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Children, Teens & Firearms – Ask The U-M Experts

– Hello everyone, and welcome to today’s Michigan Medicine live event. I’m Ed Bottomly with the Michigan Medicine Department of Communication, and I’m here with Doctors
Rebecca Cunningham, Patrick Carter, and Mark Zimmerman. All of the professors here at
the University of Michigan, who together lead a new
effort to study the issue of children, teens, and firearm
related injuries and deaths. Their program is called
the FACTS Consortium, and Facts, F-A-C-T-S, is short for the Firearms safety
Among Children and Teens. It’s funded by the National
Institutes of Health, and includes researchers
from across the country. Doctors Cunningham and
Carter are both trained as emergency physicians,
and Professor Zimmerman specializes in studying resilience and violence prevention among teens. They clearly state on the FACTS website that they’re dedicated to reducing child firearm injuries and deaths
while respecting gun ownership as an important part of the
cultural fabric of the US. Just a reminder for this Facebook Live, you can submit your questions
at any time, even now, for our panelists to answer during the Q & A portion of today’s event. Questions can be submitted
in a number of ways. You can comment on this video, but please note that your
name or your profile name will be visible to others participating. If you prefer a more anonymous option, you can also send a private
message to us via Facebook, or you can also email us at [email protected] If you can’t stay for this entire chat, if you’d like to share the recording of this chat with a friend, a video of the chat in its entirety will be available on our Facebook page, and we’ll be putting it up
on the Michigan Medicine YouTube channel soon after that too. So, let’s start with
some of our questions. Question number one. Just how many children die in America every year from firearm related causes, and how does that compare with deaths from other causes? – Patrick, you’re the data guy. – So, thank you, Mark. So, in 2017 there were about,
almost 3500 deaths from firearms among children and
teens in the United States. About, almost 60% of those
deaths were due to homicide. A little under 40% were
due to suicide causes, and about 3% are due to
unintentional injuries, or what traditionally has been
called accidental injuries. Looking back over the
past 10 years of data, firearms have been the second leading cause of death among children
and teens in the country. And if you look at kind
of trends over time among the leading causes of death, we’ve made substantial
progress since the 1950s in reducing motor vehicle crashes, which have been the leading cause of death among children and teens, and significant progress in reducing deaths for cancer related causes, which is the third leading cause of death. But specifically, since about 2003, our progress in reducing firearm deaths has been pretty much flat. And over the past several years, we’ve noticed a little bit of an uptick in the deaths due to
firearm related injuries. – Thank you for that. The next question. Can you break down the
types of firearms deaths among children and teens? How many are what people
might call accidental, compared with those that are on purpose, either because of an
action by another person, or by the person using the gun? And you guys can feel free to chose. – But you just sort of pointed that out. – So like I said, about
60% are due to homicides or intentional injuries, usually
due to impersonal violence, and a little under 40% are due to self inflicted injuries or suicides, and about 3% are what’s
traditionally called accidental injuries, but we like the term unintentional injuries
that are preventable. – I would add just a
couple things to that. I think between 2016 and 2017, we see these rates going up actually, from 2013 on we’ve seen an uptick, and from 2013 to 2016, we’ve seen about a 32% increase in gun homicides among adolescents and children. About a 26% increase in gun suicides among adolescents and children. And we know now, in 2017, we see among those 13 to 17, among all those teenagers in the country, it’s actually the leading cause of death among all of those children. And about 1800 children
under the ages of 18 die every year by firearm in our country. And when we think about that more broadly, our mass shootings that have gotten a lot of visibility have been horrific, 1800 children is actually wiping out an entire high school every year. – That really puts it into perspective. – What about the injuries. We always talk about deaths, but the injuries are even– – So we don’t have quite as good data on what we call non-fatal injuries, so firearm injuries that
don’t result in deaths. But the best data we do have suggests there are probably around 20,000 non-fatal firearm injuries every
year across the country. The majority of those are due to either firearm assaults,
interpersonal violence, or due to unintentional injuries. The lowest number are actually due to self-inflicted injuries, and that’s primarily
because a self-inflicted injury is so fatal that it’s the most lethal form of firearm injuries, because about 90% of those who try to attempt to kill
themselves actually end up dying of a suicide injury. – So to use your metaphor, that would be about 10
high schools worth of kids, are injured in some way
from firearms every year. – And those are just the
numbers for children. Children, teens, and adolescents. – This is a question, I think you guys have all touched on this
a little bit already, but let’s ask it again. What’s the general trend in these deaths over the last 20 years? How does it compare to trends in other types of deaths in teens? Sorry, in children and teens. – Sure, I’ll start that one off. So in motor vehicle crash, we’ve seen this tremendous
decreasing curve over the last two decades, of decreasing death
among children and teens, due to an overwhelming
amount of resources, and prevention, and
tireless work by scientists thinking about how to
keep kids safer in cars. And the same with cancer deaths, which is the third leading cause of death, really tremendous improvements in that. For firearm injury, it’s
really been a very flat line, a very flat line over
the past 17, 18 years, with this uptick that I
talked about since 2013, that we see continued through 2017. Really with not much improvement
at all over that time. – The next question. Is there any kind of
death that’s gone down, and if so, why is that? – Well, the car crashes have notably. I just wanted to add
that we often think about the technology activities that kinda help car crashes go down, safer cars, the safe technology that we have in cars, better lighting, better roads, but there’s also a
behavioral component to that. How parents can be more
effective teachers to their kids, and then other activities
around their kids, drinking and driving, and some of the risks
that they might go into. And so the same thing, the same kind of technological as well as
