Stricter gun laws associated with decreased in-home pediatric firearm homicides
These incidents were often associated with child abuse and intimate partner violence, according to new research
DENVER — States that have adopted stronger gun control legislation experience lower rates of in-home pediatric firearm homicides, according to research presented during the American Academy of Pediatrics 2025 National Conference & Exhibition at the Colorado Convention Center Sept. 26-30.
The research, “Killed in Their Own Homes: The Rise of Pediatric Firearm In-Home Homicides and Association with State Firearm Laws,” examined data from the National Violent Death Reporting System and U.S. Census Bureau from 2005 to 2021, focusing on pediatric in-home firearm homicides. The pool was then narrowed to only include the 14 states with consistent data covering the entirety of the study.
Researchers found that during the years examined, there were 3,289 firearm-related homicides across 14 states, including 2,633 (80.0%) among teenagers ages 13-17 years and 656 (20.0%) among children ages 12 and younger. The numbers represent a rate of in-home firearm-related homicide ranging from 0.18 homicides per 100,000 children and adolescents in 2010 (the lowest rate observed in the 17-year timeframe) to 0.48 homicides per 100,000 in 2020. These homicides were often reported alongside incidents of child abuse and intimate partner violence.
Researchers examined which of the 14 states had the strongest gun control laws. They found that extreme risk protection order laws, often called red flag laws where family members or law enforcement can petition the court to remove firearms from the home of someone they believe to be at risk, were in place in five of the seven states with the lowest rates of in-home homicide. By contrast, only two of seven states with the highest rates of in-home homicide had such laws.
Authors state that federal gun control laws may not be sufficient to curtail these incidents and suggest strengthening laws at the state level.
"Given evidence that stronger state firearm laws are associated with fewer pediatric in-home homicides, future advocacy should seek to expand gun laws, including extreme risk protection orders which may prevent these cases by removing firearms from high-risk households,” said research author Jordan Rook, MD.
The authors conducted research through the American Pediatric Surgical Association and American Academy of Pediatrics Advocacy Committee.
Dr. Jordan Rook is scheduled to present the research, which is below, from 8:50 a.m. to 8:57 a.m. MDT on Friday, Sept. 26 at the Colorado Convention Center, Bluebird Ballroom 2A. To request an interview with the authors, contact Jordan Rook at jrook@mednet.ucla.edu.
In addition, Dr. Rook will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. MDT Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338.
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 Title: Killed in Their Own Homes: The Rise of Pediatric Firearm In-Home Homicides and Association with State Firearm Laws
Jordan Rook
Los Angeles, CA, United States
Firearm-related injury is the leading cause of death for children and adolescents in the United States, with most deaths due to homicide. Prior research has demonstrated that one-quarter of child and adolescent homicides occur at home. Despite representing a major setting for pediatric mortality, it remains unknown how firearm laws, which vary widely across states, may affect rates of in-home pediatric homicide.
We used the 2005-2021 National Violent Death Reporting System and US Census data to conduct a repeated cross-sectional analysis of child and adolescent victims (0-17 years) of firearm-related homicide. We restricted analyses to 14 states that contributed continuously to NVDRS over this 17-year period. We assessed the state-based incidence of firearm-related homicide and firearm-related in-home homicide. We evaluated temporal trends with linear regression. We evaluated the association of in-home firearm-related homicide rates with the strength of state firearm laws as determined by the Giffords Law Center Gun Law Scorecard using Spearman’s Rank Correlation coefficient (ρ).
