PolicyLab

Firearm violence has long been an insidious threat to the safety of children and adolescents. From time to time, against the backdrop of this chronic tragedy, events occur that underscore the urgency of finding a solution. The shooting in Florida last month is one such event, but by no means was it the only recent incident that should inspire such a reaction.

Though mass shootings shock public consciousness and occur at an unacceptable frequency, it’s important to remember that they account for a minority of gun deaths. In 2016, there were more than 38,000 deaths due to firearms in the United States. Of those, 3,155 occurred in children aged 0-19 years, amounting to approximately eight deaths per day, with the majority of those (2,954) occurring among children aged 10-19. Ninety-five percent of these were violence-related, with 58 percent due to homicide and 37 percent due to suicide.

Any physician that has faced a family who lost a child to the horror of gun violence knows firsthand how, one victim at a time, these events devastate families and communities. From the toddler who stumbled upon an unsecured firearm to the adolescent with a life of promise ahead of them caught in the crossfires of a domestic dispute gone wrong, the damage goes far beyond the physical.

Recent Trends in Firearm Violence

Years ago, I cared for a young man who had been shot on the streets near his home. It wasn’t the first time — he had survived a prior shooting with significant longstanding health effects — and though it seemed he would again escape with his life, his body was ravaged by these events. In conversations with this young man following the shooting, one thing became clear: he fully expected to one day lose his life on the streets of his neighborhood as result of gun violence, like many of his friends and family members before him. Gun violence had become a normative experience, shaping how he faced the challenges he confronted and shaping his hopes for the future.

What is disconcerting is how these trends have changed—or failed to change—over time. In each of the three years preceding 2016, more than 2,000 preteens and adolescents lost their lives to firearms, most deemed homicide-related deaths and with minorities bearing the bulk of the burden. In regards to mass shootings, the trends are, again, discouraging. The Harvard School of Public Health found that mass shootings occurred at triple the rate between 2011-2014 when compared to the preceding 30 years.

Reviewing trends over time also reveals how firearm violence that claims the lives of children has changed in nature, requiring a fluid and comprehensive approach to prevention. For example, a recent study reviewing trends from 2002-2014 found that we’ve made some progress in reducing unintentional and homicide-related deaths from firearms, but the researchers noted an alarming increase in suicide-related deaths from 2007-2014.

Solutions That Could Lead to Change

The stories of children touched by the reverberating effects of gun violence in their communities should lead to transformative change. The only appropriate response for health care providers, child health advocates and policymakers is one that is focused on action, supported by evidence.

Emphasizing Safe Gun Storage at Home

Several strategies for gun violence prevention in children have been consistently shown to be effective in preventing death and injury. For example, we know that gun safety begins in the home. The vast majority of unintentional gun deaths in children occur with loaded guns found in the home, and the majority of guns used by adolescents in suicides are also found in the home of a family member or acquaintance. Studies have estimated that up to one-third of these deaths could be prevented with the regular use of child-proof safety locks and loading indicators. A number of resources can guide providers in counseling parents around gun safety for children.

Enacting Evidence-based Policy Solutions

But advocating for safe storage practices in the home is only the beginning. Several studies suggest that states that require universal background checks and mandatory waiting periods for purchasing firearms have lower rates of suicide, and states that enact restrictions on assault weapons have lower homicide rates. Currently background checks are only required by federally licensed dealers, which some estimates state account for just 40 percent of gun sales. Further study on the effect of these policies can help us take our efforts away from the highly contentious political sphere and into the world of evidence-based practice where they belong. This is why many academic organizations, including the American Academy of Pediatrics, have called for better funding of gun violence prevention research and surveillance.

Supporting Gun-related Research

The CHOP Violence Prevention Initiative takes a wide-lens view of the problem of violence in the many places where it touches the lives of children and adolescents with efforts directed towards bullying prevention, suicide prevention, intimate partner violence and gun violence. Our goal is to create solutions steeped in sound evidence, and we’re seeing some great success, however even this approach has been limited by restrictions, both direct and indirect, in the funding of gun violence research. Dating back to the mid-1990s, both the Centers for Disease Control and Prevention and the National Institutes of Health experienced dramatic cuts to funding available for research that could be perceived as related to gun control. This has limited our ability to study this epidemic as we would study any other disease confronting our children.

In recent weeks, we have seen youth take the lead in the fight for their lives, confronting the challenge of gun violence head on as it has crept into their neighborhoods and schools. These movements have strengthened the realization that children are indeed the future, but we must equip and support these efforts with the tools of advocacy, research and community outreach. Getting involved in state and local legislative efforts, keeping the lines of communication open between constituents and lawmakers, and telling the stories that we bear witness to in our daily work are some of the ways that we can move the needle in the direction of change, once and for all.

Ruth Abaya, MD, MPH, is an attending physician in the Department of Emergency Medicine at Children's Hospital of Philadelphia (CHOP) and a CHOP pediatric emergency medicine specialist at St. Mary's Hospital.