behavioral interventions and prevention can– – Can be applied. – Can be applied to firearms. – That’s very interesting. We go to a question from a Facebook user. They’re asking for some clarification about the 60% of gun related deaths in children and teens that are homicide. They ask if there’s a breakdown
of socioeconomic data. – Among, do you wanna– – Well, I would start out by talking, a really important point being that we know that those rates of death, which are about four per 100,000 in youth between the ages of one and through the age of 18 and 19, that those rates of death are very similar across all the communities
that we live in. So that rate is very similar, and even for rural areas,
for suburban areas, and for urban areas, we know that children are dying at about the same rate in
all of those communities. So this is a problem for
kids across our communities. – The underlying intent
behind the deaths that occur in rural, and suburban,
and urban communities may be different, but the rates are pretty much the same across the board. – Interesting. The next, we’ve got another
Facebook user question. They say they’re a gun owner. We will reduce accidents
with children deaths by charging the parents with
murder if their kid dies. Can you comment on policies
that penalize the gun owner, especially a parent or
other responsible adult, if a child uses a gun? – So there are laws that
are out there called Child Access Prevention laws, or CAP laws. Not all states have those laws, and what those laws do is
sort of along the lines of what the user is suggesting, which is holding an adult responsible, typically a parent responsible for a child having access to a gun. We don’t know, we know in general that those laws show some promise for preventing death among children. They’re not applied evenly across states, and in some laws in some states, the law may only apply to children as young as four or five, in other states it may apply to holding parents accountable for
children up to say 11. But there’s a lot to yet be understood about what is the optimal age for that, and how that accountability
should be held. But there is some promise for those laws. – And I would just add, I think it was mentioned already but, they’re not implemented
evenly across the board, so there’s a lot of work to be done on understanding how best to implement these types of laws in different states, and to see what’s most effective. – And when they’re on the books, they’re not necessarily
enforced evenly across either. So there’s much work to be
done there around culture, and that was a little bit, I think what Dr.
Zimmerman was referring to around cars and behavior. There’s been a lot of
change in our culture over the last 20 years in terms of expectations on driving and
drinking, and things like that, and ways that we’ve educated our teens to think differently about that, and safety around cars. And that education is part of a broader way that we think about
cars in the culture now, and that safety culture
is something that can also be more of an active conversation with children and teens around firearms. – Just on that car thing even, when you think about, people don’t get into cars anymore without buckling their seatbelt. When I was a kid, you know, maybe you did, maybe you didn’t, they didn’t go across your shoulder, that’s how old I am. But it’s the same, we keep
bringing back this notion of using cars as sort of
a point of comparison, and I think that’s a
good one to think about. Because there are the multiple levels of both influence and points
of change or intervention that would be– – And I might just add to that that we have more cars on the
road now than we ever did, and more people are driving more miles, but we’ve decreased the
incidents of crashes over time, and so we can do the same thing with guns. People can still own guns responsibly, but we can decrease the
potential for injury from them. – Very Important, thank you for that. Question seven. When we hear about a massive tragedy, such as a shooting at
a school or a church, we might think that these mass shootings account for a large percentage of deaths of young people from firearms, but where do such incidents fall in the types of firearm
deaths in kids and teens? – So the mass shootings of the type that are most on the news, these horrific school
shootings that we’ve seen account for about 1% of the total deaths among children and teens from firearms. They have done a lot to
raise awareness as a culture, and I think for us to think about that these events can happen anywhere, that we’re seeing people now, adults shot in yoga
studios, and in churches, and children shot through what
should be the routine course of their safe activities,
and going to school. And those are really important
to highlight for all of us that this is an issue that
needs to be addressed. But noting that most of the
firearm injuries and deaths that happen across the country are not in this mass shooting context, and are in the context of either these unintentional or accidental
shootings that happen, or in the context of
interpersonal violence and/or suicide related
attempts and fatalities. – The next question that we have, teen suicide is part of this whole discussion about firearms. You were able to see the specific causes of all kinds of suicides. What’s the role of firearms compared with other means, such as overdoses. – What is it, something
like 90% of suicide attempts that are successful
are firearm related? – So when you look at what
are the causes of suicide, so firearms are the second
leading cause of suicide, and the one that falls ahead of that is actually suffocation. But the key point that
I think Dr. Zimmerman is bringing up is that
if somebody does attempt to try and kill themselves with a firearm, 90% of the time they’re successful. Whereas if they try and
overdose on let’s say, opioids or pills, the percentage of times that they will be successful and not get to the hospital and get some help that they need, is much lower. So it’s the availability of a firearm in that moment that’s so lethal. And we know when we talk
to folks who have survived attempted firearms suicides
that the majority of them don’t go in to kill themselves, and the majority of them
say that they planned for less than five minutes
at the time of the event, and it was the availability
of a firearm in the home, or in the home of a relative at the time, about 75% have access to a firearm, that led them to be impulsive and to attempt to kill themselves. – It’s a dangerous mix of,
the brain is still developing, impulsivity is more likely to occur when the frontal cortex is less developed, and with that impulsivity
and access to significantly more lethal means, is a very
bad mix of risk factors. Which is why it makes it
even all the more important when we think about
kids and accessibility. Because often, suicide among
kids is a very impulsive act. – So there’s this real myth out there that if it wasn’t the firearm,
there would be something else, and suicide rates would be the same, and that simply hasn’t
