AMERIKA'S GUN OBSESSION
Firearm laws restricting large-capacity magazines effective in reducing child deaths in mass shootings
Research presented during the American Academy of Pediatrics 2024 Conference & Convention analyzes how different state laws impact mass shooting deaths
ORLANDO, Fla.-- The only firearm restrictions found to be effective in reducing mass shootings involving children were laws banning the sale of firearms equipped with a large-capacity magazines, according to a new analysis presented during the American Academy of Pediatrics 2024 National Conference and Exhibition.
Researchers will present, “Do State Gun Laws Affect Pediatric Mass Shootings? A 2009 - 2020 Year Analysis,” during the AAP conference held at Orlando Convention Center Sept. 27-Oct. 1.
For the eight states that adopted large capacity magazine bans, the odds of a child dying from a mass shooting was decreased by 91%, according to an abstract. In contrast, the most common laws – which include restrictions on gun purchasing or the possession of firearms around children in a school setting – failed to show a significant decrease in child deaths due to mass shootings.
“Mass shootings are horrific events. We found that large capacity magazine bans may have the biggest effect on reducing child deaths in mass shootings,” said Stephanie Chao, MD, FAAP, senior author of the study. “We hope that research like ours can help legislators to make informed choices.”
Mass shootings were defined as those with at least four recorded deaths in which one or more of the victims were under age 21 during the years 2009-2020, according to the Everytown for Gun Safety database. Researchers then analyzed these events by state using 10 categories of gun violence prevention laws: assault rifle bans; large capacity magazine bans; permit requirements; extreme risk protection (Gun Violence Restraining Orders); universal background checks; concealed carry discretionary laws; gun possession; violent misdemeanor history; pediatric population; and child access barriers.
The research identified 131 pediatric mass shootings from 2009 to 2020. Over that time, laws restricting the sale of large capacity magazines were associated with the greatest significant reduction of child deaths in mass shootings. During the time of the study, large capacity magazine bans had been adopted by only eight states (CA, CO, CT, MD, MA, NJ, NY, VT). Today, 14 states have laws banning firearms equipped with large capacity magazines.
The authors note that the study was limited to the effects on pediatric mass shootings and should not be interpreted to be generalizable to all pediatric or adult firearm related deaths.
Pamela Emengo, Postdoctoral Research Fellow, is scheduled to present the research (abstract is below) during the Session: (H3032) Council on Injury, Violence, and Poison Prevention, Sunday, Sept. 29, 2024
In addition, Pamela Emengo will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference from noon-1:30 pm ET Saturday, Sept. 28, in the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Council on Injury, Violence, and Poison Prevention
Abstract Title: Do State Gun Laws Affect Pediatric Mass Shootings? A 2009 - 2020 Year Analysis
Pamela Emengo
Palo Alto, CA, United States
In the United States, firearm related injuries have overtaken motor vehicle crashes to become the leading cause of death amongst children. A variety of legislation has been proposed, yet there remains a need for research to demonstrate effective mass shooting firearm policy, especially regarding children. We hypothesize that states with more stringent laws had fewer mass shooting associated pediatric deaths than states with less stringent firearm laws.
We evaluated the Everytown for Gun Safety database from 2009 to 2020 for shootings with at least 4 recorded fatalities where 1 or more of the included fatalities was an individual under the age of 21. We categorized gun prevention laws into 10 groupings involving the following: assault rifle bans (Assault), large capacity magazine bans (Magazine), permit requirements (Permit), extreme risk protection (gvrolawenforcement), universal background checks (Universal), concealed carry discretionary laws (May Issue), gun possession (Possession), violent misdemeanor history (Violent), pediatric population (PEDS), and child access barriers (CAP). After controlling for demographic factors, we used logistic regression and a zero-inflated negative binomial model to analyze the relationship between laws and mass shootings.
We identified 131 pediatric mass shootings from 2009-2020. Laws banning the sale of large capacity magazines were the only laws significantly associated with a reduction in child deaths (OR = 0.09 [95% CI 0.02, 0.47; p < 0.05]). Laws involving restriction of firearms around children (PEDS) were the most commonly found legislation, but failed to show significance in preventing mass shootings or preventing child deaths (p > 0.05). The next highest utilized laws were extreme risk protection laws and universal background checks, yet neither was found to have significance (p > 0. 05) (Figure 1).
