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Protecting Children From Guns

Can health professionals help prevent gun violence involving children?

Guns and young people definitely don't mix.

According to Center for Disease Control statistics, there were 2,711 firearm-related deaths of infants, children, and adolescents in 2010 alone. For young people between the ages of 10 and 19, homicide and suicide are the second and third leading causes of death with 83.8 percent of homicides and 38.8 percent of suicides being firearm-related. For children between the age of one and nine, homicide was the fourth leading cause of death in 2010. 

Research into gun deaths involving young people has turned up specific risk factors that appear to increase the likelihood of becoming a victim. Not only are homicides, suicides, and accidental deaths involving firearms more common in states with a high rate of gun ownership, but many of those deaths are directly linked to unsafe firearm storage in the home. Young people who commit suicide often use a gun belonging to a parent or other family member which they are able to access due to lax security. Despite the publicity that often surrounds gun deaths resulting from unsafe storage, many parents fail to take proper precautions. In one study published in 2007, only a third of gun-owning parents of small children report safe firearm storage in their homes. Handgun owners are also more likely to keep their guns loaded rather than storing ammunition separately.  

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Along with the availability of guns at home, young people exposed to community violence and threats to their personal safety (including bullying) are often motivated to taking guns to school for protection. While school shootings only involve one to two percent of the total number of homicides involving young people, the 2011 Youth Risk Behavior Surveillance System survey reported that 5.1 percent of high school students (Grade 9 to 12) carried guns at least once in the 30 days before the survey. That same survey also reported that 15.8 percent of students seriously considered suicide.

Concern over potential violence in schools has led to the introduction of zero tolerance policies in many school districts, particularly with respect to guns and drugs. Following the passage of Federal legislation in 1964 requiring school districts to expel students bringing firearms to school, the policies have been expanded to include a wide variety of infractions. Given the often draconian nature of zero tolerance which penalizes students without addressing the underlying problems driving potential violence, critics often regard these policies as doing more harm than good. Many high-profile cases of excessive punishments given to students for minor infractions (including a six-year old student being suspended for curling his fist into a gun shape), has led to court challenges and forced changes in school policies. Still, zero tolerance policies remain in place across many parts of Canada and the United States.

The impact of gun violence on young people, whether through grief over losing someone close or posttraumatic stress, can be devastating. In a 2012 policy statement released by The American Academy of Pediatrics Council on Injury, Violence, and Poison Prevention Executive Committee,  pediatricians and other health-care professionals are urged to counsel parents who are gun owners about safe storage of firearms. As well, health care professionals are urged to be alert to risk factors that might increase the likelihood of young people being killed or injured by guns.  

While there is no single risk factor that can predict gun-related homicides or suicides, the level of risk varies widely depending across different populations. A recently-published article in Clinical Practice in Pediatric Psychology provides a  comprehensive overview of the different factors linked to gun violence in young people. Written by Ariel Williamson and Nancy Guerra of the University of Delaware and W. Douglas Tynan of Delaware and Jefferson Medical College, the review highlights the social, ethnic, and economic factors linked to gun violence.   

According to Williamson and her colleagues, some of the predictors of gun-related homicides include:

  • Ethnic identity (gun-related homicides are highest among African American males)
  • Unsupervised access to firearms and ammunition
  • High levels of early environmental and family stress
  • Poor parent-child relationships
  • Affiliations with deviant or antisocial peers
  • Academic problems
  • Neighbourhood turmoil, including community violence
  • Exposure to violent media

Risk factors linked to gun homicides can include those biological risks that have already been linked to antisocial behaviour in children (including maternal substance abuse during pregnancy, high maternal stress, low birth weight, or poor nutrition).  Adding to those factors are the risk factors associated with family problems (poor parent-child interaction, harsh or inconsistent parenting,  inadequate gun storage in the home, and family beliefs about violence and gun use). Then there are the community factors such as fear of community violence (with young people carrying guns for their own protection), associating with antisocial peers, and problems faced at school (including bullying). Again, there is no single risk factor underlying gun violence and many young people raised in high-risk environments may never commit a crime. Still, these different factors can interact over time to increase the likelihood that a gun-related death will occur.