From 2005-2021, there were 3,289 firearm-related homicides across 14 states, including 2,633 (80.0%) among teenagers aged 13-17 years and 656 (20.0%) among children aged 12 and younger. Of these, 27.5% (n=905) occurred at home including 17.4% (n=459) of teenage homicides and 68.0% (n=446) of child homicides. In-home homicides were more often associated with child abuse (11.2% [n=101] vs 1.2% [n=29]; p< 0.001) and intimate partner violence (20.8% [n=188] vs 4.3% [n=103]; p< 0.001). From 2005-2021, the incidence of firearm-related homicide ranged from 0.69 homicides per 100,000 children and adolescents in 2013 to 1.82 homicides per 100,000 in 2021 (β=0.03; 95%CI -0.001-0.06; p=0.06). The incidence of in-home homicide ranged from 0.18 homicides per 100,000 in 2010 to 0.48 homicides per 100,000 in 2020 (β=0.01; 95%CI=0.01-0.01; p=0.02; Figure). The incidence of firearm-related in-home homicide was lowest in Massachusetts (< 0.10 deaths/100,000 children and adolescents) and highest in South Carolina (0.49 deaths/100,000). Increased strength of state firearm laws was correlated with lower rates of in-home firearm-related homicide (ρ=0.72; p=0.004). Extreme Risk laws have been passed in five of the seven states with the lowest rates of in-home homicide versus two of seven states with the highest rates of in-home homicide.
Over a quarter of firearm-related homicides among children and adolescents occurred at home, with rates of in-home homicide increasing during the study period. In-home homicides comprised over two-thirds of total homicides among children aged 12 and younger. Federal firearm laws may inadequately address the factors that precipitate these incidents like intimate partner violence and child abuse. With evidence that stronger state firearm laws are associated with fewer pediatric in-home homicides, future advocacy should seek to expand gun laws including extreme risk protection orders which may prevent these cases by removing firearms from high-risk households.
Article Title
Stricter Gun Laws Associated with Decreased In-Home Pediatric Firearm Homicides
Article Publication Date
26-Sep-2025
Safe gun storage program gives pediatricians a guide for preventing suicide by firearms
The program began in 2015 after firearms became the leading cause of death in U.S. children and adolescents in 2019
American Academy of Pediatrics
The research, “Store it Safe: Quality Improvement, Community Engagement and Advocacy to Prevent Accidental Firearm Injuries/Death in Children and Suicide by Firearms in Adolescents,” describes a program developed in 2015 to train healthcare providers to screen for depression and suicide, discuss lethal means, distribute safe storage lock boxes, and provide resources for families. The program, “Store it Safe,” was developed in Ohio alongside firearms organizations in an effort to curtail unintentional firearm injury and death in young children and suicide by firearm in adolescents.
“We know that safe storage can save lives. ‘Store it Safe’ is supporting families, training providers, and building strong community partnerships to create a safer environment for children across Ohio and beyond,” said Sarah Denny, MD, FAAP, research author and medical director of "Store it Safe".
Data showed that approximately 130,000 Ohioans were engaged with the program with 14,000 adolescents screened for depression and suicidality. In addition, over 3,500 firearms lock boxes were distributed.
Program results showed a significant increase in suicidality screening rates, jumping from 15% to 77%. The rate in which physicians were conducting lethal means restriction discussions at youth preventive visits also improved, rising to 76% from the initial 17%.
“The ‘Store It Safe’ program provides a model for how healthcare providers and community leaders can work together to reduce unintentional injuries and suicides involving firearms,” said Denny.
Plans to expand the program are already in motion. "Store it Safe" has been implemented in Indiana through a partnership with the Indiana AAP Chapter. In addition, two Ohio communities have been recognized as Store It Safe Communities with plans to continue designating communities later this year.
The authors received financial support for this research from the Ohio Department of Health; Ohio Mental Health and Addiction Services and the Ohio Emergency Medical Services for Children/Department of Public Safety.
Dr. Denny is scheduled to present her research, which is below, from 9:50 a.m. to 9:57 a.m. on Friday, Sept 26, in the Colorado Convention Center, Bluebird Ballroom 2A. To request an interview with the authors, contact Olivia Simon at osimon@ohioaap.org
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/
Program Name: 2025 Call for Abstracts
Submission Type: Council on Injury, Violence, and Poison Prevention Program and Firearm Injury Prevention Special Interest Group
Abstract Title: Store it Safe: Quality Improvement, Community Engagement and Advocacy to Prevent Accidental Firearm Injuries/Death in Children and Suicide by Firearms in Adolescents
Sarah Denny
Columbus, OH, United States
In 2020 firearms became the leading cause of death in US children and adolescents, surpassing motor vehicle collisions for the first time. There are many factors contributing to the increase in firearm deaths, thus solutions need to be innovative and varied. In 2015 the Ohio AAP developed Store It Safe (SIS), a unique program developed with assistance of firearm organizations, to reduce accidental firearm injury/death in young children and suicide by firearm in adolescents. Additionally, with the legalization of marijuana in Ohio, SIS is also being used to prevent accidental ingestions by promoting safe storage of marijuana products.
