Photo Credit: Wachiwit
Pediatricians can play a critical role as advocates for firearm safety, addressing the impact of school shootings on patients and dispelling myths about who is more likely to commit acts of violence.
“Firearm injury has become the leading cause of death among American children and adolescents,” Rebecca Bell, MD, noted in a commentary published in Pediatrics. “Although the home is the most common place for school-aged children to be injured by firearms, firearm injuries are occurring in schools at a rate that exceeds those of other high-income countries.”
Dr. Bell published the commentary in reply to a study by Luke J. Rapa, PhD, and colleagues that showed a substantially higher number of school shootings in the most recent 5 school years versus the prior 20 years. School mass shootings—defined as a shooting at a kindergarten through 12th grade school site in which three or more people were killed—have not increased, although they have become more deadly.
PW spoke with Dr. Bell to learn more about the commentary and gain insights for pediatricians about their role in addressing gun violence.
PW: What are the main points you address in your commentary?
Dr. Bell: Most firearms involved in school shootings are brought from home. The work that pediatricians do to promote secure firearm storage in the home has a direct impact on school shooting incidents.
In addition to promoting secure firearm storage in homes, pediatricians may recommend removing firearms from the home when necessary. Depending on the location, families may have the option to store firearms voluntarily and temporarily at a gun shop or shooting range. If there is concern that an individual is at high risk for hurting themselves or someone else, some states allow for an Extreme Risk Protection Order (ERPO) to be filed, which temporarily restricts the individual from possessing a firearm.
I also address the lack of gun violence prevention research funding. Firearm injury is the number one cause of death among children and adolescents, yet we have limited comprehensive databases to work with to understand this problem better. The K-12 School Shooting Database used by Dr. Rapa and colleagues is maintained by David Riedman, an independent researcher who receives no funding for his work. We should not have to rely on an individual to get complete data on school shooting incidents. This needs to be prioritized federally.
How influential are parental variables?
There is certainly a knowledge gap around the level of risk and the type of firearm injury, which occurs most frequently in young people. Conversations about secure firearm storage that we have as pediatricians start early and generally focus on the prevention of unintentional firearm injury. This is an important and preventable cause of pediatric firearm injury but less common than youth firearm homicide and suicide.
As children get older, some families feel more comfortable with their child’s ability to handle a firearm, and storage practices become less secure. Studies have shown that households with firearms are more likely to store the firearms securely if there are younger children in the house compared with households with adolescents. Many families assume that they will spot warning signs that their child might use a firearm on themselves or others, but often, those warning signs are not present.
What are the pediatrician’s primary capabilities in reducing gun violence?
Pediatricians work to make homes and communities safer, which also makes schools safer. Pediatricians are well-positioned to speak to the impact that school shootings have on their patients. They can also dispel the many myths about who is more likely to commit acts of violence.
How might pediatricians incorporate counseling?
We still need more research evaluating the most effective modes of messaging in the clinical setting. Many practices incorporate firearm storage questions into their EMR workflow. Others have posters and other messaging in the clinic rooms. Pediatricians often lack the time and training to have these conversations, but resources are available through the American Academy of Pediatrics. The free online module called Safer: Storing Firearms Prevents Harm has been shown to increase pediatrician counseling frequency in short-term follow-up. Pediatricians should also know about ERPO laws and storage options in their state.
What other steps can pediatricians take to address gun violence?
It’s important to understand the factors that put individuals at risk for committing acts of violence. A history of mental illness is not a strong risk factor for violent behavior. Exposure to violence, a history of violent victimization, and a history of aggressive behavior are among the risk factors for perpetrating violence. Threats of violence should be taken seriously and require a team-based approach led by the school.
