- Knowledgebase: Child Safety, Injury Prevention and Treatment
- Questions about child safety and injury prevention, as well as treatment for minor injuries.
- 50. AAP: PREVENTING FIREARM INJURY - Top
- PREVENTING FIREARM INJURY: PROTECTING OUR CHILDREN
Thank you for the opportunity to speak to you today about firearm injury prevention. Unfortunately, this is a very timely subject… and one of great concern to those interested in the well-being of our children. Littleton… Jonesboro… Paducah… Pearl… Springfield… these cities evoke the horrible images of children and gunfire. Who ever thought we'd be sitting here discussing how to protect our children from firearm injury? But events and reality force us to face this issue head-on.
Today I'd like to give you some background on why firearm violence was declared a public health emergency… even before the school shootings grabbed the headlines. I will also offer steps that you can take to help end this deadly epidemic.
If only we could go back to the days when children and firearms rarely came together. This famous Normal Rockwell painting is entitled, "The Winner." It shows a girl who has obviously been in a fight, and who is injured enough to be at the doctor's office. As you can see… she has a black eye and other bruises, but she is a happy child; it's clear that her opponent is worse off, and that she is satisfied that she won. While no one advocates children punching each other… the days when that kind of fighting prevailed seem almost idyllic compared to what children face now. Today, it seems children tend to throw bullets rather than punches.
Scope
Let's begin with some background information to help set the scene. The most current US statistics reveal that in 1996, more than 34-thousand Americans of all ages died from gunfire. More than 46-hundred of these deaths involved children and adolescents under the age of twenty.1 From 1985 to 1992, the number of deaths from gunfire to children under age 20 doubled. In 1995, a child died of firearm-related injury every 1½ hours. Every 2 days, the lives of a whole classroom of children were lost.2
Costs
The problem of firearm violence deserves attention from all of us for several reasons. Although deaths from motor vehicle crashes are the leading cause of injury death, experts predict that if recent trends continue, deaths from firearms would become the leading cause of death by the year 2003.3
The physical and mental disability that burdens gunshot victims . . . their friends . . . and their families . . . is immeasurable. In addition to the horrible human suffering involved with firearm injury and death, there are also tremendous financial costs that affect society as a whole. It may sound callous to discuss monetary amounts… but we can't ignore the societal impact when the numbers are this high. Listen to this: In 1990, injuries from firearms cost more than 20.4 billion dollars in direct hospital costs, medical care, and in indirect costs for long-term disability and premature death. At least 80% of the costs of treating these injuries are paid with taxpayer dollars.4
Frequency and Severity
Factors such as racism, poverty, crowded housing, poor schools, alcohol, and drug use may cause violence. These factors may affect the frequency of violent events. Injury outcomes are also affected by the severity of violent incidents. This seems like common sense to me… and the statistics bear it out: Guns tend to increase the severity of violence. Guns are more likely to kill than any other weapon used in an assault. If firearm injuries could be prevented, it's true that violent events would still occur. But without guns… the severity of the injuries would be reduced. It's just common sense.
Lethality
The use of firearms also makes suicide attempts more deadly. People are most likely to complete suicide when they use guns. As this slide illustrates, one study found that 91% of all suicide attempts with guns are fatal compared to 23% of attempts involving drug overdoses.5
Polio
To get an accurate picture of what's going on, let's compare the current gun epidemic with other epidemics of this century. The US experience with polio provides one example. In 1952, about 3 thousand Americans of all ages died of polio.6 In comparison, about 46-hundred children died of firearm injuries in 1996… and 34-thousand Americans of all ages died of firearm injuries that year.1 In 1952, 20 thousand people were paralyzed from polio.6 Similarly, approximately 20 thousand people per year are left paralyzed by a bullet from a handgun.7 Despite these facts, we spend less money to reduce the number of deaths and injuries from firearms than were spent on polio research during the height of that epidemic.
