physician, and only those designated school health officials with a need to know. For the purposes of this statement, alcohol, tobacco, and inhalants are not addressed.     

Firearm-related death and injury among children and adolescents

As the articles in this journal issue show, gun violence affects children and youth in many ways: psychologically, emotionally, financially, and legally. But first and foremost, gun violence affects children's physical safety. Therefore, this issue opens with an overview of the physical toll that firearms exact upon children and youth, reviewing the incidence of firearm-related injury and death among Americans under age 20. This article analyzes trends and current status in firearm death and injury, based on nationwide data collected by the federal government. Several key findings emerge from the data: Firearm death rates among children and youth in the United States have declined dramatically since 1993, but remain high compared with historical rates in this country and rates in other developed nations. A majority of these deaths are homicides. Certain groups of children and youth, especially adolescents, boys, minority youth, and those residing outside the Northeast, are particularly at risk for firearm death. The problem is most acute among black teenage males. Firearm injuries are much more likely to result in death than are other injuries for which children and youth visit emergency departments--a reflection of the extreme lethality of firearms. Given these findings, the authors call for a concerted effort to reduce youth firearm deaths to levels comparable to those of other industrialized nations, using a wide variety of approaches that span the public health, criminal justice, and educational spheres. They also recommend improved data systems to track firearm injury and death, so that researchers can better analyze these incidents and evaluate intervention strategies.     

Where the guns come from: the gun industry and gun commerce

Under federal law, it is illegal for youth under age 18 to purchase rifles or shotguns, and for those under age 21 to purchase handguns. However, fatality and injury statistics clearly show that guns are finding their way into young people's hands. Many of these youth obtain guns through illegal gun markets. This article focuses on how guns in the United States are manufactured, marketed, and sold. The article shows how the legal and illegal gun markets are intimately connected and make guns easily accessible to youth. Although the domestic gun manufacturing industry is relatively small and has experienced declining sales in recent years, it has significant political clout and a large market for its products, and has engaged in aggressive marketing to youth. Lax oversight of licensed firearms dealers, combined with little or no regulation of private sales between gun owners, mean that guns can quickly moved from the legal gun market into the illegal market, where they can be acquired by young people. Certain guns, especially inexpensive, poorly made small handguns, are particularly attractive to criminals and youth. The author observes that several policy innovations--including increased regulation of licensed firearms dealers, intensified screening of prospective buyers, regulation of private sales, gun licensing and registration, and bans on some types of weapons--hold promise for decreasing the flow of guns into the hands of youth.     

Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight

Although a large body of research has assessed direct genetic links between parent and child weight status, relatively little research has assessed the extent to which parents (particularly parents who are overweight) select environments that promote overweight among their children. Parents provide food environments for their children's early experiences with food and eating. These family eating environments include parents' own eating behaviors and child-feeding practices. Results of the limited research on behavioral mediators of familial patterns of overweight indicate that parents' own eating behaviors and their parenting practices influence the development of children's eating behaviors, mediating familial patterns of overweight. In particular, parents who are overweight, who have problems controlling their own food intake, or who are concerned about their children's risk for overweight may adopt controlling child-feeding practices in an attempt to prevent overweight in their children. Unfortunately, research reveals that these parental control attempts may interact with genetic predispositions to promote the development of problematic eating styles and childhood overweight. Although the authors have argued that behavioral mediators of family resemblances in weight status, such as parents' disinhibited or binge eating and parenting practices are shaped largely by environmental factors, individual differences in these behaviors also have genetic bases. A primary public health goal should be the development of family-based prevention programs for childhood overweight. The findings reviewed here suggest that effective prevention programs must focus on providing anticipatory guidance on parenting to foster patterns of preference and food selection in children more consistent with healthy diets and promote children's ability to self-regulate intake. Guidance for parents should include information on how children develop patterns of food intake in the family context. Practical advice for parents includes how to foster children's preferences for healthy foods and how to promote acceptance of new foods by children. Parents need to understand the costs of coercive feeding practices and be given alternatives to restricting food and pressuring children to eat. Providing parents with easy-to-use information regarding appropriate portion sizes for children is also essential as are suggestions on the timing and frequency of meals and snacks. Especially during early and middle childhood, family environments are the key contents for the development of food preferences, patterns of food intake, eating styles, and the development of activity preferences and patterns that shape children's developing weight status. Designing effective prevention programs will, however, require more complete knowledge than currently available regarding behavioral intermediaries that foster overweight, including the family factors that shape activity patterns, meals taken away from home, the impact of stress on family members' eating styles, food intake, activity patterns, and weight gain. The research presented here provides an example of how ideas regarding the effects of environmental factors and behavioral mediators on childhood overweight can be investigated. Such research requires the development of reliable and valid measures of environmental variables and behaviors. Because childhood overweight is a multifactorial problem, additional research is needed to develop and test theoretic models describing how a wide range of environmental factors and behavioral intermediaries can work in concert with genetic predispositions to promote the development of childhood overweight. The crucial test of these theoretic models will be in preventive interventions.     

Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985–99

OBJECTIVE: To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts. SETTING: The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually. METHODS: National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS. RESULTS: BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881-17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments. CONCLUSIONS: BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations.     

Effects of gun admonitions on the behaviors and attitudes of school-aged boys

Gun-safety programs frequently warn children not to touch guns with little consideration that the messages may enhance the allure of the guns. In the current study, boys rated and ranked their preference for a gun in comparison with other desirable objects. One week later, when left alone in the room with the objects, they were forbidden to touch either the gun or some other object. Observations of their behavior and reevaluation of their attitudes followed. Although the boys forbidden to touch the gun did not report an increased preference for it, all participants were significantly more likely to touch the forbidden gun than to touch other forbidden objects. Age, parent- and coach-reported simulated gun-play, and coach-reported risky behavior predicted gun-touching behavior. The results of the current study indicate that guns hold a unique allure and cast further doubt on the ability of gun admonitions to keep children safe around guns.     

Interpersonal violence

Interpersonal violence is unfortunately part of the social landscape for many American children. Physicians who care for children and adolescents may find it challenging to incorporate techniques to "screen and intervene" for violence. In order to guide these youth toward safety, the clinician must recognize the scope of the problem, understand the risk factors for violent injury, apply this knowledge to clinical practice, and either refer clients to or implement interventions on behalf of these youth. Unfortunately, despite an overall decrease in firearm mortality in the past few years, the prevalence and severity this problem in American adolescents remain high. Recent studies have further elucidated the demographic, behavioral, environmental, and psychosocial factors that may identify the high-risk patient. Other important work has concentrated on applying these risk factors in clinical settings. In addition, small but significant steps have been made toward educating physicians about their role in violence prevention. Finally, we have begun to scientifically evaluate interventions designed to keep youth from becoming part of a very grim statistic. This review focuses on the most recent advances that have been made toward addressing violence as a public health concern.     

Policing guns and youth violence

To combat the epidemic of youth gun violence in the 1980s and 1990s, law enforcement agencies across the United States adopted a variety of innovative strategies. This article presents case studies of eight cities' efforts to police gun crime. Some cities emphasized police-citizen partnerships to address youth violence, whereas others focused on aggressive enforcement against youth suspected of even minor criminal activity. Still others attempted to change youth behavior through "soft" strategies built on alternatives to arrest. Finally, some cities used a combination of approaches. Key findings discussed in this article include: Law enforcement agencies that emphasized police-citizen cooperation benefited from a more positive image and sense of legitimacy in the community, which may have enhanced their efforts to fight crime. Aggressive law enforcement strategies may have contributed to a decline in youth gun violence, but they also may have cost police legitimacy in minority communities where residents felt that the tactics were unfair or racially motivated. Approaches that emphasize nonarrest alternatives and problem-solving strategies offer an intriguing but unproven vision for addressing youth gun violence. None of the initiatives presented in the case studies has been shown conclusively to reduce youth gun crime over the long term. The author suggests that policing alone cannot contain youth gun violence, but by carefully balancing enforcement with community collaboration, police departments can help shift social norms that contribute to youth gun violence.     

Teaching firearm safety to children: failure of a program

The present study investigated the effectiveness of a skills-based firearm safety program on reducing children's play with firearms. In a randomized control study, 34 children aged 4 to 7 years participated in a week-long firearm safety program; the Control Group was composed of 36 children. After the program, pairs of children were observed playing in a structured setting in which they had access to a semiautomatic pistol. A total of 53% of the pairs played with the gun, and there was no difference in gun-play behavior between those children who did and did not receive the intervention. Interview data revealed significant discrepancies in parent and child reports of parental gun ownership and inaccurate parental predictions of their children's interest in guns. The results of the current study cast doubt on the potential effectiveness of skills-based gun safety programs for children.