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2012, Pediatrics
The absence of guns from children' s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents. Adolescent suicide risk is strongly associated with firearm availability. Safe gun storage (guns unloaded and locked, ammunition locked separately) reduces children' s risk of injury. Physician counseling of parents about firearm safety appears to be effective, but firearm safety education programs directed at children are ineffective. The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use. SCOPE OF THE PROBLEM Although rates have declined since the American Academy of Pediatrics (AAP) issued the original policy statement in 1992, firearm-related deaths continue as 1 of the top 3 causes of death in American youth. 1 As shown in Fig 1, the firearm-associated death rate among youth ages 15 to 19 has fallen from its peak of 27.8 deaths per 100 000 in 1994 to 11.4 per 100 000 in 2009, driven by a decline in firearm homicide rates. 1 No single study has adequately explained the decline in firearmrelated homicide rates. Postulated reasons include improved socioeconomic conditions, violence prevention programs, decline in the crack/cocaine market, changes in legislation, declines in firearms availability for other reasons, and community policing. Nevertheless, firearm-associated death and disability rates remain unacceptably high. Of all injury deaths of individuals 15 through 19 years of age in the United States in 2009, more than 1 (28.7%) in 4 were firearm related, and of those younger than 20 years, nearly 1 (19.5%) in 5 were firearm related. 1 These firearm deaths result from homicide, suicide, and unintentional injury (Fig 2). Black Americans are particularly affected; injuries from firearms were the leading cause of death among black males 15 through 34 years of age in 2009. 2 Although national data cannot fully document urban and rural differences in the patterns of injuries from firearms that involve children, local data indicate that children in rural areas as well as in urban areas are at risk for firearm-related mortality. 3-5
Journal of Surgical Research, 2020
Background: Gun violence among children and teenagers in the United States occurs at a magnitude many times that of other industrialized countries. The trends of injury in this age group relative to the adult population are not well studied. This study seeks to measure trends in pediatric firearm injuries in the United States. Methods: Data from the National Trauma Data Bank (2010-2016) were used in selecting patients evaluated for firearm injury. Patients were classified as children and teenagers (<20 y) or adults (20 y). Changes in the proportion of firearm injuries among children and teenagers relative to the overall population (pediatric component) were determined using trend analyses. Results: There were 240,510 firearm injuries with children and teenagers accounting for 45,075 of these injuries (pediatric component of 18.7%). Pediatric firearm injury was mostly among males (87.4%), Blacks (60.7%), and victims of assault (76.0%). The pediatric component of firearm injuries decreased from 21.7% in 2010 to 18.2% in 2016 (P-trend < 0.001). Although there was a decrease from 22.7% to 17.6% in the pediatric component of assault (P-trend < 0.001), there was an increase from 8.7% to 10.1% in the pediatric component of self-inflicted injuries (P-trend ¼ 0.028). Substratification by race/ ethnicity showed decrease in the pediatric component of firearm injuries among all groups (P-trend < 0.001) except Whites (P-trend ¼ 0.847). Conclusions: Despite reductions in the pediatric component of firearm injuries, there remains a significant burden of injury in this group. Continued public health efforts are necessary to ensure safety and reduce firearm injuries among children and teenagers in the United States.
The American Journal of Surgery, 2017
Background: Firearm injuries have the highest case-fatality rate among pediatric trauma related deaths. We sought to determine whether demographics, mechanism of injury, and outcomes were age specific. Methods: We performed a 5 year retrospective analysis of patients 0-19 years old with firearm related injuries. Children were divided into two cohorts based on age. Mann-Whitney and Pearson's X 2 were used to compare continuous and categorical variables, respectively. Significance was established at p <0.05. Data: Compared to their younger counterparts, children >15 years old were more likely to be male (82% vs. 90%, p=0.02), African-American (71% vs 89%, p<0.0001), and injured due to assault (76.9% vs 44.6%, p<0.0001). Mortality rates for children <14 was 1.4 times the national average (10.7% vs. 7.5%) while the rate for children >15 was 3.9 times the national average (12.4% vs. 3.2%). Conclusion: Firearm injuries continue to be a prevalent public health concern greatly affecting African-American adolescent males. Prevention strategies and trauma related healthcare resource utilization should target this group in order to reduce the risk of injury and improve outcomes and case-fatality in our population.