been found to be true. We know if there’s not
lethal means right there, and in fact, with the rates
that were going up in suicide over the past couple
years that I mentioned, from gun suicide, the
non-gun suicide rates actually increased 15%, where the gun suicide rates went up 26%. So that easy, or access to lethal means in an impulsive moment, is
really the deciding factor. And so if we reduce that deciding factor, and have that firearm
instead stored safely away from teens that are
impulsive or depressed, then we decrease that fatal wound often. – And the key is firearm access in that really high risk time, and how do we decrease their access to an unsecured firearm. – I want to also just mention that the key to all of it around
depression and suicide, is recognizing signs early, and prevention in the first place, so that people, kids are
getting the kind of attention, and services, and help that they need to cope with their depression, to cope with that
impulsive kind of behavior, and that sort of thing. We don’t wanna lose the
idea that firearms are not, adolescent suicide is a significant issue that’s a preventable problem that we have to think about too, even outside of the whole gun debate. – Absolutely. Thank you for highlighting that, and thank you for your answers as well. But the next question, there’s an incident in the
news, actually right now, about a four year old who
shot his pregnant mother with a gun that was in the house. How many such incidents happen each year, where the child fires the gun, and an adult is the victim? – Do we, we don’t really have, do we have specific data on that? – So we know that it’s not
uncommon for children to have, for young children, often
in this preschool age, to, and early adolescent age, to have a firearm and accidentally shoot either a playmate or someone else. Those deaths where the death is the child, is the other child or another teenager, is about 100 a year. And the numbers all
together in the population are about a thousand a year, either adult or children, are fatally shot by, an inadvertent, somebody finding a gun, playing with it, the teen not realizing it was loaded when he was showing to his buddy, the toddler being curious with it. And that’s a really important,
tragic event this week. It’s an event, as I said,
on average in a year, we’ll see about 100 of,
if we do nothing different in our culture around firearm safety. And that’s the statistic that we’ve seen every year before this for the past decade or two decades. There’s not a real reason unless we really change our mindset around this to think that we will
see anything different. And the things that come to my mind with that toddler are, sort of the question
your viewer asked before, which is, in our society, whose responsibility is it to make sure a four year old doesn’t
have access to a loaded gun, or can’t find a loaded gun, is one, and two, why does a young
family feel the urgent need to have a loaded gun under their mattress? And those questions I
don’t have easy answers to, but I think we, as a culture, need to spend a fair amount
of time thinking about deeply, and addressing both of those root causes. – Absolutely. Another question we have from Facebook from one of our users is about parents who choose to teach
their children about firearms. What do we know about the
effects of teaching children about responsible handling of firearms, and the impacts on the risk
of firearm injury or death? – So I could start, and then I think I’ll hand off to you. So I would say, education
is critically important, and families and gun owning families, and non-gun owning
families all need to teach their children some basics
about safety around firearms, what to do with one, how
to handle one safely, if you have one around, how to keep it locked safely and stored, when is an appropriate time to touch it, IE not when there’s not an adult there. All of those things are
critically important, and there’s a number of programs around to help with that education. Education being really
important, but not sufficient. So there’s been, none of
the education programs that have been out there now
have shown to demonstrate that a young child especially,
can get over that impulse, of then reaching out and touching it. It’s like a child not reaching
for the chocolate candy. They can tell you that they know they shouldn’t touch the chocolate candy, and that is where the education comes in. They can’t necessarily
resist that impulsive urge. And so the education is really important, and may help with some aspect of it, but isn’t sufficient instead of having them locked, and safely stored away. – Yeah, I mean I would just echo that. The evaluations that have been done on the programs that
are currently out there haven’t shown to be
effective at preventing kids, especially young kids,
from accessing firearms. So really the number one message is, if there’s a firearm in the home, that that firearm needs
to be stored in a way that it’s safe and secure so that the child can’t access it. – Thank you, thank you for that. So far in the main, we’ve
been talking about deaths. Do we know how many children and teens are injured by firearms each year, and if not, why not? – Well, we talked about it,
it’s about 18,000 to 20,000. – Yeah, it’s about 18,000 to 20,000. Unfortunately, the data that we have on non-fatal firearm injuries that end up in emergency departments
is not the best data. The fatality data is
what’s called a census, so it’s an actual account of every death. The data that we have on
non-fatal firearm injuries is a probability account, so it’s an estimation
based on what me know from a small number of
emergency departments, so our data there is
not quite as rigorous. And it’s certainly one of the areas, as we look at what can we do around investigating and understanding
firearm injuries further, is we need better data
on people who show up to emergency departments with injuries. – And another thing
just about injuries that makes it even more difficult is what we don’t really have a very good handle on is what affect that has on
their psychological well-being, if they’ve been victimized, or the psychological
well-being of the people around the injured person, so their friends or their family members, and how that plays itself out. We know, for example, that injury, or experiencing violence,
even just witnessing violence, witnessing a shooting in a neighborhood, in your neighborhood down the street, has long-term physiological and psychological affects
10, 15 years later. So that’s a whole level of injury that we have less information about. We do know that it has
significant effects on school, when there’s a school shooting, mental health professionals swoop in to provide services to all
the kids, all the survivors. And we don’t spend a lot of
time talking about survivors, the whole idea of secondary prevention. So, just wanted to add that point. – The definition of
injury is not just limited to the actual injury from the bullet. There’s an injury that’s
much broader than that, is what I think Dr.
