To Protect Kids and Teens from Firearm Harm, Answer These Questions First

Firearm injuries kill more American children and teens than anything else, except automobile crashes. But research on how those injuries happen, who’s most likely to suffer or die from one, or what steps would prevent them, has lagged behind research on other causes of death in young people.

Meanwhile, firearm deaths among people age 19 and under have grown 44 percent since 2013.

Now, as more researchers and funding sources appear interested in pediatric firearm injury prevention research, a team of 24 experts from around the country has published a list of the 26 most pressing questions that they call for impartial studies to address.

Writing in the new issue of JAMA Pediatrics, the team lays out the list they developed after an extensive review of the existing scientific literature and a structured consensus-building process. Their effort involved input from stakeholders from organizations that represent gun owners, law enforcement, clergy, the educational community, firearm injury prevention advocates, medical organizations, and more.

The team of authors includes researchers from 12 different universities and hospitals across the country. All are scientists who have led most of the research on pediatric firearm injury prevention to date and belong to the Firearm Safety Among Children and Teens (FACTS) consortium, including Charles Branas, PhD, Gelman Professor and Chair of Epidemiology at the Columbia Mailman School of Public Health. “This new scientific consortium is a history-making opportunity funded by the National Institutes of Health to prevent the tragedy of gun violence that so many of our kids experience each day,” said Branas.

“Firearm injury prevention research could answer many questions, but we need to address the most urgent questions first, and focus on what could bring death rates down fastest, just as we have with other causes of injury,” says Rebecca Cunningham, MD, one of the leaders of FACTS and an emergency physician at University of Michigan’s academic medical center. “Answering these questions in an objective, rigorous way will provide valuable information for the country to use, just as past research on automobile injury led to changes that cut the death rate for children and teens in half.”

The FACTS team addressed research across multiple firearm outcomes, including knowledge and attitudes toward firearms; access and storage of firearms; carrying firearms; exposure to firearm violence; intentional firearm injury, including suicide; mass shootings; and accidental injury.

Some of the most urgent types of questions they identified, for which no definitive, research-based answers exist, include:

• How many children and teens annually suffer fatal and non-fatal firearm injuries?
• How do children and teens gain access to firearms?
• How are firearms stored in homes where children and teens live?
• How effective are various programs for improving firearm handling, and reducing firearm violence and suicide?
• How often, and under what circumstances, are children and teens protected by self-defensive use of firearms, by themselves or by others?
• How effective are existing and new technologies, such as higher-pressure triggers and RFID identification safeguards, at preventing firearm injuries and deaths among young people?
• What effect do existing public policies on firearms have on firearm injuries and deaths among children and teens?
• How can we use data technology to provide near real-time information on firearm injuries and deaths among young people?
• What are the immediate and long-term costs of pediatric firearm injuries, from health care to criminal justice and disability?

“We hope the full list of questions will guide funding agencies at the local, state and federal levels, and foundations, as they consider new research proposals,” said Branas.  In the past year, and especially since the launch of the FACTS website at www.childfirearmsafety.org, researchers are more interested in studying firearm issues than ever before.

In addition to the list of questions, the FACTS group will soon publish a series of review papers that review the existing research on firearm injuries and deaths in children and teens, and related topics. That review informed the team that compiled the list of questions.

FACTS has funds from its initial grant to support 10 pilot studies that can produce data to guide larger studies. Some already underway include (1) a nationally representative survey of teens and adults about firearm-related behaviors and (2) an inventory of state and county firearm policies and their relationship to the risk of school shootings. At the same time, FACTS has gathered or identified over 60 existing pools of data that researchers can examine immediately for answers to urgent firearm research questions. It has made them available on the initiative’s website for free, with another 40 expected to be online this year.

All of this, the FACTS team hopes, will ensure that their colleagues will focus on the key issues with the most urgent questions.

Columbia researchers also include Paul Reeping, Columbia Mailman School Department of Epidemiology; Sonali Rajan, Columbia Mailman School Department of Epidemiology and Columbia Teachers College; and Lou Klarevas, Columbia Teachers College. The complete list of authors is published at JAMA Pediatrics.

FACTS is funded by the NIH National Institute of Child Health and Human Development (HD087149).