Advance data, 1993
JAMA Pediatrics
IMPORTANCE Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is a critical step for reducing pediatric mortality. OBJECTIVE The Firearm Safety Among Children and Teens (FACTS) Consortium, a National Institute for Child Health and Human Development-funded group of scientists and stakeholders, was formed in 2017 to develop research resources for the field, including a pediatric-specific research agenda for firearm injury prevention to assist future researchers and funders, as well as to inform cross-disciplinary evidence-based research on this critical injury prevention topic. EVIDENCE REVIEW A nominal group technique process was used, including 4 key steps (idea generation, round-robin, clarification, and voting and consensus). During idea generation, stakeholders and workgroups generated initial research agenda topics after conducting scoping reviews of the literature to identify existing gaps in knowledge. Agenda topics were refined through 6 rounds of discussion and survey feedback (ie, round-robin, and clarification steps). Final voting (using a 5-point Likert scale) was conducted to achieve consensus (Ն70% of consortium ranking items at 4 or 5 priority for inclusion) around key research priorities for the next 5 years of research in this field. Final agenda questions were reviewed by both the stakeholder group and an external panel of research experts not affiliated with the FACTS Consortium. Feedback was integrated and the final set of agenda items was ratified by the entire FACTS Consortium. FINDINGS Overall, 26 priority agenda items with examples of specific research questions were identified across 5 major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement. CONCLUSIONS AND RELEVANCE These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next 5 years.
Economic or policy analysis
Journal of Health Care for the Poor and Underserved, 2012
Homicide is seven times as common among U.S. non-Hispanic Black as among non-Hispanic White youth ages 15 to 24 years. In 83% of these youth homicides, the murder weapon is a firearm. Yet, for more than a decade, the national public health position on youth violence has been largely silent about the role of firearms, and tools used by public health professionals to reduce harm from other potential hazards have been unusable where guns are concerned. This deprives already underserved populations from the full benefits public health agencies might be able to deliver. In part, political prohibitions against research about direct measures of firearm control and the absence of valid public health surveillance are responsible. More refined epidemiologic theories as well as traditional public health methods are needed if the U.S. aims to reduce disparate Black-White youth homicide rates.
Academic Emergency Medicine, 2016
The Lancet Public Health
Firearm-related injury is a leading cause of death disproportionately affecting adolescents and young adults across the world, especially in the Americas. Little progress has been made over the past four decades, as inaction and the adoption of ineffective or unevidenced interventions have become commonplace. The COVID-19 pandemic reconfigured health systems towards prevention and harm reduction, sharpened public attention to the burden of preventable deaths, and inspired a fresh ambition of eliminating avertable deaths. In this Viewpoint, we argue that preventing firearm injury should garner bolder action in post-pandemic public health and we present a case for reducing the global burden of firearm injury supported by evidence and international examples. Crucially, we aim to guide policy making in directions that end the cycle of grief, anger, activism, deflection, and inaction and create more peaceful and fairer societies.
The Journal of Trauma: Injury, Infection, and Critical Care, 2004
Background: This study aimed to determine whether firearms are a more prevalent cause of pediatric death in the United States than in Canada. Methods: All pediatric trauma deaths from 1991 to 1996 in Ontario and Missouri were reviewed. Socioeconomic data were compiled for the two jurisdictions. Results: During the period reviewed, there were 1,146 pediatric trauma deaths in Ontario (10.4 per 100,000 population) and 1,782 in Missouri (32.4 per 100,000 population). Firearm injuries accounted for 19% of the trauma deaths in Missouri and 0.5% of such deaths in Ontario. Overall, a child was 100 times more likely to die of firearm injury in Missouri (6 per 100,000 population) than in Ontario (0.06 per 100,000 population). The incidences of violent acts unrelated to firearms were similar between the two groups. Both populations were similar in terms of socioeconomic and education parameters, but differed in their rates for guns carried. Conclusion: The significantly higher death rate from firearm injuries in Missouri likely reflects differing gun control attitudes and legislation, and provides a rationale for prevention and future investigation.
American Journal of Epidemiology, 2017
Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001-2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (P trend < 0.0001). FFIs remained constant (change = 0.02; P trend = 0.22) while NFIs increased (change = 0.35; P trend < 0.0001). Homicide FFIs declined (change = −0.05; P trend < 0.0001) while homicide NFIs increased (change = 0.43; P trend < 0.0001). Suicide FFIs increased (change = 0.07; P trend < 0.0001) while unintentional FFIs and NFIs declined (changes = −0.01 and −0.09, respectively; P trend < 0.0001 and 0.005). Among whites, FFIs (change = 0.15; P trend < 0.0001) and NFIs (change = 0.13; P trend < 0.0001) increased; among blacks, FFIs declined (change = −0.20; P trend < 0.0001). Among Hispanics, FFIs declined (change = −0.28; P trend < 0.0001) while NFIs increased (change = 0.55; P trend = 0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.