Motor Vehicle Crashes
Here is another comparison. This figure displays the number of US deaths from motor vehicle injuries and from firearm injuries since the late 1960s. As you can see, the number of motor vehicle-related deaths has fallen quite steadily over this time (though there has been a slight increase in the last couple of years that is not shown here).3 Prior to the late 1960s, car crashes were viewed as primarily a problem of drivers who broke the law, and who needed to be punished. Motor vehicle-related deaths drastically decreased after motor vehicle injuries came to be seen as public health problems and appropriate interventions were implemented. The fall in the number of deaths is particularly remarkable in view of the fact that the number of cars on the roads and miles traveled rose substantially during this period.
During this 25-year-period, as motor vehicle injuries have decreased, firearm injuries have increased. The predominant approach to reducing firearm injuries during this time has remained a criminal justice approach. Only over the last decade have researchers and policy makers in the United States begun to view and address firearm injuries as a public health problem as well as a criminal justice problem.
Numbers and Rates
Data show that firearms put everyone at risk, but different groups are affected by firearm violence in different ways. To understand how firearms affect different groups, it is important to understand the difference between numbers and rates. Annual numbers give a raw sense of how many people were affected by a particular condition - in this case, firearm deaths. Annual rates express the probability or risk of firearm death to a defined population group.
Summary
This slide provides a summary of some of the data on firearm deaths. Black males have the highest firearm death rates of any group. In terms of sheer numbers, though, more white male adolescents die in firearm-related deaths than any other group of adolescents. That includes suicides. Females have much lower rates of homicide, suicide, and unintentional firearm-related deaths than males do. 2
Rates
This chart shows that both black and white adolescents die from firearms. The rates shown here illustrate what we discussed with the last slide - that black males have the highest overall firearm death rate, followed by white males, black females, and then by white females. Homicide rates seem to follow this pattern of overall firearm-related deaths . . . but the pattern is different for suicide. White males have higher firearm death rates due to suicide than any other group; they are followed by black males and then by both white and black females. 2
Numbers
This slide displays the difference between numbers and rates that we discussed earlier. More white males die from firearm-related causes than any other group. More black males die of homicide, but fewer black males are affected by suicide and unintentional injury when compared to white males. Don't let this slide fool you. It may look like a rather sterile representation of statistics… but what it really shows is that all of our children are affected by firearm violence; we can't consider it to be "someone else's problem."
Urban
Here are some more numbers that come from a population-based study in three urban areas (Memphis, Galveston, and Seattle). These numbers show that firearms and violence against another person go hand in hand. Assaults - physical injuries to another person inflicted with the intent to cause harm - made up the overwhelming majority of firearm injuries and deaths. Suicide attempts and unintentional injuries by firearms represented 7% and 5% of the total, respectively. Regardless of the intent of the person involved, handguns were most often the firearm of choice. 9
Rural
Firearm injuries are not restricted to urban areas… they happen in rural areas as well. Researchers did a population-based study of all deaths and injuries due to firearms in a rural county in North Carolina. Again… assault was the leading category of firearm injuries and deaths and, in a substantial majority of assault cases, handguns were involved. As you can see… the assault and handgun predominance is less marked in rural settings than it is in urban areas.10 But it is still a major concern.
International Comparison
And this is an even greater concern. Take a look at this slide. It shows that the United States is way ahead of other countries… but in this case being "number one" is nothing to be proud of. The firearm injury death rate among males aged 15 through 24 in the United States far exceeds those rates from other industrial countries. The US rate is 54.0 per 100 thousand. That's four and a half times . . . to more than 60 times… greater than the rates of firearm injury death from comparison countries.11 Yes… we're number one in deaths due to firearms in the industrialized world.
Nonfatal
The firearm deaths that I've been discussing are just the tip of the iceberg. Statistics for nonfatal firearm injuries are more difficult to obtain than data on deaths… because of the lack of a national tracking system. But 1992 data from the National Electronic Injury Surveillance System led to this estimate: 100 thousand Americans sought care in an emergency department for a firearm injury. Of these people, more than half sustained an injury severe enough to require hospitalization. For every death, there are 2.6 nonfatal injuries.12 We can't forget the often shattered lives of gunshot survivors.
