Improving Injury Prevention Capacity in the Child Death Review Process: Best Practices: Firearm

List of Potential Interventions

Overview

Firearms are responsible for over 38,500 deaths per year. Injuries resulting from firearms are estimated to be 5 fold higher than deaths. Motor vehicle crashes, in comparison, result in approximately 42,500 deaths per year in the US. In 6 states, firearm deaths exceed motor vehicle deaths.

Firearm injuries are the third leading cause of injury death for Washington children 10-17 years old. Firearm injury rates were highest among males 15-17 years old. Most (91 percent) of the firearm deaths among Washington children were intentional (50% suicide; 41% homicide). The majority (73 percent) of all the deaths occurred in the home of the child, a friend, or a relative. Firearms used in most of the child deaths in Washington State were not stored safely.

The intent of firearm death is not always clear: a death that is unintended may still be classified as "suicide" if the child shoots himself or "homicide" if the child shoots another. Unintentional firearm injuries are thus likely underreported based on death certificate analysis (Schaechter 2003). Despite this potential for confusion, many strategies to combat intentional injury are equally effective in addressing unintentional firearm injury death. We thus consider these interventions together. Additional intervention suggestions may be found in the Suicide and Homicide sections of this decision support tool.

The 1994 National Survey of the Private Ownership of Firearms (NSPOF) reported that American adults owned 192 million working firearms, an average of one per adult (Cook, 1996). The NSPOF also indicated that firearm ownership was unevenly distributed in the population: only 24.6% of U.S. adults owned a firearm (41.8% of men and 9.0% of women). Another survey reported that 35% of homes with children aged <18 years had at least one firearm (Schuster MA, Franke TM, Bastian AM, Sor S, Halfon N. Firearm storage patterns in US homes with children. Am J Public Health 2000;90:588). About 25% of Washington 12th graders surveyed reported that it was "easy" to get access to a handgun.

Of the estimated 192 million firearms owned in the United States at the time of the 1994 NSPOF survey, 65 million were handguns; 70 million, rifles; 49 million, shotguns; and the remainder were other guns. Among handgun owners, 34.0% kept their guns loaded and unlocked. An estimated 10 million handguns, one sixth of the handguns owned, were regularly carried by their owners, approximately half in the owners' cars and the other half on the owners' persons.

Gun violence is a public health problem as well as a criminal justice problem. Firearm injuries should be addressed and dealt with in a similar fashion as the injury prevention community has addressed other types of injuries. The multifaceted approach to motor vehicle injuries has resulted in a decline in motor vehicle deaths in spite of ever increasing number of miles traveled. A similar approach is suggested for combating firearm injuries using education, product modification, environmental modification and legislation and regulation.

References

Cook PJ, Ludwig J. Guns in America: results of a comprehensive national survey on firearms ownership and use. Washington, DC: US Department of Justice, National Institute of Justice, 1996.

Schaechter J, et al. Are "accidental" gun deaths as rare as they seem? A comparison of medical examiner manner of death coding with an intent-based classification approach. Pediatrics. 2003 Apr;111(4 Pt 1):741-4.

The Violence Prevention Internet Guide
The American Association for the Surgery of Trauma site provides educational tools, reports and links to other resources to address firearms injury.

HELP Network
The HELP Network's annotated bibliography of Gun Injury Prevention Research.

American Academy of Pediatrics
The American Academy of Pediatrics' Violence Prevention site.

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