Zimmerman is alluding to. – And not just the specific
victim, is the other point. – So in terms of research, what kind of research is most needed? What do we most need to know about children, about
teens, about firearms? – Well we’ve just spent
almost a whole year looking into that question. Do you have a couple more hours? – So I mean, everything
from basic epidemiological research on who’s getting injured, and why they’re getting injured, and the context around which
they’re getting injured, to better research around
primary prevention programs. How do we prevent these incidents from happening in the first place? As an emergency physician, I feel like once I see somebody come
into the emergency room with a firearm injury,
we’ve failed them in a way, because we haven’t done
the work up ahead of time to prevent that injury from
occurring in the first place. And there are a lot of things we can do, but we don’t understand yet what works. In addition to that, after
somebody has suffered a firearm injury, or has
witnessed a firearm injury, all of the subsequent
injury related to that, we don’t know what all those effects are, or how do we prevent that. All the mental health complications, we need a lot more better
understanding of that. We know that kids who
suffer a firearm injury, when they go home from the hospital, about 50% of them have life long physical or mental injury related that affects them for the rest of their life. – I, yeah. I mean, that’s just
the tip of the iceberg. We can get really nerdy and talk about different ways of measuring it, and how do you assess it well, the kinds of samples we study so, I don’t want to get too
nerdy methodologically, but there are a host, I mean, what is it, we haven’t really had
federal dollars focusing on the kind of information that we need to really do prevention
in the last 30 years. And the limit of those
dollars in that research has limited our knowledge to know exactly what could be, what
are points of intervention. The other thing I wanna also point out is, and a lot of the
conversation has been around the risk factors, and
sort of what’s wrong, but we also need research on what’s right. What are things that prevent a kid who feels depressed
from hurting themselves, or what prevents, what
are the positive factors in a family that, where
safe storage does occur. And so we need that kind
of research as well. – I think also the analogy
with motor vehicle crashes, I’m sorry, is illustrating, is that we spent 50 years to get to the point where we are
with motor vehicle crashes with interventions, and testing, and understanding the data, and studying it, and intervening, and if we had the type of resources applied to this problem that we’ve applied to motor vehicle crashes,
or cancer deaths, that could have a similar
impact in terms of the– – I’d almost guarantee it, actually. You’ve been trying to say
something, Dr. Cunningham. (laughing) – So I think on the other analogy, and you started to touch
on it there with cars. If you think about what you brought up, which is we hardly know for sure exactly how many children and teens,
or adults for that matter, are getting shot every year. If we think about a cancer, and we’re trying to cure the cancer, and we barely know how many people have gotten the cancer that year, there’s a whole host of questions, you can imagine, we would ask, after we knew exactly how many people had gotten that cancer, as to what might work to cure that cancer. What the small things,
what the big things are, what the family things are, what the community influences might be. All of those questions need to be answered as we start to dig in to
really scratch the surface of the science, there
is a science to this. There’s a science to
firearm injury prevention, the same way there’s a science to all the other kinds of injury
prevention that we do. This isn’t fairy dust, and magic, and wishes, and magical thinking here. There’s a science, science questions here, and science related answers and research that can be done, but that surface is really
just beginning to be scratched. – When you asked the question about what do we need to do for research, we need to do everything across the board. – Everything. – It’s possible. – And it is possible. Actually, I think that’s the key. I mean, we do have models
of injury prevention that could fit here, but
we need to have information so that those models can
be applied appropriately, and tailored appropriately. And the lack of research
has been a real issue. – The lack of research
has been a big issue, and when you apply those
injury models though, we had a lot more children dying in house fires 30 years ago, and then the science of
smoke alarms got better, and we taught families
to install smoke alarms, and we taught them on a
certain day every year to change the battery in it, and we taught kids that’s what they meant, and we addressed smoking inside the house, and all these different things. And with that, we have a
lot less children and teens dying of fires in houses
than we did 30 years ago, by applying a basic science technique. – Yeah, thank you, thank you for that. We have another question
off the press on Facebook about gun violence and violence in general that affects children who don’t
have a father in the home, or spend only weekends with fathers. Are there data on the
risks of death or injury among children in different
family structures? – Well, I could just speak to that more generally, not specifically. My research, I’m not aware of any research that looked at this issue
specifically to firearm injury, but it’s not about the family structure, it’s about the family process. And by that I mean, how we interact with our children, how we treat our children, how we behave in front of our children, is almost more important than who’s necessarily in the home. One of the things we
have found, for example, is that absent fathers, I mean, let me say it a different way. Single mothers does not
necessarily mean absent fathers. That fathers can be and
are engaged in kids lives. And so just because they
don’t sleep with them in the same house all the time doesn’t mean that they’re
necessarily absent. So I think that’s an
important point about that. So I’m not sure it’s the right question. I think the more important question, we do know that adults and parents play an important role in kid’s lives, regardless of their age, the age of the parents or the
age of the child, actually. There was a debate in
developmental science about as kids get older, their
friends matter more and their parents matter less. And it’s not a zero sum game. Yes, the kids may start to
matter more than they used to, but parents are still important,
still play a key role. And so if you take some of
that science that we’ve done around the role of parents and adults, wherever they live, and apply that to firearm injury and death, there’s no reason to think that it couldn’t play an important role. But where the father