American Journal of Public Health, 2021
Injury, 2012
Maternal and child health journal, 2015
Objectives To determine the temporal patterns and the difference in trends by race/ethnicity of pediatric firearm hospitalizations (FH) among those aged 15 years or younger in the United States. Methods Data on pediatric FH was retrieved from the Nationwide Inpatient Sample between 1998 and 2011 (n = 16,998,470) using external cause of injury codes (E-codes) of the International Classification of Diseases, Ninth Revision, Clinical modification, (assault: E9650-E9654, unintentional: E9220-E9224, E9228, and E9229, suicide: E9550-E9554, E9556, and E9559, undetermined: E9850-E9854, and E9856 and legal: E970). Meta-regression was used to determine the significance of temporal trends. Survey logistic regression adjusted for survey year was used to examine association of pediatric FH with social and demographic characteristics. Results An annual reduction of 1.07 per 100,000 hospitalizations (p-trend = 0.011) was observed between 1998 and 2011. There was reduction in rate of unintentional-...
Academic Emergency Medicine, 1997
Objective: To determine population-based firearm-related morbidity and mortality for Allegheny County, PA (population = 1.3 million), for the year 1994. Methods: Fatalities were identified from a review of death certificates. To identify nonfatal cases, an active surveillance was conducted at all 24 acute care EDs in the county. The ED surveillance used 2 existing sources of case identification from each hospital to minimize undercount. Results: Firearms were the leading cause of injury death to county residents, accounting for 155 deaths. The crude mortality rate from firearms was 11.7/100,000. Black males aged 15-19 years were most at risk for a firearm fatality (293/100,000). There were 514 nonfatal firearm injuries, producing a case fatality rate of 23%. The highest age-specific rate for nonfatal firearm-related injuries treated in the county EDs was observed for black males aged 15-19 years (2,245/100,000), which is 58 times higher than the firearm-related injury rate for the entire county population (38.7/100,000). Conclusion: Firearm-related injury and death are a significant public health problem in Allegheny County. Although the crude mortality rate from firearms in the county is lower than the reported national rate, the observed rate for nonfatal injuries in the black youth of this community is the highest firearm injury incidence rate ever reported. Local surveillance of firearm-related injuries, including nonfatal events, is needed to more accurately demonstrate the magnitude of this problem.
1993
A previous report released by the National Center for Health Statistics (NCHS) documented the level of firearm mortality among children,
The journal of trauma and acute care surgery, 2014
Firearm control laws vary across the United States and remain state specific. The aim of this study was to determine the relationship between variation in states' firearm control laws and the risk of firearm-related injuries in pediatric population. We hypothesized that strict firearm control laws impact the incidence of pediatric firearm injury. All patients with trauma Ecodes and those 18 years or younger were identified from the 2009 Nationwide Inpatient Sample. Individual states' firearm control laws were evaluated and scored based on background checks on firearm sales, permit requirements, assault weapon and large-capacity magazine ban, mandatory child safety lock requirements, and regulations regarding firearms in college and workplaces. States were then dichotomized into strict firearm laws (SFLs) and non-strict firearm laws (non-SFLs) state based on median total score. The primary outcome measure was incidence of firearm injury. Data were compared between the two gro...
The American Journal of Surgery, 2017
Journal of Adolescent Health, 2005
Firearm violence is one of the most serious threats to the health of adolescents in the United States. In 2002, 277 youth aged 10 to 14 years and 2474 youth aged 15 to 19 years were killed by firearms [1]. Several-fold more are treated in emergency rooms each year for nonfatal injuries, many of them resulting in permanent disabilities. National estimates indicate that in 2003 there were 704 youth aged 10 to 14 years and 11,014 youth aged 15 to 19 years with emergency department visits for nonfatal gunshot injuries [1]. Among adolescents aged 15 to 19 years, firearm deaths outnumber deaths from any disease category and rank second only to motor vehicles among causes of injury-related deaths [1]. Within some demographic areas and subgroups, firearm deaths surpass deaths from any other cause. Considerable evidence indicates that availability and access to firearms increases the risk of homicide, suicide, and unintentional gun injury in the home and in the community [2-6]. Yet firearms are present in 35% of U.S. households with children younger than 18 years, and 43% of these homes have at least one unlocked firearm [7]. Nationwide, 6% of youth completing the Youth Risk Behavior Survey in 2003 reported carrying a gun on at least one of the 30 days preceding the survey [8]. From 1983 to 1993, the sharp rise in homicides in the United States was tied to an increase in the use of firearms in the commission of crimes; likewise, the significant decline in homicide arrests from 1993 to 1999 can be traced largely to a drop in firearm use [9]. Among youth aged 15 to 19 years, firearm-related suicides accounted for 96% of
1991
Data not available ,., Category not applicable Quantity zero 0.0 Quantity more than zero but less than 0
Pediatrics, 1997
Background. Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms. Methods. A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries. Results. On...
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