Witnesses
It is also important to remember the indirect victims of firearm violence: those who witness these events. Children who witness firearm violence may suffer all kinds of ramifications. They may develop risk-taking behaviors… self-medicate by abusing alcohol or other drugs… imitate violent acts… or use violence as a way to resolve conflict. They may also develop post-traumatic stress disorder, depression, or other mental health problems. These behaviors increase the risk that children who witness violence will eventually become direct victims or perpetrators of violence themselves.
Cartoon
Take a minute to check out this cartoon. (Pause)
As you can see… the teacher's desk is covered with guns, and she's saying "Gum, class… I said get rid of your gum!"
Yes… it's funny… but it also illustrates that guns are a part of society and are present in the lives of our children. The choices that our society has made have contributed to firearm violence… and to the vulnerability of our children. We, as a society, need to focus efforts on protecting our children from firearm injury.
Risk Factors
Here's why young people may use firearms against themselves or against others: They may be angry, depressed, or scared. Those who get into violent situations are particularly likely to have witnessed violence and to use drugs. Many of our young people have absorbed what the media has shown and taught them about guns. They may have come to accept or even glamorize firearm use.
We know that the boys who did the shooting in Littleton, Colorado were angry and depressed. And we know they were avid fans of internet sites and video games that glamorize violence.
Advertising
But what about people who don't seek out violent images? In the late 70s and early 80s, gun manufacturers noticed a slump in sales, so they began to advertise to people in prospective new markets. One of the groups targeted was women.13 Advertisements portrayed firearms as fashionable and suggested that women and children are safer with firearms in their homes. In addition, the ads suggested that responsible parents keep guns in the home. This outraged those of us who knew that evidence exists showing the exact opposite! In fact… guns in the homes of women cause more harm than they provide protection!
Developmental Issues
Firearms pose different kinds of risks as children grow and move through different stages of development. When small children have guns in their homes… or encounter them in the homes of their friends… they are most at risk of being victims of… or committing… unintentional shootings. Children can injure or kill themselves, their friends, or their siblings with firearms without realizing that guns are not child's play.
And of course, sometimes the injuries are intentional. We know that the boys who did the shootings in Jonesboro Arkansas grew up around guns, and clearly had easy access to them. Remember, they were just eleven and thirteen years old when they shot and killed five people and wounded many more.
Typically, the risks are different for adolescents than for young children who may simply not know better. Teens are impulsive… and they lack the information and experience needed to make mature decisions. When teens use firearms, they may not understand the full impact of their actions. There is no magical age when this behavior stops; some adults also use guns impulsively.
Ability
Some people may wonder if a child has the physical strength needed to fire a gun. Well they do… and unfortunately they have the strength long before they have developed the impulse control and decision-making capacity that may prevent them from doing so. One study looked at 64 different models of handguns. The study showed that most guns have a trigger-pull setting of 10 pounds or less… and that young children do have the strength to fire such guns: 25% of 3- to 4-year-olds, 70% of 5- to 6-year-olds, and 90% of 7- to 8-year-olds were strong enough to be able to pull the trigger on nearly all the handguns in the study. 14
Consumer Product 1
So clearly… firearms pose a much greater threat to our children's safety than say… a teddy bear does. And yet… stuffed animals, along with most other consumer products, are covered by safety regulations. But there are no regulations in place to make the design of guns safer. Although the Consumer Product Safety Commission's mission is to protect the public from unreasonable risks of injury and death associated with consumer goods, it has no authority to regulate firearms.15
Federal and state regulations have focused on imposing restrictions on owners rather than on manufacturers. But manufacturers are finally being taken to task. More than twenty different cities in this country have filed lawsuits against gun manufacturers, holding them responsible for the gun-related crime in those cities.
Bullet
Of course a gun doesn't work without bullets… and those are not regulated either. This is a picture of a Black Talon bullet before and after it has struck a target. It opened on impact, exposing razor sharp edges. Bullets like this enter the body, open, and their sharp edges spin around cutting everything in their path. This particular bullet is off the market now, but other similar bullets are still available. Bullets like these… that maximize harm… are available to the average person… even though their design and purpose would cause them to be banned as weapons for war.
