Examining the Evidence: A Pediatric Perspective on Firearm Safety Research

Statement of Problem

On December 14, 2012, 20 children and 6 adults were the victims of gun violence at Sandy Hook Elementary in Connecticut. Following this profound tragedy, families, educators, health professionals, and policymakers issued an urgent call for immediate action to prevent this kind of gun violence in the future, particularly to protect the most vulnerable among us: children.

In response to the Sandy Hook tragedy, Children’s Hospital of Philadelphia (CHOP) established the Violence Prevention Initiative (VPI), a multidisciplinary effort to address the exposure to and impact of violence in the lives of children and their families. VPI, a PolicyLab partner, has since become a nationwide leader in hospital-based and community-delivered violence prevention interventions.

Despite increased attention across the country to the epidemic of gun violence, over the past 7 years, the rate of firearm-related injury in children in the U.S. has remained largely unchanged. Of the youth killed by guns in high-income countries, a staggering 92% are killed in the United States, and the overall rate of firearm fatalities among children has continued to increase. Throughout the country, the rate of firearm-related suicide in children has steadily risen since 2008, and firearm-related homicide has increased by 28% between 2014 and 2016.

This public health crisis impacts children and families physically and emotionally, and takes a toll on the vibrancy and economies of the communities it touches. Many policy proposals exist to prevent firearm injuries, but research specifically looking at the impact on child injury and death—including data that could inform solutions to move the needle on this issue—is lacking.


As researchers at a pediatric institution with a commitment to maintaining and improving the health and well-being of all children, we want to understand which evidence-based interventions work to protect kids and teens. We also need to identify where there are gaps in the research that could help community leaders and decision-makers create evidence-informed policies.

Some states have taken action over the last 7 years in an attempt to specifically reduce youth firearm injury and death. We have some early research demonstrating whether or not these policy changes have had an impact on youth outcomes, and if they are being implemented in the way that policymakers intended. For example, there is strong evidence that states that have implemented universal background checks for gun purchases have a lower rate of firearm-associated deaths in children, after adjusting for factors that may influence this rate like socioeconomic variables and numbers of gun owners.

There have also been studies showing that laws that require adults to keep their guns safely stored away from kids (often referred to as Child Access Prevention laws, or CAP) result in significant decreases in unintentional firearm injuries and suicides in children. At the same time, other state efforts, such as implementing age restrictions on purchasing or owning a gun and juvenile curfews, have not demonstrated a reduction in harm.

We also know that there are evidence-based opportunities for health care providers to promote firearm safety and to prevent ongoing morbidity in injured youth. For example, recent research shows that interventions that provide gun owners with the tools to safely store their firearms can be effective in promoting safety and preventing unintentional firearm injury. Here at CHOP, we’re exploring whether providing parents with safe-storage devices like gun locks in primary care offices and the emergency department is a feasible strategy to improve firearm storage practices in homes with children. We also know that youth violence prevention programs targeted at survivors of violence can help prevent recidivism of injury and are cost effective.

However, while we do have some information on what works, there are often significant limitations: data may be focused on adults only, may include a small sample or other issues with validity and generalizability to other settings or, in many cases, may not exist at all. That’s why PolicyLab and VPI are launching a collaboration to bring an evidence-based, child-focused lens to the issue of firearm safety for children.

Next Steps

Over the coming months, we’ll be developing an Evidence to Action brief that highlights existing research and provides recommendations rooted in data for new public health approaches to protect youth from accidental firearm injury. It is our hope that this can serve as a resource for policymakers looking to make evidence-informed decisions to keep families safe in their communities and across the country.

This project page was last updated in December 2019.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Examining the Evidence: A Pediatric Perspective on Firearm Safety Research [online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here]. 

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