Firearms

Firearm-related injuries are the second leading cause of death in children. If one our goals as PCPs is to prevent premature deaths, we need to make this issue a focus of attention during WCCs. James W. Mold, MD, MPH

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Firearm-related injuries are an urgent health crisis in the United States, with firearm-related deaths surpassing deaths from motor vehicle crashes in 2017.1 In contrast to other conditions for which clinicians have evidence-based solutions to reduce harm, the 25-year gap in federal research funding2,3 halted substantial advances in the science of firearm-related injury prevention. Yet renewed funding and emerging science continue to highlight the critical role clinicians have in prevention efforts.2,3 Similar to other complex health issues, firearm-related injury is heterogeneous, with multiple causes (Figure 1). Each of these causes has entry points within clinical encounters that represent opportunities to interact, interrupt, and prevent negative outcomes.

The lack of research has resulted in a generation of clinicians currently lacking the training necessary to implement the solutions generated by recent science. As a result, despite clinicians recognizing the need for prevention and agreeing that prevention of firearm-related injury is within their scope of practice,13 few deliver evidence-based interventions even though their patients find such measures acceptable within the context of clinical care.14 This lack of training is compounded by a shortage of adequate health care infrastructure necessary to support the integration of useful approaches into practice. Clinicians note multiple barriers, including a lack of knowledge, guidelines, time, clinical support, and reimbursement, as well as a fear of offending patients or encountering legal trouble.15-17

Clinicians routinely provide harm-reduction measures and anticipatory guidance for a range of complex health issues (e.g., substance use and vaccination), capitalizing on available evidence, their relationships with patients, and their community standing to promote health and safety. Although gaps exist, there remain opportunities to improve the current standard of care for the prevention of firearm-related injury. In this article, we review clinical approaches to prevention, ranging from ones implemented within individual clinical encounters to ones advanced by health care leaders within the systems and communities they serve.

Author/s:

Patrick M Carter, Rebecca M Cunningham

Firearm-Related Violence in the Pediatric Population

Linda Fowler — Fri, 26 Jan 2024 21:39:50 +0000

Date Added:

January 26, 2024

Journal/Publication:

Pediatric Annals

Publication Date:

January 1, 2024

Issue:

Volume:

Pages:

e28 - e33

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3928/19382359-20231114-02

Keywords

PMID (1):

38194661

MeSH

Firearms

Adolescent Health

Mass Shooting Events

Violence / prevention & control

Humans

Disease Progression

Firearm-related events are one of the leading causes of death in children and adolescents. If one of our roles as clinicians is to prevent premature deaths, then we need to be sure that parents are educated regarding safe storage of firearms and other firearm safety measures. James W. Mold, MD, MPH

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Children, particularly adolescents, are dying from firearm-related injuries. Screening for firearms, early recognition of firearm-related concerns, appropriate referrals, and follow-up are crucial to the safety of our patients and their families. Clinicians are strongly encouraged to address firearm-related violence during clinical encounters. Risk reduction, advocacy, and policy implementation are key in mitigating the long-term negative sequelae of firearm violence in youth. The epidemiology of firearm-related death, mass shootings, school firearm violence, adolescent health, prevention, injury patterns, postinjury care, policy, and resources are all discussed in this article. [Pediatr Ann. 2024;53(1):e28–e33.]

Author/s:

Katherine M Marsh, Felicia Scott-Wellington

What Parents Should Know About Gun Safety in the Home and Vehicle

Erin Blanchette — Tue, 14 Nov 2023 20:28:26 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA Pediatrics

Publisher:

American Medical Association

Publication Date:

October 30, 2023

URL:

What Parents Should Know About Gun Safety in the Home and Vehicle

Type:

Patient Education Materials

Format:

Article

DOI (1):

doi:10.1001/jamapediatrics.2023.4668

Keywords

PMID (1):

37902742

MeSH

Information for parents on safe gun storage in homes and vehicles. James W. Mold, MD, MPH

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This Patient Page describes safety measures parents can take to protect children from gun violence.

Guns are now the leading cause of death for children in the US.