Self-Defense
Well… since we know these dangerous weapons are out there… what about the argument that we should have a gun for self-defense? Parents often keep guns, especially handguns, as self-defense against strangers. The problem is that there's very little chance that the gun will be used for self-protection. Research in several U.S. urban areas indicates that a gun stored in the home can make a homicide in that home three times more likely. 16 And a gun can make a suicide in the home five times more likely. 17 We may hear reports about all the good a gun does for self-defense… but don't you believe it. 18 The truth is that guns kept in the home are forty-three times more likely to be used to kill a family member than to be used in self-defense. 19
Second Amendment
Now, what about the right to bear arms? We hear that phrase so often. But listen to this: The Second Amendment reads as follows: "A well-regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed." This is often cited as a part of the constitution that establishes individuals' rights to keep guns in their homes. However, the Supreme Court has ruled repeatedly that the individual right to bear arms was not protected by the Second Amendment. This amendment protects the state's right to keep well-organized militias. Lower Federal Courts have followed the lead of the Supreme Court and have never overturned a law regulating gun purchase, ownership, or use on Second Amendment grounds. 19 So… gun regulation is constitutional… and could in fact help to reduce gun injuries, death, and suffering.
Ownership
And there certainly are a lot of guns to regulate… since a lot of Americans own guns. According to a 1994 survey conducted by the National Opinion Research Center, 40% to 43% of households own guns. This means that 44 million Americans own 192 million firearms, of which 65 million are handguns.
Storage
Unfortunately, few of the guns in families' homes are stored safely. Safely stored guns would be unloaded and locked up, with the ammunition locked up separately. However, one study showed that 39% of parents keep firearms unlocked, 15% keep them loaded, and 7% keep at least one gun both loaded and unlocked. Handguns were 13 times more likely than long guns to be stored unsafely.20
Access
Given that improperly stored guns are in so many homes, it is not surprising that young people have access to guns. A 1993 survey questioned more than 2 thousand students in the 6th through 12th grades in U.S. public, private, and parochial schools. Nearly 60-percent of the students said they could get a handgun if they wanted one . . . 15% said they had carried a gun within the last month . . . and 4% had taken a gun to school in the past year.21
In some areas, the rates of children with guns are even higher. A Bureau of Justice survey of 758 males in 10 inner-city high schools found that nearly a quarter of the boys had a gun. 22
Public Health Model
So… how can we combat this problem and protect all our children from firearm injuries and death? Well… the traditional public health model for creating a response to a specific problem can help. The first step is defining the problem, using the best data obtainable. Accurate information allows us to identify the risk factors… by understanding who is affected by firearm violence, at what rate, and to what degree. In the next step, we develop the interventions that will address the patterns of occurrence and risk. Finally, we can implement and evaluate programs around interventions that work.
Supply Side
Any approach to handgun injury prevention will need to include steps to minimize unnecessary exposure and product-related risk… as we do for other hazardous consumer products. One common supply side approach that could be used would be to change gun design requirements. For example, to stop guns from firing when dropped and to eliminate the possibility of loaded bullets that are not visible. Another approach would be to hold manufacturers and retailers liable for some or all injuries. As we discussed… we're seeing this approach in action already. Other approaches include taxing the manufacture and sale of firearms to raise prices and so reduce sales; tightening regulation of the federal firearm licensee system (which currently provides licenses to sell guns for $60 per year); tightening scrutiny of retail procedures that are now extremely lax; and taking steps to reduce the odds that a high-risk user will purchase a gun.
Demand Side
But clearly the supply side issues are only part of a comprehensive approach to reducing the flow of handguns to our communities and homes. We must also address demand issues. Several approaches to reducing demand for handguns are possible. For instance, if people had more information and education about the risks associated with owning handgun… they may make better choices about owning a gun.