Of the parameters we evaluated, laws restricting the sale of large capacity magazines were associated with the greatest reduction of pediatric deaths in mass shootings. Our work is one of the first to analyze how laws impact pediatric mass shootings. Despite a relatively low adoption in the United States, we show how large capacity magazine bans have the potential to prevent pediatric deaths secondary to mass shootings. This study was only limited to the effects on pediatric mass shootings and should not be interpreted to be generalizable to all pediatric or adult firearm related deaths.
Figure 1
The percentage of states that have adopted firearm laws from 2009-2020. The percentages to the left of each bar represent the exact percentage of states who had passed the law by 2020
Table 1
Description of the law codes analyzed within each law code category
Caregivers underestimate suicide as the leading cause of firearm death: study
Research presented at the American Academy of Pediatrics 2024 National Conference & Exhibition analyzes Colorado survey findings
ORLANDO, Fla.—A study found fewer than one in four Colorado residents living with children at home recognized suicide as the leading cause of firearm death and less than half thought suicide can be prevented, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition.
The study will be published online in the journal Pediatrics Sept. 27, the first day of the conference at the AAP National Conference and Exhibition that runs from Sept. 27-Oct. 1 at the Orange County Convention Center. While most research presented during the conference is preliminary, the study, “Colorado Caregivers’ Perceptions of Firearm Safety and Youth Suicide,” will publish in the October 2024 Pediatrics.
“We are all working toward the same goal of keeping our children safe,” said the lead author, Maya Haasz, MD FAAP, Associate Professor of pediatrics at the University of Colorado School of Medicine. “With this study, we have identified an opportunity to educate families about the preventability of suicide and how limiting firearm access in times of crisis can decrease suicide deaths.”
The study was conducted using data from the 2023 Colorado Firearm Injury Prevention Survey (COFIPS), an annual state-representative survey of Colorado adults conducted by the University of Colorado Firearm Injury Prevention Initiative (Emergency Medicine | Major Programs | Firearm Injury Prevention Initiative (cuanschutz.edu).
The 1,520 adults completing the survey included 512 caregivers with children younger than 18 years in the household. Survey questions assessed firearm storage, perceptions of firearm-related risks, and concerns about suicide among youth
Researchers found that Coloradans living with children in the home underestimated the risk of firearm-related suicide. Additionally, although nearly two thirds of participants were concerned about youth suicide in the community, only one third were concerned about suicide among youth in their own families. Finally, while those living in households with firearms believed that secure storage decreased risk of firearm injury, less than half thought suicide can be prevented and only 60% believed that removing firearms from the home would decrease the risk of injury in times of mental health crisis.
“This is especially concerning when many believe that suicide can’t be prevented by measures such as limiting access to home firearms,” Dr. Haasz said. “It highlights a crucial messaging opportunity – that there are effective ways to decrease the risk of suicide for our youth.”
Dr. Maya Haasz, is scheduled to present her research, which is below, at the Hyatt Regency Orlando, Plaza International Ballroom on September 29, from 12 pm – 1 p. To request an interview with Dr. Maya Haasz, contact the Children’s Hospital Colorado media relations team at media@childrenscolorado.org.
In addition, Dr. Haasz will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference from noon-1:30 pm ET the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Council on Injury, Violence, and Poison Prevention
Abstract Title: Colorado Caregivers’ Perceptions of Firearm Safety and Youth Suicide
Maya Haasz
Aurora, CO, United States
In the US, 4.6 million households with youth contain loaded and unlocked firearms.1 Household firearms, particularly unsecured household firearms, are associated with increased risk of youth suicide.2,3 This study examined perceptions of firearm risk and suicide among caregivers with and without household firearms.
The Colorado Firearm Injury Prevention Survey was administered by the Ipsos survey firm online in English and Spanish from April-May 2023. Of 1,520 adults completing the survey, we included 512 caregivers (children < 18 years in the household). Survey questions assessed firearm storage, perceptions of firearm-related risks, and concerns about suicide among youth. Likert scales were dichotomized to improve interpretability. We estimated weighted prevalences and 95% confidence intervals (CI), and compared differences between households using weighted chi-square tests. Poststratification weights were applied to make findings representative of Colorado adults. The study was approved by the Colorado Multiple Institutional Review Board.