lives is not as important. – Thank you, thank you for that. – Let’s talk a bit about you guys. Let’s talk about what
motivates you as researchers. So Doctors Cunningham and Carter, you’ve both worked in emergency rooms. Professor Zimmerman,
you’ve worked directly with young people in the community. Why are you guys driven
to study this issue? – So I’ll start. I think as an emergency physician, that Doctor Carter touched on, I took care of, for many years, many youth and adults who arrive in our emergency department,
in our trauma bay, and are either very ill or
dying from that firearm injury, and I’ve been very motivated to see what we can do before the trauma bay, to try to keep them out of the trauma bay. Because once, we know that firearms have so much lethality to them, that after that shot is fired, what we can do for them medically in the trauma bay is really
going to be very limited. And if we’re gonna really
make a substantial impact, we need to work before that, and work on the prevention ends. – Thank you. – And I would just echo that, I already kind of said that earlier. – Well given that I’m the real doctor, actually, it really kinda
grew out of the work that we’ve been doing working with youth violence prevention in general, and looking at the social relationships, and the social context, and the environmental context, where youth aggression and
violence generates from. And some of the factors
kind of play themselves out in terms of protecting
them from those influences, or making those influences worse, or those risk factors worse. And it just became abundantly clear, the more we did this work, that these were all similar precursors to the ultimate use of a firearm in some kind of these activities, and they’re also rooted in the same place. And the frustration around, almost being, there’s almost gag orders about what you’re allowed to talk about, or what you can talk about
by some funding sources, that it’s a very frustrating thing where you can’t keep
climbing up the mountain to really try to understand that. So that kind of came out
of, basically for me, more out of the research and the work that we’ve been doing with kids. – Absolutely. Thank you, thank you all
three for that answer. So you’ve gathered researchers from around the country to study these issues, and also to offer free
online education tools for healthcare providers and others. Can you talk about who you have working with you on this effort, including your advisory group? – Sure. So we have a mix of about 25
senior and junior investigators from around the country who
are research investigators, who are engaged in the consortium, and they’re from a variety
of different universities. And then knowing that firearms are somewhat of a controversial issue, we recognize that
similar to studying cars, you can’t study a car
unless you understand what the issues are that the driver has, you know, people who own guns are an important part of the
discussion and the conversation. And so we put together an advisory group that is made up of folks
who are gun owners, who are gun trainers, who are sportsmen, who are people from the community and education community
who have an interest in understanding this issue, and contributing to the
work that we’re doing. And they’ve been a very,
extremely valuable part of what we’ve been doing, because they’ve been able to provide input and context that
is apart from what we get from academic folks
who are doing research, but folks who are really engaged with us at the ground level. – And just to be clear who we are, I don’t mean we. I think the we in that sentence is FACTS, is the FACTS Consortium, and the work that we’re trying to do to identify these areas. – We also have our team based here at the University of Michigan, but is engaged with 12 other universities around the country, east, and
west, and north, and south, kind of a broad perspective
of life across the US. – And medical researchers,
public health researchers. – Criminology. – Criminologists, so it’s
also interdisciplinary. So it’s not just– – Law enforcement. – Not just spatially diverse,
but also topically diverse, because we’re really
trying to get a handle on kind of the gaps, and
trying to fill those gaps. – Absolutely. – Also with a unified, with
a really clear unified goal of we just want less children and teens dying by gun violence, and being injured by gun violence, and that’s if we hold that truth to be together amongst us, we can cross a lot of different languages, and a lot of different
concepts and cultures. – I think you said before that there’s no gun owner who wants to see a four year old or an adolescent die of a firearm injury. So if we can all sort of
coalesce around that goal, we can make progress. – That’s the common ground, ’cause that’s what it’s about. Full stop. Is getting that 100 a
year, or 1000 a year, or 3000 a year, whatever all the numbers we were talking about, the goal is to get that to zero. It’s probably idealistic, but a goal of reducing it 10% this year, 10% next year. – We did it with car crashes, we did it with drowning,
we did it with fires, we reduced deaths by 50% of those children over the past two and three decades. – Wow. Next question, what is
the role of doctors, nurses, social workers, psychologists, clergy, and even teachers, and youth sports coaches in all of this? Can you offer them something now to help them address firearm risks with young people and their parents? What about cities and
other municipalities? – Sure. (all chattering) – We’ll all take a turn at that. – Sure, so everyone has a role. I think obviously, this
is all our communities, these are all of our kids. We all have a role in doing something. I’ll start with the doctoring, and I’ll let you go from there. So physicians have been a
source of trying to keep families and children safe, and their patients safe for our entire profession essentially. And that’s been a common
part of the language with families, and with
kids around car seats, and around hot water,
how hot the temperature of your bathtub should be, and about having smoke alarms. And so, I think physicians, we’ve really seen over the past year, have found their
collective voice in the US, and really come to see
that they do have a role in preventing firearm injuries among children and kids for sure, and this is part of an active discussion we can have with families. Respecting all of their rights, and helping them think about how firearms in their house can be stored more safely, and kept more safely, and what we can be doing
together to think about that. – Yeah, I mean, I think
physicians have a key role, as Dr. Zimmerman was saying earlier, in identifying kids who are at risk for mental health
issues, or are depressed, and how do we address
firearms in the home, especially during that high critical time. Or young kids, if there’s
