Twenty-Five Years After Columbine –What to Do About Firearms and Public Health

Posted on May 6, 2024 by gutsandgrowth

D Hemenway. NEJM 2024; 390:1352-1353 Twenty-Five Years after Columbine — Firearms and Public Health in the United States

This commentary notes that in the aftermath of Columbine, Smith and Weston had agreed “to upgrade its products and practices to help reduce the harms caused by its guns. Since a common cause of unintentional shootings is incorrectly believing that the gun is unloaded, its pistols would have chamber load indicators, and magazine disconnects would be available. The company would provide “ballistic fingerprints” on new firearms to help law-enforcement agencies trace guns. It would sell its guns only to dealers who had a plan for preventing gun theft and — to reduce gun trafficking — would agree to limit multiple-handgun sales to any individual buyer. The dealers would also have to agree not to sell large-capacity magazines.¹ But the firearms industry immediately began boycotting the company, and its chief executive officer was forced to retire.”

This article offers the following advice to reduce firearm mortality, the number one killer of children:

“The Surgeon General could provide biannual reports on guns and suicide; the federal government could both conduct and fund research into smart guns and safer means of home protection than owning a handgun”
“Police could have social workers embedded in precincts”
“The faith community could make it clear that it is a cardinal sin to sell a gun to a stranger without a background check”
“Probably the most important thing our country can do is to elect more officials who will help make changes where the effect will be greatest — in the gun industry and the gun culture”
“To achieve a huge reduction in gun deaths will probably require mandating what is common for car drivers in the United States and for gun owners in other high-income countries: gun licensing, gun training, and handgun registration, along with universal background checks. These requirements are supported by most Americans”
“PLCAA (Protection of Lawful Commerce in Arms Act) protections should be eliminated, and the gun industry treated like other industries”
“And just as car manufacturers had to be forced to put seat belts, airbags, collapsible steering columns, and safety glass into their vehicles, the gun industry should be forced to take the types of steps that Smith and Wesson was willing to take 25 years ago”

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Firearms: #1 Cause of Pediatric Deaths & Households with Guns =More Deaths
“Crossing Lines” and Why Firearm Deaths are The Leading Cause of Death in Children
No Exaggeration: Too Many Children Are Dying in the U.S. “The sad fact is that a child or adolescent in the United States is 57% more likely to die by the age of 19 years than those in other wealthy nations.” This is due mainly to more deaths from MVAs and from gun violence.
Shush -Let’s Not Talk About Firearm Safety
Firearm Mortality -Tragic Inertia
Another Day in the US: School Deaths Related to Firearms
Is It OK for Pediatricians to try to Prevent Firearm Injuries? Focus on Child Safety –Not on Gun Safety “We know that nearly 1 in 10 families with guns admit to keeping at least 1 gun loaded and unlocked, and nearly one-half keep at least 1 gun unlocked.
”Physician narrative on gun control | gutsandgrowth
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Firearm Mortality -Tragic Inertia

Posted on October 4, 2017 by gutsandgrowth

When it comes to gun violence, the U.S. is the leader among developed nations. It is sad how that despite the magnitude of this problem there are not significant efforts to mitigate this tragedy.

We know from Australia’s experience that changes in gun laws can make a big difference: Link: Gun Law Reforms and Firearm Mortality, Australia 1979-2013

Politico report: The gun lobby: See how much your representative gets

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Is It OK for Pediatricians to try to Prevent Firearm Injuries? Focus on Child Safety –Not on Gun Safety

Posted on January 18, 2017 by gutsandgrowth

A recent study (JM Garbutt et al. J Pediatr 2016; 179: 166-71 and related editorial by MD Dowd, pg 15-17) provide relevant information on the issue of firearm injury prevention.

The study describes the results of a survey provided to 1246 parents at a diverse group of practices around St Louis.

Key findings:

36% reported being owners of firearms
Of the owners, 25% reported ≥1 firearm was stored loaded and 17.9% carried a firearm when leaving the house.
75% of all parents thought pediatricians should provide advise on safe storage of firearms (71% of owners); however, only 12.8% of all parents reported a discussion about firearms with the pediatrician

The discussion and commentary on this study are more interesting than the actual results. Key points:

The AAP has recommended that pediatricians screen for the presence of household firearms and has stated that a “home without guns is the safest option…Advising safe storage is also encouraged.” Prior surveys have echoed this study that few pediatricians counsel families about firearm safety.
Despite AAP recommendations, over “60% of Americans believe that a ‘gun in the house makes it safer’ which is a more common attitude than in 2004 when 42% of Americans held that view.
Providing a child with firearm avoidance educational programs (eg. NRA’s “Eddie Eagle”) “is unlikely to lead to safe behaviors…[and] may give parents a false sense of security.”
“Children cannot distinguish real guns from toy guns and are strong enough to pull a trigger as early as 3 years of age.”
Approaching the topic of safe storage “as an expert in child development” and children’s unpredictable behavior rather than in firearm safety “may be acceptable to both pediatricians and parents.”
The authors advocate keeping firearm storage on a checklist of hazards (eg. medication storage, avoiding household poisons) –though this has not been well-studied.
From editorial: “When compared with other developed nations, US children under 15 years of age are 12 times more likely to be killed by a gun…We know that nearly 1 in 10 families with guns admit to keeping at least 1 gun loaded and unlocked, and nearly one-half keep at least 1 gun unlocked.”

So, in fact, having a gun in the home does not make a home safer, just the opposite. But delving into this topic is probably not productive due to strong feelings tangential to gun ownership. There have been unsuccessful legislative efforts in over 10 states to prevent physicians from discussing the topic as well as a protracted legal battle in Florida.

My take (borrowed from editorial): “Although the difference between “gun safety” and “child safety” may seem subtle, such a shift allows a consistent approach to home injury prevention across mechanisms of injury with the focus on the child, not the gun.” “Little children are curious and big children (teens) are impulsive, so exposure to unsecured guns can lead to tragic outcomes that cannot be prevented by child education. Who better to deliver this message than pediatricians?”

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