QI: QI program to train healthcare providers to screen for depression and suicide, discuss lethal means, distribute safe storage lock boxes, and provide resources for families. Provider training includes virtual reality simulation to help providers get more comfortable talking about safe firearm storage during well child visits. Resources were developed collaboratively with coalition partners and multiple focus groups. Coalition Building/Community Engagement: The Ohio AAP has been intentional in coalition building, forming a unique partnership of organizations with varying viewpoints on firearms - healthcare providers, firearm safety experts, law enforcement, education leaders, and community organizations to have unified messaging of “Store It Safe”. The SIS City Designation serves as a way to engage communities across the state to educate families and youth facing organizations about the restriction of access to lethal means. Advocacy: Establishing common ground and strong relationships are key to advocacy successes. Setting clear boundaries as to what is and is not the goal of this specific coalition has allowed a diverse group of organizations to come together around a unified goal.
QI: To date, approximately 130,000 Ohioans have already been reached by the SIS program, 14,000 adolescents have been screened for depression and suicide during healthcare visits and over 3,500 lock boxes have been distributed. Coalition Building/Community Engagement: The SIS Coalition has reached over 52 members, each supporting and spreading the SIS. We just piloted our first Store It Safe City Designation and two additional cities are exploring this opportunity. SIS is currently spreading to Indiana AAP. Advocacy: SIS has bipartisan support, with a current amendment in the Ohio budget to make SIS the official safe storage program for the state, with a $1 million dollar earmark to support the spread of SIS.
Healthcare providers can engage in firearm-related injury prevention efforts in many ways. SIS is a well-established program that can be replicated in its entirety or various parts to help providers, their patients and communities keep firearms and marijuana products stored safely.
Subject of Research
People
Article Title
Safe Gun Storage Program Gives Pediatricians a Guide for Preventing Suicide by Firearms
Article Publication Date
26-Sep-2025
Medicaid billed for 52% of U.S. hospital costs from gun injuries
Gun-injury care cost U.S. hospitals $7.7 billion from 2016 to 2021, with Medicaid covering 52% of costs
CHICAGO --- The initial hospital treatment of firearm injuries cost the U.S. health care system an estimated $7.7 billion between 2016 and 2021, with the largest share falling on urban trauma center hospitals that serve the highest proportion of Medicaid patients, reports a new study led by Northwestern Medicine.
The study analyzed emergency department and inpatient visits for firearm injuries between 2016 and 2021. Annual costs held steady at about $1.2 billion through 2019, then jumped to $1.6 billion in 2021, a 33% increase that coincided with a rise in firearm injuries during the COVID-19 pandemic.
More than half of all firearm injury costs were billed to Medicaid. Yet, Medicaid reimbursement often falls short of actual treatment costs, leaving safety-net hospitals, which serve vulnerable, lower-income patient populations, on the front lines of the gun violence epidemic to absorb substantial losses. The study authors warn that recent Medicaid funding cuts adopted by Congress could further strain these hospitals.
The findings will be published on Friday (Sept. 26) in JAMA Health Forum.
“Gun injuries are a source of financial strain on hospitals, particularly large safety-net trauma center hospitals that often operate on thin margins,” said study corresponding author Alexander Lundberg, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine.
“Because in many states Medicaid reimbursement is typically below the true cost of care, trauma center hospitals are already absorbing significant losses,” added study co-author Dr. Anne Stey, assistant professor of surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine trauma surgeon.
“Medicaid funding cuts could further financially destabilize trauma centers. Some could close, or stop being trauma centers that provide the high-level and life-saving trauma care that all American families need after car accidents, falls and bike accidents.”