Colorado caregivers were primarily female (56.4%), aged 25-54 (77.4%), White (87.8%), non-Hispanic (74.9%), and had a child ≤12 years at home (79.3%). Nearly half (45.5%) reported a firearm in the home (Table 1). Among all caregivers, 23.7% correctly identified suicide as the leading cause of firearm death in Colorado, with no difference between groups. Caregivers with household firearms were more likely to believe a firearm in the home made them safer (52.2% vs 22.4%, p< 0.001) and that secure storage reduced the risk of firearm injury. They were less likely to believe that suicide can be prevented (47.8% vs 68.9%p< 0.001), or that temporary removal of firearms decreases risk of firearm injury or death (59.6% vs 77.7%, p< 0.001). Two thirds of caregivers were concerned about youth suicide in their community. Caregivers with household firearms were less likely to be concerned about suicide among youth within their own family (28.1% vs 38.5%, p=0.013) (Table 2).
Less than a quarter of caregivers in Colorado recognized suicide as the leading cause of firearm death in their state. There was more concern for youth suicide in the community than in the family; caregivers with firearms were less concerned about youth suicide in their family than those without. This risk is compounded by a belief that suicide is not preventable and that strategies to mitigate the risk of suicide are not effective. This study has several limitations. Respondents were all in Colorado; results may not be generalizable. Responses may have been impacted by non-response or social desirability bias. The study did not include context that may affect violence risk (ex. neighborhood crime). Our finding that firearm owners believe that secure firearm storage is protective against firearm injury is a promising messaging strategy. Future research should explore effectiveness of preventive messaging in improving perceptions around household firearms and suicide risk.
Firearm culture, perceptions of firearm-related risks, and concern about youth suicide among Colorado caregivers with and without household firearms
Table 1: Sociodemographics of Colorado caregivers with and without household firearms
Journal
PEDIATRICS
Parents open to firearms counseling from doctors; Ensuring secure storage remains a challenge
In survey, Houston parents of teenagers with suicidal ideation or suicidal attempts agree doctors should discuss secure gun storage with parents; 20% of gun-owning families report they aren’t storing firearms securely
American Academy of Pediatrics
ORLANDO, Fla.— Firearms are the leading cause of death in children in the United States and are linked to over half of youth suicides. Secure storage of firearms (stored locked, unloaded, and separate from the ammunition) can significantly decrease the rates of child and adolescent firearm-related suicides.
According to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1, “Caregiver Perspectives on Firearm Safety Guidance for Children Hospitalized for Suicidal Ideation or Attempt,” parents—both firearm-owners and non-owners—overwhelmingly agree that doctors should be discussing secure firearms storage with parents. However, 19% of firearm owning caregivers reported that they were not storing their firearms securely.
“The health and safety of children are the top priority for pediatricians. Previous studies confirm that firearm secure storage can decrease the risk of youth suicide and that pediatricians’ discussions with families can increase the likelihood of firearm secure storage practices,” said Taylor Rosenbaum, MD, MA, lead author.
Authors surveyed 100 caregivers of children and young people, ages 8-21 years, who were admitted to the hospital for suicidal ideation or suicide attempt. Families were questioned about their attitudes toward firearm counseling and were offered secure storage counseling and a free firearm lock. The survey results show that parents were receptive to talking about firearms in the home with their doctors.
This is an ongoing study. Since the abstract was submitted to the AAP, the researchers have continued the study and are providing updated data that is not included in the abstract. (The original data is included in the abstract below.) According to the updated data including 100 parents, of the parents surveyed:
- Only half (51%) reported being asked about the presence of home firearms by their healthcare team
- 96% agreed it was important for their child’s hospital team to ask about firearm ownership
- 96% thought secure firearm storage counseling by the healthcare team was important
- 89% felt it was important to distribute firearm locks in the hospital
- Firearm non-owners were more likely to think firearm lock distribution was “very important,” however both groups recognized the importance.
“As a result of our recent efforts, we have also confirmed that parents of children hospitalized for suicidal thoughts or actions want to have firearm secure storage discussions with their healthcare team during the hospitalization and benefited from a free firearm lock,” Dr. Rosenbaum said. “This insight gives pediatricians actionable ways to make a positive difference in the safety of these children.”
The research was completed at Baylor College of Medicine / Texas Children’s Hospital.
Study author Dr. Rosenbaum, MD, MA, is scheduled to present the research, which is below, from 8:48 - 8:58 a.m. on Sunday, Sept. 29, during the Section on Hospital Medicine program at the Orange County Convention Center.