a firearm in the home, how do we address that. And so I think addressing the issue, specifically firearm
access among those families and those kids at those high
risk times is really key, and I think everybody can
play a role in doing that. – Just thinking about roles
for example, with clergy, or sort of non-professional types. We have interventions that are called mental health first aid in schools, where we’re trying to
train teachers and staff to recognize changes in behavior, recognize what, when somebody
might need some help, but who isn’t getting it. Things like starting to
give away all their things, the death talk, and hurtful talk, or real significant changes in behavior. All of a sudden they’re not
as talkative, or as engaging, or they’re sitting along more often, and recognizing those,
and getting early help. And that’s a role that teachers, clergy, and coaches could play. And again, being the nerdy guy, they could also play a role
in helping do research, helping gain access to settings to do some community based work. Whether that’s a nurse, a physician, or people in schools
creating those opportunities to do the kind of research
that needs to be done so that we know what works
or what doesn’t work. – Yeah, I mean school
nurses, and teachers, anybody really who’s interacting a lot with children and teens,
and are around them, have the opportunity to see when something isn’t going right, and really be paying a lot of attention. And then also, adults,
one of the most things that helps youth the most,
separate from their parents, is positive role models
in children’s lives. And so to the extent that your coach is often the biggest positive role model for many, many, many children and teens across the country, those relationships are
critically important, and critically important in helping kids get through bumpy times. – Thank you for that,
thank you for that answer. So we’ve got another
question from Facebook. Is there a geographical tendency for firearm incidents, types, trends, etc.? – I think we talked a little
bit about this earlier, which was that if we
look across the spectrum of rural, and suburban, and urban America, we see that really, firearms deaths rates in all of those settings are pretty much even across the board. The underlying intent that we see behind those firearm injuries differs a little bit in context so homicides tend to be a little
more common in urban settings, and suicides, unintentional injuries, tend to be a little more
common in rural settings. But ultimately at the end of the day, and if you’re talking about numbers of fatalities in those settings, they’re even across the population in terms of incidents. – That’s 19, thank you. Another one, new from Facebook. We’ve had the question about
suicide deaths in particular. Do we know, from data on the
different means of suicide, enough to conclude that
attempts made with firearms are more likely to result in death. – Yes. – By a wide margin. – By a wide margin. We know that suicide attempts by firearms are somewhere in the
realm of 90% completion. And every other mean beyond that is substantially less than that by an order of magnitude or two. Yeah. – There’s a lot of public
polling going on about what measures Americans support or oppose when it comes to laws, regulations, and policies around guns. Is your research driven by a certain point of view about these matters? Are you setting out to support certain changes in public policy? And are you studying what is happening when policies change in certain states or in certain cities? – We’ll go with the latter. So our job is not to have a particular agenda here at all. We’re about looking at the data, trying to sort through
this mountain of data that we either have hardly
collected at all yet, or are just beginning to analyze and make sense of that. And we will go with the solutions to where that data guides us. There are, in the meantime, Americans are desperate
for solutions around this, and policy makers are passing laws. And as those laws get passed, it is important to do analysis of those, to try to understand how those laws may be impacting injuries and deaths. And we are looking, as laws
get passed, what happens, but we’re not in the business
of driving, necessarily, a particular view point
or agenda, by any means. – Go ahead. – I would just add to that, and it’s not just, is this law effective, it’s is the component
of the law effective. What parts of it are effective? How is it implemented, and is it enforced? And what are those key
components that need to be done in order to have that
actually have that effect that we’re looking for
on injuries and deaths? – I would disagree, I think we do have a particular point of view, and that is reducing the number of injuries and deaths due to firearms. That, I think, is the common ground, the common point of view. We’re not advocating for any one thing. And I think it’s really important, what Patrick says in really important, and that is, not all
laws are created equal, and not all laws are implemented equally. So even if they look the same, they may, on the ground, be
implemented in different ways. The Extreme Protection laws, for example, we do know that they do
differ across states. There’s what, 10 or so states,
that have it, 10 or 12. But they’re pretty different. We don’t know if the
differences make a difference. So I think that is a
really important point. And it isn’t about one
point of view or another. I mean, if none of them work, and they’re implemented to the
letter of the law, literally, then we have to rethink
about what we need to do to make it work to reduce those numbers. I think that’s the bottom line. – I think, and with the kind
of underlying understanding that with that, we don’t anticipate that there will be less firearms in the country over the next decade. So I think that’s the, nor am I gonna drive a
horse and buggy any longer. We have cars, and we have guns. Those are going to remain
well within our households, and we don’t anticipate
there to be changes in that within the realm of the
work that we’re doing. But understanding those facts, what can we do to make this safer? – Absolutely. The next question we have from Facebook, how can we go about regulating firearms? What would be the issues or difficulties in regulating firearms, and creating a system like we have for getting a driver’s license? And what are the steps
we’re taking currently? – I think we’re very much at
the beginning of that question. And I would say we’re ahead
of ourselves, in some ways, from a research standpoint,
and a data standpoint. There’s more to be learned in terms of what policies might work. There’s wide support, for
example, in the country, and the House will be debating later on this week, background checks. I think 70% or 80% of the country supports some version of that. We have more to learn there about that. And we need the data to drive us. – I think the question goes