Guns are even more lethal than motor vehicle crashes. The reasons for this gun violence increase in children are multiple, including a rapid rise in gun purchases, an increase in depression and anxiety in children and adolescents, and widespread stress from a global pandemic. The causes of these injuries and deaths vary by age. Younger children are more commonly injured unintentionally. Curious toddlers can find guns and fire them quickly. Older children and adolescents are more likely to be harmed by homicide or suicide.

The most important factor for children being injured or killed by guns is having a gun in the home where a child lives or the car where a child rides. Adults must make sure their guns are stored safely to prevent access by a child or adolescent. There are gun locks, safes, and other techniques to promote safer storage. As an additional safety measure, caregivers should strongly consider removing guns entirely from the home or vehicle, especially when children are older than about 11 years. These youths know how to find and access guns, even if they are stored safely. Considering the increase in mood disorders and risk of suicidal behaviors in older children and adolescents, they should not be around guns.

Parents and caregivers should follow the Be SMART framework to improve gun safety:

S: Secure all guns in your home and vehicle.

M: Model responsible behavior around guns.

A: Ask about unsecured guns in other homes.

R: Recognize the role of guns in suicide.

T: Tell others to Be SMART.

Author/s:

Rebecca J. Palmer, Leila H. DeWitt, Lindsay A. Thompson

Handgun Ownership and Suicide in California

Brian Desmarais — Thu, 04 Jun 2020 19:59:09 +0000

Date Added:

June 4, 2020

Journal/Publication:

New England Journal of Medicine

Publication Date:

June 4, 2020

Volume:

382

Pages:

2220-2229

URL:

Handgun Ownership and Suicide in California

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMsa1916744

Keywords

MeSH

Proportional Hazards Models

Ethnic Groups

I know it isn’t always easy to inquire about gun ownership in Oklahoma. However, if the goal is to prevent premature death, you should certainly ask patients who are depressed. James W. Mold, MD, MPH

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BACKGROUND

Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership.

METHODS

We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns).

RESULTS

A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition.

CONCLUSIONS

Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.)

Author/s:

Studdert, D.M., Zhang, Y., Swanson, S.A., Prince, L., Rodden J.A., Holsinger, E.E., Wintemute, G.J., Miller, M., Spittal, M.J.

Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines.

Brian Desmarais — Wed, 28 Aug 2019 19:36:58 +0000

Date Added:

August 28, 2019

Journal/Publication:

Annals of Internal Medicine

Publication Date:

August 27, 2019

URL:

Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines.

Format:

Article

DOI (1):

10.7326/M19-0687

Keywords

MeSH

evidence-based practice

DESCRIPTION:

In May 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update to the 2013 joint clinical practice guideline for assessing and managing patients who are at risk for suicide. This guideline provides health care providers with a framework by which to screen for, evaluate, treat, and manage the individual needs and preferences of VA and DoD patientswho may be at risk for suicide.

METHODS:

In January 2018, the VA/DoD Evidence-Based Practice Work Group convened to develop a joint VA/DoD guideline including clinical stakeholders and conforming to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel drafted key questions, systematically searched and evaluated the literature through April 2018, created algorithms, and advanced 22 recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

RECOMMENDATIONS:

This synopsis, which includes 3 clinical practice algorithms, summarizes the key recommendations of the guideline related to screening and evaluation, risk management and treatment, and other management methods. Risk management and treatment recommendations address both pharmacologic and nonpharmacologic approaches for patients with suicidal ideation and behavior. Other management methods address lethal means safety (such as restricting access to firearms, poisons, and medications and installing barriers to prevent jumping from lethal heights) and population health strategies.

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These guidelines produced by the VA apply equally well to all adults. James W. Mold, MD, MPH

Author/s:

Sall, J., Brenner, J., Bell, A.M.M., Colston, M.J.

Preventing Firearm-Related Death and Injury

Brian Desmarais — Wed, 05 Jun 2019 19:32:12 +0000

Date Added:

June 5, 2019

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

June 4, 2019

Issue:

Volume:

170

URL:

Preventing Firearm-Related Death and Injury

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/AITC201906040

Keywords

MeSH

A comprehensive summary of what we know about firearm-associated injuries and firearm safety to support physician-initiated patient education. James W. Mold, MD, MPH

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Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.

Author/s:

Pallin, R., Spitzer, S.A., Ranney, M.L., Betz, M.E., Wintemute, G.J.