In addition, Dr. Rosenbaum, along with other featured research abstract authors, will give a brief presentation and be available for interviews during a press conference from noon to 1:30 p.m. Saturday, Sept. 28, in the National Conference Press Room W208 AB. During the meeting, you may reach AAP media relations staff in the press room at 407-685-5401.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Hospital Medicine
Abstract Title: Caregiver Perspectives on Firearm Safety Guidance for Children Hospitalized for Suicidal Ideation or Attempt
Firearms are the leading cause of death in United States youth and are utilized in over half of youth suicides. The safe storage of firearms significantly decreases the risk of youth suicide. As hospitalizations for pediatric suicidal ideation or attempt (SI/SA) rise, there is a need to explore caregiver perspectives on in-hospital firearm storage guidance. We aimed to explore caregiver receptiveness to firearm safe storage counseling and free firearm locks while their child is hospitalized for SI/SA.
Using a cross-sectional study design, we surveyed caregivers of children ages 8-21 admitted to the Pediatric Hospital Medicine service for SI/SA at a quaternary children’s hospital in Houston, Texas from June 2023 - March 2024. We used the electronic medical record to identify caregivers of patients with a primary diagnosis of SI/SA and a primary spoken language of English or Spanish. We excluded caregivers who were not the legal guardian. We developed a 26-item anonymous survey, administered using RedCap either in-person, through email, or over the phone after obtaining informed consent. The survey assessed caregiver demographics, firearm ownership and storage practices, firearm discussions with their child’s healthcare team, and willingness to receive firearm storage guidance and free firearm locks. We used Chi-squared or Fisher’s exact tests to compare responses between firearm owners and non-owners.
Of 120 caregivers approached, 84 (70%) enrolled. 29% were firearm owners, 64% were non-owners, and 7% did not disclose. Of all caregivers, 46% reported being asked about the presence of home firearms by their healthcare team; 96% agreed it was important for their child’s hospital team to ask about firearm ownership; 96% thought safe firearm storage counseling by the healthcare team was important; and 87% felt it was important to distribute firearm locks in the hospital. Of firearm owners, 21% reported their firearms were not securely stored. Compared to firearm owners, more firearm non-owners spoke Spanish and identified as other race and Hispanic ethnicity. Firearm non-owners were more likely to think firearm lock distribution was “very important”, however both groups recognized the importance (74% vs 67%, p-value 0.034).
Caregivers of children hospitalized for SI/SA were not consistently counseled on safe storage by their healthcare team. However, most caregivers, both with and without firearms, acknowledged the importance of firearm counseling and distribution of firearm locks during their child’s hospitalization.
Table 1
Caregiver demographics of children admitted for suicidal ideation or attempt. Six participants did not disclose firearm ownership and are not described in this table.
Table 2
Caregivers of children admitted for suicidal ideation or attempt (SI/SA) firearm ownership and home storage practices, firearm discussions with their child’s healthcare team, and willingness to receive firearm storage guidance and free firearm locks. Six participants did not disclose firearm ownership and are not described in this table.
Firearm injuries lead to more complications, greater risk of death and higher inpatient costs than other injuries
New research presented at the American Academy of Pediatrics 2024 National Conference & Exhibition evaluated firearm injuries, penetrating injuries and blunt force injuries over four years
American Academy of Pediatrics
ORLANDO, Fla.— Children who are injured by firearms require significantly more inpatient care, have higher medical complication rates and face a greater risk of death than children with other forms of trauma, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition in Orlando, FL.
The abstract, “Pediatric Firearm Injuries: Unveiling the Unmatched Healthcare Burden and Costs,” to be presented during the conference Sept. 27-Oct. 1 at the Orange County Convention Center, evaluated data from patients ages 21 and younger between 2017 and 2020. Using data provided by the National Inpatient Sample (NIS), researchers compared complications, costs and mortality risks of injuries caused by firearms, penetrating trauma (such as stab wounds), or blunt trauma (such as from motor vehicle collisions).
“Children are particularly vulnerable to the devastating impact of gun violence, often resulting in severe, life-altering and life-long injuries,” said Colleen Nofi, DO, PhD, MBA, MSc, surgeon at Northwell Health’s Cohen Children’s Medical Center, scientist at the Feinstein Institutes for Medical Research, and lead author on paper. “Our study shows that children injured by firearms are more likely to need life-saving procedures, inpatient interventions, and major surgeries than other traumas, all of which will profoundly affect survivors’ lives forever -- as well increased health care costs.”
The abstract analyzes 82,405 patients whose injuries were categorized using the International Classification of Disease, 10th revision injury codes. Of the total patients, 6,615 sustained firearm injuries; 9,787 were penetrating traumas; and 66,003 were blunt traumas.