Overall, the largest share of costs went toward treating patients who were Black, men and from low-income areas.
How the study was conducted
To get a national picture of the health care costs of firearm injuries, the scientists analyzed hospital records from six states: Arkansas, Florida, Maryland, Massachusetts, New York and Wisconsin. The team chose these states because they collect high-quality data on both inpatient hospitalizations and emergency visits.
The team analyzed every hospital visit in those states for a new firearm injury from 2016 to 2021 and then used these patterns to generate national estimates.
To find out where in the health system the costs are most concentrated, the team broke down the data by patient demographics, hospital size and health insurance coverage, among other factors.
Key findings
- The initial treatment of firearm injuries cost U.S. hospitals $7.7 billion from 2016 to 2021
- Annual costs stayed stable from 2016 to 2019 (about $1.2 billion per year) before climbing to $1.6 billion in 2021
- The annual cost of treatment for pediatric patients grew 54% from 2019 to 2021
- Medicaid was the primary payer for 52% of all hospital costs, followed by private insurance (20%), self-pay or uninsured patients (16%) and Medicare (6%)
Beyond the hospital bill
The Northwestern team notes that their estimate likely understates the complete financial toll of firearm injuries. Their analysis included only the initial hospital stay or emergency visit and did not capture other significant health care costs related to firearm injuries, such as ambulance or air transport, rehabilitation, follow-up visits and return to hospital.
The study also does not account for indirect costs to American families such as lost wages of patients and their caregivers, long-term disability or the emotional and economic burden on communities.
Solutions
Lundberg and colleagues say their findings highlight the need to strengthen financial support for trauma center hospitals to sustain trauma care in their communities most affected by gun violence.
The authors also call for more investment in injury-prevention programs and safe-firearm storage education to prevent unauthorized firearm access.
The study is called “Health Care Costs of Firearm Injury Hospital Visits in the US.”
Journal
JAMA Health Forum
Article Title
Health Care Costs of Firearm Injury Hospital Visits in the US
Child and adolescent firearm-related homicide occurring at home
JAMA Surgery
About The Study:
This study found that nearly one-quarter of pediatric firearm-related homicides occurred at home. Young children were more often affected. These data point to domestic violence and child abuse as significant risk factors for in-home firearm homicide. Traditional safe storage laws may be inadequate preventive measures. Extreme risk protection orders and mandatory domestic violence–related firearm relinquishment may prevent these deaths and warrant further investigation.
Corresponding Author: To contact the corresponding author, Jordan M. Rook, MD, email jrook@mednet.ucla.edu.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamasurg.2025.3429)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
# # #
Media advisory: This study is being presented at the American Academy of Pediatrics 2025 National Conference & Exhibition.
Embed this link to provide your readers free access to the full-text article
Journal
JAMA Surgery
Research shows significant association between emergency department visits for firearm and motor vehicle-related crashes
Researchers present their findings showing ‘trauma doesn’t happen in isolation’ during American Academy of Pediatrics 2025 National Conference & Exhibition.
American Academy of Pediatrics
DENVER — One in four patients treated in an emergency department for firearm injuries had been treated in a prior visit for injuries caused by a motor vehicle crash or other violent incident, according to new research presented during the American Academy of Pediatrics 2025 National Conference & Exhibition. The significant association between types of injuries could indicate a pattern of risky behaviors.
The authors of an abstract, “Associational Analysis for Pediatric Firearm Injury Risk,” found that children and youth with firearm, non-firearm violent, and motor vehicle crash injuries visited a Midwest hospital system’s emergency department on multiple occasions within a four-year period. They will present their findings during the AAP national conference at the Colorado Convention Center from Sept. 26-30.
“As a pediatric emergency physician, I see firsthand how trauma doesn’t happen in isolation,” said Mike Levas, MD, senior author and pediatrics professor at the Medical College of Wisconsin and Medical Director of Project Ujima, Children’s Wisconsin’s hospital-based violence intervention program.
“Our study reveals a troubling pattern: nearly one in four children with firearm injuries return to the emergency room with another violent or crash-related injury within just four years. These aren’t random events—they’re interconnected.”