Other information can help as well. Since people usually keep handguns for self-protection, they may be less likely to do so if they see themselves at reduced risk for crime. Usually, people overestimate the risk in their communities when compared to objective data; so, increased information about actual rates of violent crime may reduce anxiety… and in turn… reduce gun possession. In areas where crime rates really are very high, efforts to reduce these rates may be the most effective approach to reducing handgun demand.
People who buy handguns are likely to be concerned about cost, as they would be with any product that they buy. As a result, increased prices, via increased taxes and licensure fees, could reduce demand. Since people's desires to protect themselves from attacks are understandable, an important component of any approach to reducing handgun possession is the promotion of alternative approaches… such as keeping a dog… and the development of new technologies… such as alarm systems… that are less likely to cause harm than a handgun in the home.
Recommendation 1
The American Academy of Pediatrics has made specific recommendations about ways to reduce firearm injuries. The main point is that children are safest when there are no guns in the environments where they live or play, and, therefore, the safest choice is to remove guns from the environments of children.23
Recommendation 2
When guns must be kept, such as in the homes of families in which a parent has a gun that must be carried on the job, parents must keep guns unloaded… and locked up… with the bullets locked up separately from the guns. Parents should make absolutely sure that children never have access to the keys.
Recommendation 3
Even when families don't keep guns in their own homes, guns can still pose a threat to children. There are certain steps to follow to make sure their children are safe in the homes that they visit. Parents should talk with their children about the risks that guns pose, and tell them to steer clear of guns. Also… parents should speak with the families of their children's friends to find out if they keep a gun at home. If so, they may want to reconsider whether or not they want their child to play in that home. Or they can urge the gun-owners to safely dispose of the weapon, or else empty it out and lock it up.
Community Members
All members of a community can take responsibility for reducing firearm injury and death. Individuals and neighborhoods can create gun-free environments for children. We can all educate others about the dangers of handguns and speak out against violence in hopes of reducing the demand for handguns.
You may also want to join handgun injury prevention advocacy organizations. These groups exist to create safer communities for our children. Such groups include the Center to Prevent Handgun Violence and the HELP Network. HELP stands for Handgun Epidemic Lowering Plan. These national organizations often have projects that you could become involved with in your own community.
Contact your local health and police departments. Both have resources that may be helpful to you such as local firearm death statistics or educational flyers. They may also know of community programs or projects in which you could be involved in educating others about firearm injury prevention.
Political System
Working as an advocate within the political system is another way to reduce firearm injuries. First learn what the legislative issues are. Challenge pro-gun legislation such as that which allows people to carry concealed weapons. Support legislation that strives to regulate the sources of the problem of firearm injury and death… that bans handguns and assault weapons… and that calls for greater control of ammunition distribution and greater regulation of gun manufacturers and dealers. Support laws that regulate the users of firearms through registration of guns and gun owners. Support laws such as the Brady Act, requiring a national 5-day waiting period and background check prior to purchasing a gun. During 1997, this law prevented nearly 70 thousand handgun purchases. About 62% of those rejected purchasers had been convicted of a felony.24
Support candidates who will focus on decreasing firearm injury. Write and call legislators about proposed legislation. If possible, share statistics on local deaths from firearms with them. They are also interested in hearing about the financial costs of gun injuries and deaths. If you have a unique perspective to present… offer to testify in front of legislators.
There are local groups with which you can become involved that strive to monitor legislation and communicate effectively with legislators. Join their efforts. One such organization is Handgun Control, Inc, which has a group leader in every state. In most states, the American Academy of Pediatrics has a pediatrician who deals with legislative issues related to guns, as well as with other health matters.
Norman Rockwell Illustration
Through these various action steps… you can make a difference in preventing firearm injuries and deaths. Chances are we'll never return to the innocence of this Normal Rockwell scene… when a childhood fight became a colorful anecdote, not a deadly statistic. Littleton and the other school shootings have forced us to lose our innocence in a way.
But that doesn't mean we have to give up and just accept the level of firearm injury in our society.
What you do to get involved could help your community, and our society better protect your child… and all of our children. We can help our communities to see that we need to protect our children more than we need to protect our guns. Thank you for your time… and for your commitment to this critical issue.
- Updated: March 5, 2001
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