Firearm Injury Interventions

Gun Safety Curriculum

Background

One possible strategy to decrease firearm injury and deaths to children is educational programs. These can be directed at the children themselves, or at parents and adults to store guns more safely in the home (or out of the home). The NRA’s Eddie Eagle program is an example of the former type of educational intervention. For more information on gun-safety education, see the section entitled, "Firearm safety training" under the topic Youth Violence.

Unfortunately, few of these educational interventions have been evaluated. We review here those evaluations which have been done to date.


Review of educational interventions:

Author

Hardy et al., 1996

Study design and target population

Randomized controlled trial

24 pairs of preschool children from 2 day care centers in S.E. United States (N.C.) matched on age and sex..

Intervention

30 minute educational intervention stressing not to touch or play with guns and to notify an adult if they saw a gun. Session included firearm safety coloring book, question & answer session, warning by police officer and signing a certificate promising not to touch gun. Parents and children interviewed re gun ownership, access and parental responsibility.

Outcomes

(1) Gun related play measured by video taped structured play sessions before and 1 week after the intervention.

(2) Ability to distinguish toy guns from real guns.

Results

No difference in gun play behavior between intervention and control group (MANOVA p>0.5). No difference between groups for parental gun ownership, SES, attitudes towards gun safety.

False negative errors by the children (believing real guns are toys) more likely than false positive errors (believing toys are real guns), p<0.001.

Study quality and conclusions

Telling children to stay away from guns and notify an adult when they find a gun does not appear to be an effective safety intervention.

Adults should be responsible for protecting children. This was a careful evaluation of educational intervention using observed behavior change, randomization to control group and adjustment for confounding variables.



Author

Davidson et al., 1994

Study design and target population

Before/after study design comparing Central Harlem, to Washington Heights area of New York City from 1988-1991.

Intervention

Multifaceted community wide Safe Kids/Healthy Neighborhoods program targeted at youth 5-16 years of age. It targeted many types of child injury problems, including firearm injuries.

Outcomes

Hospitalization or death due to guns, assault, traffic accidents and outdoor falls. Incidence rates during intervention 1988-91 compared to pre-intervention rates, 1983-88.

Results

Decrease in gun injuries in Central Harlem RR=0.56, 0.31-1.02) compared to Washington Heights, RR=1.58, 0.68-3.66) Decrease in all targeted injuries in Harlem RR=0.56, 0.45-0.71) with no change in all non-targeted injuries RR=1.03, 0.78-1.35) Decrease in both targeted and non targeted injuries in comparison community due to decline in MV injuries.

Study quality and conclusions

Poisson regression models used to adjust for annual and seasonal variations in injury incidence. Local surveillance data collected to validate statewide hospital data. Additional follow up necessary to determine the effects of the program and/or its specific components on the reduction in injury incidence.

Summary of educational interventions

One study of an intervention with pre-school children failed to show an increase in gun safety. The Davidson study26  was a multi-faceted investigation of a variety of problems and interventions, and thus is difficult to know what exactly affected GSW rates.

Recommendations on educational interventions

Unfortunately, not enough data exist to make a recommendation on educational interventions for the prevention of gun injuries to children.

Recommendations on future research

There is a clear need for evaluations of educational programs, particularly safe storage programs and programs educating children about gun safety.

At the present time there is not a systematic framework in place to reduce firearm injuries and deaths. This comprehensive framework should be modeled after that which was developed for motor vehicle injuries beginning in 1968. Specifically, we have the National Highway Traffic Safety Administration (NHTSA), nationwide databases such as FARS and a series of laws and regulations governing motor vehicle. We need a National Firearm Injury Surveillance System which would collect data about fatal and nonfatal firearm related injuries, patterns of firearm ownership and use, and specific information on the models and types of firearms used in homicides, suicides, and unintentional injuries. This database would provide information needed to more precisely define the risks and benefits of gun ownership and modifiable factors that increase the risk of death and injury. Good surveillance data bases are needed to evaluate intervention efforts.

Healthy People 2000 calls for laws in each of the 50 states requiring new handguns be designed to minimize the likelihood of discharge by children and product modification strategy to reduce "accidental" death and injury. Also advocated to help minimize injuries are the reduction in immediate access to loaded guns, changes in the laws for concealed weapon permits, environmental and behavioral measures to increase safe storage of firearms (its purpose being to reduce access to children and adolescents), the reduction of weapon-related violent deaths to 12.6 per 100,000 (it currently stands at 12.9 per 100,000 by firearms and 1.9 per 100,000 by knives).27