Adolescent firearm violence: position paper of the Society for Adolescent Medicine

Conceptualization of Firearm-Related Terms Among Rural Adolescents: Definitions Matter

Rural adolescents are at risk for firearm-related injury and death. In response, professional organizations have called for communication between adolescents, parents, and providers about firearms. A shared understanding of firearms between providers and families can facilitate effectiveness of health interventions. However, few studies engage adolescents in identifying their perception of common firearm terminology. The current study aimed to understand how adolescents in rural communities defined firearm-related terms including firearm, carrying, and handling, and differences in terms based on prior firearm training. Data were from a mixed methods community-based participatory study of 93 adolescents from rural Washington state. Thematic qualitative coding identified themes for firearm (gun, weapon, projectile, and tool), carrying (on you/your person, transportation, and holding), and handling (actively using, safe use, and holding) and differences between those with prior firearms training. Findings provide insight into perceptions of firearm-related terms for adolescents, an often-neglected voice, and inform rural policy and prevention efforts.

Hospital-Based Suicides: Challenging Existing Myths

Myths are widely held and often based on false beliefs. To improve patient safety and speed the translation of research to clinical practice, we highlight and then debunk 10 common myths regarding the assessment, treatment, and management of hospitalized patients at risk for suicide. Myths regarding hospital-based suicides are examined and empirical evidence that counters each myth is offered. Ten common myths regarding hospital-based suicides are found to be untrue or unsupported based on existing empirical evidence. Rethinking common beliefs and practices that lack empirical support and seeking alternatives based on research evidence is consistent with an emphasis on evidence-based practices leading to improved patient care and protection.

Child access prevention legislative language and pediatric firearm injury rates

Backgroud

Firearm injuries are a significant public health problem facing young people in the USA. In 2015, a total of 16 878 people under 19 years old were injured or killed by firearms. To reduce firearm injuries, 29 states and Washington, DC have enacted child access prevention (CAP) legislation. CAP legislation is intended to reduce the likelihood of a minor obtaining a weapon and subsequent injury or death. This study evaluates the impact of CAP legislation based on language of the legislation, specifically it evaluates a relationship of the legal threshold of liability and the number of firearm injuries per capita of minors.

Methods

Data were collected from the Web-based Injury Statistics Query and Reporting System for patients less than 19 years of age who presented to emergency departments with firearm injuries in 2016. The Giffords Law Center classification was used to group states into three categories (strong/weak/no CAP) based on CAP language. Differences of firearm-related injury rates per capita were assessed.

Results

When controlling for population, states with CAP legislation had a 22% decrease in firearm injuries per capita compared with states without CAP legislation. States with ‘strong’ CAP legislation had a 41% decrease in firearm injuries per capita compared with states with ‘weak’ or no CAP legislation when controlling for population.

Conclusions

States with ‘strong’ CAP legislation had lower pediatric firearm injury rates per capita, but more complete data and further studies are needed to evaluate this relationship as well as other factors that may impact firearm injury rates.

Preventing Firearm Violence in Youth Through Evidence-Informed Strategies

Firearm injuries are the leading cause of death for adolescents and young adults (AYA) aged 12-24 years in the U.S. The Society for Adolescent Health and Medicine (SAHM) believes that a comprehensive approach addressing firearm access for AYA can decrease the morbidity and mortality that AYA experience due to firearms. SAHM's position paper builds on the 2005 position statement, the scientific literature, and expert opinion. SAHM believes that the safest home for AYA is one without firearms. If firearms are present, they must be stored unloaded, locked up, with ammunition locked and stored separately. SAHM supports legislative efforts at the local, state, and national levels that focus on sensible laws proven to decrease 1: mortality from firearms; 2: the availability of illegal firearms; and 3: the availability of firearms to individuals who should not possess firearms, such as children and those with suicidal ideation. Clinicians across disciplines working with AYA can affect change by screening AYA and their parents for the presence of firearms in their home and environment; administering safe storage counseling to all, including those without firearms in their homes; and facilitating distribution of safe storage devices-lock boxes or cable locks, including when possible through the clinic setting. Clinicians should pay particular attention to higher risk situations, such as youth with suicidal ideation, to convey the risk that firearms pose. Finally, as part of a comprehensive approach that values scientific evidence, SAHM supports the expansion of research on firearms and youth safety through federal agencies and encourages firearm risk reduction education for all health care providers.

Guns in the Home and the Possibility of Aggressive Tendencies: Exploring a Community Sample of Adolescents in Low-Income Communities

Firearm violence has been the second leading cause of death among adolescents and young adults in the United States since 2000 and is a major public health concern. But firearms may be related to less lethal forms of violence as well. Here we examine the relationship between the presence of a gun in the home and several behavioral and psychosocial measures related to aggression and violence among adolescents using data from a community-based survey of nearly 2,000 youths living in low-income neighborhoods. Our results indicate that adolescents living in homes where a gun is present display more aggressive attitudes and behaviors than their counterparts living in homes with no gun present. More research is needed to better understand the mechanisms underlying the relationships, but they may relate to a weapon's effect or social learning.

Mortality of Youth Offenders Along a Continuum of Justice System Involvement

INTRODUCTION

Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts.

METHODS

Criminal and death records of 49,479 youth offenders (ages 10-18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014.

RESULTS

From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality.

CONCLUSIONS

Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention.