While not as widely researched as gun-related homicides, there are well-known risk factors linked to gun-related suicides as well. These factors can include:

  • Unsupervised access to firearms and ammunition
  • Ethnic identity (suicides are highest among non-Latino white males)
  • Previous suicide attempts
  • Male gender
  • Psychological problems, including substance abuse
  • Other psychological issues including impulsivity, hopelessness, isolation, and a feeling of being a burden.

Young people who feel that they are a burden to others or who lack a basic sense of belonging appear to be more likely to commit suicide (especially if they have easy access to guns). Children and adolescents exposed to community violence and who develop symptoms of posttraumatic stress disorder are also at high risk for suicide.  

But are there more effective ways of preventing gun violence involving young people? Ariel Williamson and her co-authors suggest that preventing gun-related homicides and suicides among children and adolescents would need a comprehensive approach at the family, school, and community level.   

There have already been promising approaches, including the use of community-oriented policing to target "hot spots" with higher-than-average levels of crime and gun violence. One of these, the Boston Gun Project (also known as Operation Ceasefire) involves reducing gun violence through regular meetings between gang members, police officers, and probation officers. The program also targets black market traffic in firearms and outreach with detention centres and the community at large. Program evaluations of the Boston Gun Project show a modest reduction in youth homicides after being implemented and similar programs have been set up in other cities such as Chicago, Richmond, Virginia and Baltimore, Maryland.

Another program that shows promise in curbing gun violence is Project Safe Neighborhoods.   Launched by the United States Department of Justice, the program is based on principles used in Operation Ceasefire and related programs. By having State Attorneys working with local law enforcement and community groups, Project Safe Neighborhoods curb gun violence through community policing policies, aggressive enforcement of federal firearm legislation, and prosecutions to curb gang violence. One of the features of the project is Gang Resistance Education and Training (GREAT) which is provided by police officers going into schools to train students in life skills to combat delinquency. Early research has shown modest effectiveness in reducing gun-related homicides in children and adolescents.

Gun violence prevention has become more widely used in many school districts to identify high-risk children and adolescents, particularly those young people who have made violent threats. Also, crisis intervention teams made up of specially trained officers and mental health professionals have been formed to defuse risk situations and to divert young people considered to be at risk into treatment rather than being sent to jail.  

As for the role of health care providers can play in preventing gun deaths, Williamson, Guerra, and Tynan make a series of practical recommendations about the prevention strategies that providers dealing with young people can make part of their practice. They include:

  • Integrating basic questions about gun access and safe storage into all interviews involving young people, whether in routine checkups or psychological assessments. This follows guidelines laid down by many professional and non-profit organizations focusing on child safety
  • Asking questions about aggressive behaviour, homicidal and suicidal thoughts, violence, and use of weapons into even routine visits, as well as risk assessments.
  • Using structured screening tools that have a proven track record for measuring suicide and other risk behaviours.
  • Providing basic counseling about safe gun storage to gun-owning families. That includes storing guns and ammunition separately and keeping guns securely out of the reach of children.
  • Providing families and young people with educational handouts about gun safety and preventing youth violence.
  • Providing young people showing an elevated risk of violence or suicidal intention with appropriate psychological or psychiatric referrals.
  • Seeking out training opportunities to learn more about gun safety and preventing gun deaths.

There are already online resources such as the American Academy of Pediatrics Bright Futures practice guidelines to provide pediatricans and other health professionals with sample questions and gun safety information.   

Health care professionals need to do everything in their power to make young people safer and to try preventing those tragedies that seem to be occurring regularly in many parts of the United States.

Romeo Vitelli, Ph.D. is a psychologist in private practice in Toronto, Canada.

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