Researchers found the procedures and operations more frequently required for firearm injuries, such as major organ resections, breathing device insertions, and ostomies, often result in significant morbidity and long-term consequences. Additionally, firearm injuries confer significantly greater costs than other types of trauma.
The results showed that Black patients were more often injured by firearms (57%), compared to only 14% and 17% for penetrating and blunt trauma, respectively. A majority of firearm injured patients were in the lowest income quartile (53%) compared to penetrating and blunt trauma patients, at 29% and 32%, respectively.
The mean length of a patient’s stay in the hospital was significantly greater for firearm injuries, at 10.8 days, compared with 8.3 days for penetrating injuries and 9.8 days for those with blunt trauma.
“These findings highlight the urgent need for targeted prevention, supportive measures, and resource allocation to mitigate the devastating impact of firearm injuries on children and healthcare systems alike,” Dr. Nofi said.
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The study was funded by the Center for Gun Violence Prevention, Northwell Health.
Study author Dr. Nofi is scheduled to present her research, which is below, from 10:30 AM to 11:30 AM on Saturday September 28, 2024, at the Hyatt Regency Ballroom.
In addition, Dr. Nofi will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference at 12:00-1:30 PM on Saturday, Sept. 28, 2024, in the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Surgery
Abstract Title: Pediatric Firearm Injuries: Unveiling the Unmatched Healthcare Burden and Costs
Colleen Nofi
Manhasset, NY, United States
Trauma is a leading cause of morbidity and mortality in the U.S. As of 2020, firearm injuries became the leading cause of death in children. Although the heightened mortality risk of firearm injury is known, the burden of inpatient care for initially nonfatal firearm injuries is poorly understood. This study aimed to characterize the inpatient burden of care and association of increased charges for firearm injuries compared to other penetrating and blunt traumas in the pediatric population.
The National Inpatient Sample (NIS) was analyzed for pediatric patients (age 0-21) with International Classification of Disease, 10th revision injury codes for firearm injury, penetrating trauma, and blunt trauma from 2017-2020. Demographic information, hospital interventions, and outcomes were compared. Multivariable regression was performed to evaluate predictors of hospital charges.
82,405 patients were identified, of which 6,615 were firearm injuries, 9,787 were penetrating traumas, and 66,003 were blunt traumas. The national total estimate over the 4 years was 33,075 firearm injuries, 48,935 penetrating traumas, and 330,015 blunt traumas. The mean age differed by mechanism: 17 years for firearm, 16 years for penetrating, and 12 years for blunt traumas. The distribution of race significantly differed by mechanism, as firearm injuries more commonly impacted Black patients at 57%, compared to only 14% and 17% for penetrating and blunt trauma, respectively (p< 0.001). Traumas disproportionally impacted males with the greatest gap for firearm injury (87%) compared to penetrating and blunt trauma (36% and 63%, respectively, p< 0.001). Median income quartiles also differed by traumatic mechanism, where a majority of firearm injured patients were in the lowest income quartile (53%) compared to penetrating and blunt trauma patients (29% and 32%, respectively). Patients sustaining firearm injuries incurred a significantly greater burden of inpatient care, assessed by transfusions, CPR, ECMO, and major surgical procedures including pericardiotomy, chest tube placement, exploratory laparotomy, exploratory thoracotomy, solid organ resections, tracheostomy, and feeding tube placements (Table 1). Firearm injured patients also exhibited higher rates of complications than other traumatic mechanisms and greater rate of inpatient death (Table 2). Mean length of inpatient stay was significantly greater for firearm injuries (10.8 days) compared to penetrating (8.3 days) and blunt trauma (9.8 days, p< 0.001). When controlling for age, sex, race, insurance, region, and median household income, firearm injury was predictive of greater hospital charges with an incidence rate ratio (IRR) of 1.27 relative to blunt trauma, whereas the IRR for penetrating trauma was 0.39 (p< 0.001).
Firearm injuries impose significantly greater burden of inpatient surgical care, interventions, complications, hospital charges, and mortality compared to other traumatic mechanisms. These findings underscore the urgent need for targeted prevention, supportive measures, and resource allocation to mitigate the devastating impact of firearm injuries on children and healthcare systems alike.
Table 1: Inpatient Care Differs by Trauma Type
CPR, cardiopulmonary resuscitation; ECMO, extracorporeal membrane oxygenation. *Censored for absolute number of cases <10.
Table 2: Complications and Disposition Differ by Trauma Type
*Censored for absolute number of cases <10.