Effects of a youth substance use prevention program on stealing, fighting, and weapon use

Using a sample of sixth graders in 11 public schools in a large Southwestern city, this longitudinal study examined how a model substance use prevention program, keepin' it REAL, that was implemented in 7th grade, influenced three other problem behaviors (fighting, weapon use, stealing), measured in 8th grade. Using a non-equivalent control group design, we compared 259 students in the intervention to 322 students in a treatment-as-usual condition. At baseline, 37% of the sample reported fighting in the last 30 days; 31% reported stealing in the last 30 days, and 16% reported using a weapon in the last 30 days. Regression analyses adjusted for students nested in schools through multi-level modeling and for missing data through multiple imputation. We found that at posttest the rates of all three behaviors were lower in the intervention group than the control group at posttest: 35 versus 37% got into a fight in the last 30 days; 24 versus 31% stole something in the last 30 days; and 16 versus 25% used a weapon in the last 30 days. The program impact for fighting and stealing was not statistically significant and involved minimal effect sizes. The program impact for weapon use was not statistically significant but had an effect size comparable to that for other problem behavior interventions. Promoting positive development via life skills may be a key to broadening program impact.

The nature of violence: a multilevel analysis of gun use and victim injury in violent interpersonal encounters

A large number of studies have examined predictors of crime quantities yet considerably less attention has been directed toward exploring patterns in the nature or quality of violence within and across communities. The current study adds to the literature on qualitative variations in violence by assessing the incident and contextual-level predictors of offender gun use and physical injuries sustained by victims of robbery and aggravated assault. Specifically, we examine incident-level data from the National Incident Based Reporting System in conjunction with contextual-level data on the cities in which the incidents occurred. We use hierarchical linear and nonlinear modeling techniques to explore variations in predictors of offender gun use and extent of victim injury. Supporting cultural effects explicated by Anderson, results reveal certain individual-level predictors are conditioned by community characteristics.

Specifying the role of exposure to violence and violent behavior on initiation of gun carrying: a longitudinal test of three models of youth gun carrying

Two waves of longitudinal data from 1,049 African American youth living in extreme poverty are used to examine the impact of exposure to violence (Time 1) and violent behavior (Time 1) on first time gun carrying (Time 2). Multivariate logistic regression results indicate that (a) violent behavior (Time 1) increased the likelihood of initiation of gun carrying (Time 2) by 76% after controlling for exposure to violence at Time 1, which is consistent with the stepping stone model of youth gun carrying, and (b) youth who were both exposed to violence at Time 1 and engaged in violent behavior at Time 1 were more than 2.5 times more likely to initiate gun carrying at Time 2 compared to youth who had neither of these characteristics, which supports the cumulative risk model of youth gun carrying. The authors discuss the implications of these findings in clarifying the role of violence in the community on youth gun carrying and the primary prevention of youth gun violence.

Can media effects counteract legislation reforms? The case of adolescent firearm suicides in the wake of the Austrian firearm legislation

To assess the impact of the Austrian firearm legislation (1997) on adolescent suicides, we investigated time trends in youth suicide prevalence (1986-2006) with Poisson regression. A temporary increase in firearm suicides after the reform was observed, followed by a continuous decrease. The hypothesis that media reporting triggered the short-term backlash effect is discussed.

Risk for Repeat Emergency Department Visits for Violent Injuries in Youth Firearm Victims

Objective

To identify significant risk factors associated with repeat emergency department (ED). Visits for violent injuries in youth firearm victims.

Methods

The study subjects of this retrospective cohort study were firearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV) at any emergency department in Milwaukee for a violent injury.

Results

A total of 495 subjects were eligible for the present study in the pediatric firearm victim's ED visit database. Eighty-five percent (n = 420) were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6). A majority of them had a single-parent family. Eighty-eight subjects (17.8%) had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047), controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003).

Conclusion

Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.

Are household firearms stored less safely in homes with adolescents?: Analysis of a national random sample of parents

OBJECTIVE

To examine whether firearms are more frequently stored loaded, unlocked, or both in households with adolescents only (aged 13-17 years) compared with households with younger children only (aged 0-12 years).

DESIGN

Random-digit-dial survey on firearms (n = 2770). We computed bivariate associations between the presence of adolescents and firearm storage practices. Statistical significance was assessed using prevalence ratios with 95% confidence intervals.

SETTING

United States.

PARTICIPANTS

Survey respondents with children (aged <18 years) who reported the presence of a household firearm.

MAIN OUTCOME MEASURES

Prevalence of firearms in the home stored loaded and/or unlocked.

RESULTS

Of the 392 respondents, 22% had a loaded firearm, 32% had an unlocked firearm, and 8% had a firearm stored loaded and unlocked. Compared with households with younger children, households with adolescents only were somewhat more likely to store a firearm unlocked (42% vs 29%; prevalence ratio, 1.48; 95% confidence interval, 1.04-2.02), loaded (26% vs 20%; prevalence ratio, 1.25; 95% confidence interval, 0.82-1.91), or both (10% vs 8%; prevalence ratio, 1.43; 95% confidence interval, 0.64-3.19).

CONCLUSIONS

Parents of adolescents appear to be more likely to keep household firearms stored unsafely, especially with regard to keeping firearms unlocked. This is of concern because most youth firearm injuries happen to adolescents. Firearm injury prevention programs should directly target parents of adolescents to promote safe firearm storage.