to what we said earlier, that’s part of what do we need to study to understand how we reduce
child firearm deaths. We need to understand what
the best components are of these type of interventions. – Yeah, so far for me, two main things are ones I’ve said already, which is what the common ground is. And the other one is,
we need more resources, more support, more data, to be able to answer a
lot of these questions. I mean, it’s frustrating to be, we’re competent researchers, we know how to do this kind of research, but research is expensive. And we spend a whole lot of money on all sorts of relatively rare diseases, much more than we do on
firearm injury and death, especially among kids, so. I think that would be something– – Yeah, we’re gonna get to, what should we do around regulations? Those answers will come
with a mountain of data that needs to be, that
we need to work through, and that will come with research. That will generally not come by us sort of sitting around going,
what do you think, Mark? And Pat, do you think we should do this? That’s not really the way
we came up with seatbelts. We didn’t sit in a room together and go, I think the seatbelt would work best if we put it across this way. We tested them on mannequins, we tested them on people, we tested them in cars, we did, across the street here at Umtree, we did a lot of hard research
studies for many years, and that’s how we found
out what actually worked. So if we’re gonna find
out what actually works, we’re gonna have to do a
number or research studies. And we’re beginning to do that work, and our colleagues in our consortium are beginning to do that work. And people are really anxious, and I know they want the
answers to that right now, and our country needs to invest a lot more if we wanna have those answers. We invested billions of
dollars to figure out how to decrease the death rate in cars. We’re going to have to invest
if we’re gonna really want, if we really want those answers, they’re not gonna come
magically out of the sky. – Thank you, thank you,
very important there. Your program includes some jobs for young researchers who
want to base their own research careers around studying firearms. Why is this important? – It’s important to build a pipeline. So due to some of the challenges around funding and this issue there, when we started the consortium, I believe there were maybe 12 senior researchers in the country that had careers focused around firearms. And so, and those folks, as they get closer to
finishing their careers, there needs to be the junior researchers that come behind them, that can continue that research, and all that institutional knowledge about how to do the research, I think is important to
convey to junior researchers. So that’s one of the key
goals with the consortium, is that we have a mix of
senior level researchers and more junior level researchers, and we’re training new researchers as they come up through the pipeline to do this kind of research, and to be able to have long term careers focused in this area. – It’s directly related to
the funding issue, right? I mean, if there isn’t sort
of attention paid to this, or there isn’t enough people
doing this kind of research, then we don’t do the research. So we need more brains. We need a lot of brains to work on, just like we need a lot
of brains to work on cars, we need a lot of brains to work on firearm injury and death. And at every level. At the practice level,
at the research level, at the treatment level. – I think there’s really good news though. There is an outpouring right now of young, really brilliant minds in universities across the
country, and in schools, and in high schools across the country who really want to
focus on this topic now, and are looking to our group to help learn how to do that the way scientists teach each other how to do these things. And we’re really excited to
have them engage with that. Over the next several years,
we expect there will now be increasing hundreds, and then thousands, of young researches on this, the same way that we need thousands of cancer researchers, we need thousands of
researchers focused on this. It’s really important to move that education pipeline along, and that’s a big focus of the work that we’re doing together. – Yeah, very important,
thank you for that. The next question that we have, your work includes studies of efforts to prevent future firearm injuries by intervening when a teen or young adult comes to an emergency department, or even outside of the medical system, such as in schools. Can you discuss what you
did, and what happened? – I can talk a little bit about the cleaning work that we’re doing, and the idea of busy streets. One of the things that we notice is, there are certain kinds
of places where people may gather and do nefarious,
and not so many good things, and often may involve firearms
or weapons of any kind. And so one of the things
that some colleagues and I are doing is looking at what happens in areas of neighborhoods
in more urban centers where there’s basically vacant lots that become a source
of people saying that, well we can do negative
things in this space. What happens when we
start cleaning those up? What happens when we
start just mowing them, or engaging community in
making their neighborhood or their street look a lot nicer? And what happens is, all sorts of other positive things occur with people. And we’re finding that there are fewer violent incidents, specifically assaults, which are a precursor to gun assaults. We’re just now beginning to
look at some gun outcomes, but some of our colleagues
who work in Philadelphia found that cleaning up lots reduces the gun assaults around that lot, and it doesn’t increase in other places. So it doesn’t get displaced. When people say, well
doesn’t that just displace where it’s gonna occur,
it’s gonna occur anyway. And the answer that we have found, and our other colleagues have found is, no, the answer is no, it
doesn’t get displaced. It goes away, it doesn’t have
that place to work anymore. So, now we’re doing some work in schools where we’re doing this
mental health first aid kind of work, some
procedural justice where kids who engage in sort
of negative behaviors, and aggressive behaviors, have to give back to the community to, sort of as their punishment. So their punishment is
engaging in positive behaviors, and learning that. We’re looking at trying
to change school climates. Recognizing the signs,
standing up to bullies, and creating an environment where people talk to one another, rather than alienate
and divide each other. So those are some of the things that we’re trying to do outside
of the clinical settings. – Sure, so I think in
emergency departments, around firearm injury, and around other types
of violence as well. You know, for firearm injury, I think a lot of people don’t realize about 70% to 85% of youth who get shot actually go home right from
