Preventing Unintentional Firearm Injury in Children: The Need for Behavioral Skills Training.

Abstract Unintentional firearm injury in children is a problem in the United States that warrants attention. Recent research has identified several risk factors for such injuries and has developed prevention strategies for reducing their occurrence. Many of these programs, however, have not been evaluated or have been shown to be ineffective. Research on the prevention of other childhood injuries, on the other hand, has shown behavioral skills training to be successful for teaching protective behaviors to children for a variety of injury threats. This paper examines risk factors for firearm-injury in children, briefly reviews existing protection programs and their limitations, provides a brief overview of research on effective childhood injury prevention, and concludes with a description of the components of an effective injury prevention program and directions for future research. ********** Unintentional firearm injury and death among children is a significant problem in the United States. The American Academy of Pediatrics (AAP) Committee on Injury and Poison Prevention (1992) reported that 203 children under the age of nine were killed by firearms, half of these unintentional, in the year 1987 alone. The most recent statistics available from the Centers for Disease Control and Prevention (2001) reported that, on average, 162 children under the age of 14 years were accidentally killed by firearms each year between 1993 and 1998. Stennies, Ikeda, Leadbetter, Houston, and Sacks (1999) reported that firearm injuries were the sixth-leading cause of death for children between the ages of 5 and 9 and the eighth leading cause of death for children between 1 and 4 years in 1995. As might be expected, nonfatal firearm injuries represent an even larger problem. The Centers for Disease Control (2001) reported that, on average, 1,459 children under the age of 14 years were involved in unintentional, nonfatal injuries each year between 1993 and 1998. Annest, Mercy, Gibson, and Ryan (1995) examined the medical records from gunshot victims in 91 hospitals and found the ratio of nonfatal to fatal firearm injuries to be 2.6 to 1. For children between the ages of 0 and 14, this ratio climbed to 4.2 to 1. In addition, Annest et al. found that, across all age groups, nonfatal firearm injuries were 12.8 times more frequent than fatal injuries when the shooting was unintentional. These findings confirm that firearms continue to threaten the lives and health of children. Few would disagree that this issue warrants attention from researchers, health care professionals, parents, and other concerned persons. In order to protect children and their families from the potential dangers of firearms, it is essential that we recognize and address risk factors associated with firearms. In addition, it is necessary that researchers critically examine and systematically evaluate existing prevention programs to ensure their maximum effectiveness. The purpose of this paper is to summarize existing literature on unintentional firearm injuries to children, to critically review existing prevention programs, and to propose directions for future research so that more effective prevention-based interventions can be implemented and systematically evaluated. Parental Behaviors as Risk Factors Availability of Firearms in the Home Numerous researchers have identified firearm availability in the home as one of the most important and consistent factors in firearm injury among children (Ordog et al., 1988; Senturia, Christoffel, & Donovan, 1994; Wintemute, Teret, Kraus, Wright, & Bradfield, 1987). Although precise, nationwide estimates of the percentage of homes that have guns are difficult to obtain, regional reports of gun ownership in homes with children estimate that ten to more than fifty percent of homes with children have at least one gun stored in the residence (Senturia et al. …