Researchers analyzed records from 2,614 emergency department visits between 2018-2022, finding the type and severity of a child's repeat injuries were predictive of whether they'd return to the emergency department in the future with a firearm injury. The findings revealed a significant association between motor vehicle crashes and firearm injury, with motor vehicle crashes and violent injuries serving as predictors for subsequent firearm injury.
Maria Beyer, study author and community health evaluation manager, said that partnership between community, clinical, and scientific team members is essential to generate evidence-based insights, which are necessary to create meaningful, sustainable solutions.
“Our community health teams work closely with kids and families to understand their experiences, alongside clinical teams who have robust information at their fingertips through a patient’s medical history and are repeatedly treating kids for these injuries,” she said. “Together they share observations and compile evidence, setting the stage for the kind of statistical modeling we were able to achieve through this study.”
The authors conclude their findings will help inform ways to prevent or intervene early to lessen future risks of injury or death.
The authors did not receive financial support for this research.
Maria Beyer is scheduled to present the research, which is below, from noon-1 p.m. Sunday, Sept. 28 in the Poster Hall. To request an interview with the authors, contact Sara Silver Traband at Ssilvertraband@childrenswi.org.
In addition, Ms. Beyer and senior author Dr. Mike Levas will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338.
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/
Program Name: 2025 Call for Abstracts
Submission Type: Council on Injury, Violence, and Poison Prevention Program and Firearm Injury Prevention Special Interest Group
Abstract Title: Associational Analysis for Pediatric Firearm Injury Risk
Maria Beyer
Shorewood, WI, United States
Nationally, children and youth have experienced significant increases in injuries related to firearms and motor vehicle crashes (MVCs). A midwestern pediatric health system observes similar trends, with many patients with firearm injury presenting with a history of MVC-related injuries and other violent injuries with growing frequency. To investigate the potential relationship between injury types and identify predictive factors for subsequent firearm injuries, authors conducted secondary analyses focused on potential associations between injuries and the role of injury severity across repeat encounters. A deeper understanding of injury patterns and their risk factors may facilitate the development of targeted early interventions and preventive strategies.
A four-year retrospective study was conducted of 0–17-year-old patients presenting in the Emergency Department (ED) with violent and MVC injuries from January 1, 2018 through December 31, 2022. Study methods include descriptive, correlation, and chi-squared analyses to examine demographics and the association between MVC and firearm injury, with stepwise logistic regression modeling to identify predictive factors for future firearm injury.
Nearly one in four patients (23.6%) with firearm injury had more than one encounter in the ED for firearm, non-firearm violent, or MVC injury within the four-year timeframe. Chi-square tests for independence indicate a statistically significant association between MVC and firearm injury (2 (1, n = 2614) = 9.683). Regression analysis indicate a statistically significant model with five predictive factors for firearm injury at a third ED encounter: age, first encounter MVC injury, first encounter acuity, second encounter violent injury, and second encounter acuity (2 (11, n = 84) = 31.228, p = .001). After adjusting for all other factors in the model, with each worsening in acuity score at first encounter patients have twelve times greater risk for firearm injury at third encounter (OR = .083, p < .05, 95% CI: .010, .691), and patients with a violent injury at second encounter have ten times greater risk for firearm injury at third encounter (OR = 10.298, p < .10, 95% CI: .685, 154.737).
These findings reveal a significant association between MVC and firearm injury, with MVC and violent injuries serving as predictors for subsequent firearm injury. These results underscore the importance of early intervention in addressing the risk of firearm injury. Further investigation is needed to identify best practices for connecting resources for youth presenting with MVC and non-firearm violent injuries to prevent future firearm injury and death. Additionally, opportunities exist to explore risk stratification within clinical and community practice to focus limited resources on patients at higher risk for firearm injury and death. Leveraging this data to inform clinical and community intervention decision-making can prevent further injury, reduce financial costs to health systems, and improve individual and community health outcomes.
Subject of Research
People
Article Title
Research Shows Significant Association Between Emergency Department Visits for Firearm and Motor Vehicle-Related Crashes
Article Publication Date
26-Sep-2025