the emergency department, don’t get admitted into
the emergency department. It’s really important
that we try to identify youth when they’re coming in, both either as a victim of shooting, or as a kid who’s at risk, on how we can help them stay safe over the next couple years. So I mentioned earlier,
if you’re a teenager in the United States at this point, your most likely cause of death, no matter what I see you for
in the emergency department, before the age of 18, is
going to be firearm injury. So what should we do from
all of our clinical settings to try to help keep you safer? So we’ve worked for a fair amount of years working on screening
and violence prevention from the emergency department, think of that sort of as our job, the same way it’s our job to recognize kids who might have child abuse, or a woman or adult who might be the victim of domestic violence, to be asking about those questions, to be asking youth a number of questions when they come into the
ED, or emergency room, and think about what makes them at risk before we just send them back out to the community without anything. And then what should we
do while they’re there? We have developed some interventions for emergency departments,
and hospital systems. One of them is called Safer Teens. We can have the resources
on the comment page here. And that, we’ve shown
that that intervention, if we can identify kids while they’re in emergency departments, separate from their doctor visit, not getting in the way
of their doctor visit, we can provide about a 30
minute counseling session, and that session decreases their violence and their fighting over the next year. Decrease their dating violence, decrease their regular violence, puts them at less risk by the interaction that we can have with them
in a clinical setting. Even a brief clinical
intervention like that can really matter for the
kid’s lives over the years. So I think it’s really
important to think about the clinical setting as a location to interact with youth. Not just the youth for
whatever reason they’re there, because again, the thing
that they’re most likely to have harm from, fatally,
over the next years, is something that we
can do something about. – And I would just add
that a number of the kids who are highest at risk are
not necessarily in schools, so they may not get access
to school based programs. So one of the advantages
of having parallel clinical programs that can
intervene with these kids, is that they are showing up
in the emergency department, and we do have the opportunity to intervene with them at that time, and potentially prevent future injuries. So it’s a key setting in
which to do this kind of work. – Yeah, thank you for that, Dr. Carter. So we are moving into
our final few minutes. Not surprisingly, we had a lot
of questions on this topic. – The penultimate question,
what can a parent, or grandparent who owns firearms, do right now to help their child or grandchild to be safer? What can a parent do if
they don’t own firearms, but their child might be going to a home where firearms are present, or encountering firearms on the street? It’s a big one. – It is a big one. – I think it’s about firearm access. I think it’s about
making sure that firearms that are in the home are secured, safe, away from kids so that
they can’t access them. Whether that’s a younger child, or a teen, making sure that firearm is stored safely. And if you’re a family
that doesn’t necessarily own a firearm but your kid is going to play at another house, it’s about making sure that there aren’t firearms in that other house. – And asking the questions. – Asking if there are,
there likely are homes at the other houses they’re playing at, and that’s great, making
sure that you have that conversation with the other family, who may not be used to
having kids come over, and that includes your
uncle, and your grandfather, and saying, I appreciate that
you have guns in your house, can we just have a
brief conversation about how those are stored, where they are, are they locked up safely, because my kids are really curious. And even if my kids aren’t really curious, I don’t know what they’ll
do if they come across one, and we just wanna make sure, we need to check in on that. So be just okay asking that question, asking that question of our relatives. I think it’s harder sometimes
to ask it of our relatives, asking it of our relatives as well as all the places where our kids are playing. – And actually the American
Academy of Pediatrics has a nice pamphlet, or
information of strategies you can have to ask
these kind of questions. Because they are uncomfortable questions. – [Ed] Yeah, thank you for that. – And we keep saying safe storage, so I just wanted to say
what those things are. There’s lock boxes that
are fingerprint opening, and there’s all sorts of
technologies around that. There are different
kinds of trigger locks. There are strategies of
not keeping the gun loaded, keeping ammunition and guns
apart from one another. So just to be somewhat explicit
about those strategies. – Yeah, and I would
say with that explicit, on our website we have a nice handout that gives examples
clearly of all of those, as well as links to where a
family can click directly. A lot of local police
departments and hospitals give out gun locks and free
safety storage devices. – Right, right, right. – And I appreciate, you guys have really, you know, at one point
you tried to filter down and whole year’s research
into one question. We’ve got about a minute left. What do you hope people
take away from today’s chat? Where can they go for more information? – So I think the key
message to take is that firearm injuries are preventable. It takes resources to figure out what is the best way to do that. We, if they’d like more information on the work that we’re doing, we have a website, its, and they can go to that website and on the website it describes all the work that we’re doing. It has number of resource for parents, as well as clinicians that they can use, or learn about more of
the work that’s going on. – I’ll add just briefly, my
one pitch is that collectively, we start thinking about
this as firearm safety, because it is preventable, and this isn’t firearm control,
this isn’t gun control, and really trying to move that language away from our culture, and really be thinking
instead about firearm safety. – If I had one message,
I would probably say that it’s not only about firearms. We can think about this in the context of other kinds of issues that kids are dealing with all the time. So. – Thank you so much, thank you, all three of you. I really appreciate your time. So that’s the closing on our chat today. Doctors Cunningham, Carter, and Zimmerman, thank you for sharing your time and expertise with us today. And this will be up on the
YouTube channel shortly. Thank you, and have a good afternoon.

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