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Preventing Firearm Injuries Among U.S. Children

Hello, I’m Dr. Patrick Carter I’ll be talking with you today about the epidemiology of firearm
injuries among children. In module one we’ll be discussing the epidemiology of
firearm injuries among U.S. children There are no conflicts of interest or
relevant financial disclosures for this presentation. The objectives of this
module are to discuss trends in national firearm injuries, firearm injuries
specifically among pediatric populations including racial disparities among
firearm injuries as well as the importance of firearm access and safe
storage in the home. Nationally, there are approximately
33,000 firearm injuries annually among adults and children. When broken down by
mechanism this is roughly 61 percent suicides, or self-inflicted injuries, a
little over a third homicides or assault-type firearm injuries and
approximately 2% unintentional firearm injuries. In this graph we present trends
in both motor vehicle crash and firearm-related injuries over time since
the early 1950s. As you can see there have been significant
decreases in motor vehicle crash injury primarily due to the presence of public
health interventions, better built vehicles, laws regarding seat belt use,
alcohol impaired driving, and distracted driving and interventions by physicians
in terms of making trauma care improved. You can also see from this graph that
firearm-related injuries have increased over time without any significant
reductions. In fact, in 2010 firearm-related injuries surpassed motor vehicle crash
injury in 12 states. Among pediatric populations specifically, firearm-related
injuries are the second leading cause of death. As opposed to adult populations,
among children, homicide and firearm assault remains the single leading
mechanism for firearm injury in approximately three-quarters of cases.
This is followed by unintentional or accidental causes for firearm injury and
then self-inflicted or suicide cases.When we specifically look at firearm homicide we
see that the highest burden of injuries among youth populations. Here, the homicide rate is more than twice that of
the overall U.S. population and firearm violence is the second leading cause of
death There are significant health disparities
regarding firearm homicides and firearm homicide has been the leading cause of
African-American youth fatality for well over a decade. In fact, African-American
youth are eight times more likely than Caucasian youth to be injured by a
firearm. The peak incidence for firearm related homicides is among youth and
emerging adult populations. When looking at trends over time we see that firearm
related homicide rates have increased substantially since the early 1980s. Among 15 to 19 year olds we’ve seen a 56% increase in firearm-related
homicide and among twenty to twenty-four year olds who had a higher
firearm homicide rate to begin with rates have increased 27 percent. When
compared to other countries, the U.S. has one of the highest firearm homicide
rates. The firearm homicide rate among the U.S. population as a whole is
almost 20 times higher than that seen among twenty-two other developed nations.
When specifically examined among youth populations the firearm homicide rate is
almost 43 times higher than that of other developed nations. Among
U.S. youth, suicide is the third leading cause of death overall and firearms
remain the most common method for completed teen suicides. In fact, firearms
were implicated in forty percent of suicides among children of all ages. Firearms also have the highest case
fatality rate of all suicide methods and are fatal in almost 90% of cases.
Handguns remain the most common type of firearm that’s used in completed firearm
suicide. Firearm suicides as opposed to firearm homicide, disproportionately affect
Caucasian and Native American youth populations. However among
African-American youth, rates of firearm suicide have increased almost 133% since 1979 and current rates are almost equivalent to
those seen among Caucasian populations in some areas of the country. Unintentional firearm fatalities
represent a small proportion of the total number of fire fatalities however
they disproportionately impact pediatric populations. In fact twenty percent of
all unintentional firearm fatalities occur among children.These types of
injuries often result from the inadvertent discharge of a firearm while children
are playing together and most commonly the shooter is a family relative often
the victim’s older brother. Prior research has shown that children
as young as three or four years of age are old enough to pull a firearm trigger
and many, in fact in 20 percent of cases, the child that shot the firearm did not
know that it was loaded when they found it and were playing with it. Half of all pediatric unintentional
firearm injuries involve a firearm that was loaded and unlocked in the home.
While school shootings gain a lot of media attention they represent less than 1
percent of all firearm homicides and suicides. However in eighty percent of
these firearm related incidents the firearm was obtained from a friend or
relative. The data we have examined brings up the importance of firearm
access among youth in the home 38% of U.S. households have firearms
50% of those households including 40% with children
report that their firearms are stored loaded and unlocked in the home. This
increases the risk for negative health outcomes. In homes with firearms, the
homicide of a household member has been shown to be three times as likely and
firearms stored in the household increase a woman’s risk for intimate
partner homicide by seven times. This also increases the risk for children
witnessing violence in the household. Firearm access in the home has been shown to
increase the risk for completed suicide among household members. This risk has
been shown to be significant even among those without a prior psychiatric
diagnosis. In fact, homes with a loaded firearm are over nine times as likely to be
the site of a suicide. Prior research has shown that adolescent suicides are often
the result of impulsivity and firearm access in a 85% of these cases
the adolescent used a family member’s firearm to attempt suicide and a quarter
of suicide survivors report that they had planned for less than five minutes
and a third reporter a recent crisis within the preceding 24 hours. This
highlights the danger of having a firearm in the household with an
impulsive teen. The epidemiological data that we’ve
reviewed highlights the need to address the issue of firearm safety in the home the American Academy of Pediatrics has
reported that the most effective measure for the prevention of firearm-related
injuries among children and adolescents is the absence of a firearm from the
home and in the cases where that is not possible The American Academy of Pediatrics
recommends physicians counsel their patients and family members regarding
safe storage of firearms and firearm safety in the home. Prior research has
shown that parents are receptive to discussions of the risk for firearm
injury during their visits and that anticipatory guidance regarding firearms
safety is effective at both increasing safe storage as well as prompting
families to get rid of firearms altogether. Hopefully the data that we’ve
presented on firearm injury will help guide you as you learn more about how to
counsel patients and family members about safe storage in the household.

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