Thursday, April 24, 2025

 

How a President Becomes a Dictator


By Executive Order



130 executive orders in under 100 days.

Sweeping powers claimed in the name of “security” and “efficiency.”

One president acting as lawmaker, enforcer, and judge.

No debate. No oversight. No limits.

This is how the Constitution dies—not with a coup, but with a pen.

The Unitary Executive Theory is no longer a theory—it’s the architecture of a dictatorship in motion.

Where past presidents have used executive orders, decrees, memorandums, proclamations, national security directives and legislative signing statements to circumvent Congress or sidestep the rule of law, President Trump is using executive orders to advance his “unitary executive theory” of governance, which is a thinly disguised excuse for a government by fiat.

In other words, these executive orders are the mechanism by which we finally arrive at a full-blown dictatorship.

America’s founders established a system of checks and balances to prevent the concentration of power in any single branch. To this end, the Constitution establishes three separate but equal branches of government: the legislative branch, which makes the law; the executive branch, which enforces the law; and the judicial branch, which interprets the law.

And yet, despite this carefully balanced structure, we now find ourselves in a place the founders warned against.

Despite Trump’s attempts to rule by fiat, the president has no unilateral authority to operate outside the Constitution’s system of checks and balances—no matter how urgent the crisis or how well-meaning the intentions.

This is what government by fiat looks like.

Where Congress was once the nation’s lawmaking body, its role is now being eclipsed by a deluge of executive directives—each one issued without public debate, legislative compromise, or judicial review.

These executive orders aren’t mere administrative housekeeping. They represent a radical shift in how power is exercised in America, bypassing democratic institutions in favor of unilateral command. From trade and immigration to surveillance, speech regulation, and policing, the president is claiming broad powers that traditionally reside with the legislative and judicial branches.

Some orders invoke national security to disrupt global markets. Others attempt to override congressional control over tariffsfast-track weapons exports, or alter long-standing public protections through regulatory rollbacks. A few go even further—flirting with ideological loyalty tests for citizenshipchilling dissent through financial coercion, and expanding surveillance in ways that undermine due process and privacy.

Yet here’s where these actions run into constitutional peril: they redefine executive authority in ways that bypass the checks and balances enshrined in the Constitution. They centralize decision-making in the White House, sideline the legislative process, and reduce the judiciary to an afterthought—if not an outright obstacle.

Each of these directives, taken individually, might seem technocratic or temporary. But taken together, they reveal the architecture of a parallel legal order—one in which the president acts as lawmaker, enforcer, and judge. That is not how a constitutional republic operates. That is how a dictatorship begins.

Each of these orders marks another breach in the constitutional levee, eroding the rule of law and centralizing unchecked authority in the executive.

This is not merely policy by another name—it is the construction of a parallel legal order, where the president acts as lawmaker, enforcer, and judge—the very state of tyranny our founders sought to prevent.

This legal theory—the so-called Unitary Executive—is not new. But under this administration, it has metastasized into something far more dangerous: a doctrine of presidential infallibility.

What began as a constitutional interpretation that the president controls the executive branch has morphed into an ideological justification for unchecked power.

Under this theory, all executive agencies, decisions, and even enforcement priorities bend entirely to the will of the president—obliterating the idea of an independent bureaucracy or impartial governance.

The result? An imperial presidency cloaked in legalism.

Historically, every creeping dictatorship has followed this pattern: first, undermine the legislative process; then, centralize enforcement powers; finally, subjugate the judiciary or render it irrelevant. America is following that roadmap, one executive order at a time.

Even Supreme Court justices and legal scholars who once defended broad executive authority are beginning to voice concern.

Yet the real danger of the Unitary Executive Theory is not simply that it concentrates power in the hands of the president—it’s that it does so by ignoring the rest of the Constitution.

Respect for the Constitution means obeying it even when it’s inconvenient to do so.

We’re watching the collapse of constitutional constraints not through tanks in the streets, but through policy memos drafted in the West Wing.

No matter how well-meaning the politicians make these encroachments on our rights appear, in the right (or wrong) hands, benevolent plans can easily be put to malevolent purposes. Even the most principled policies can be twisted to serve illegitimate ends once power and profit enter the equation.

The war on terror, the war on drugs, the war on illegal immigration, asset forfeiture schemes, road safety schemes, school safety schemes, eminent domain: all of these programs started out as legitimate responses to pressing concerns and have since become weapons of compliance and control in the police state’s hands.

We are approaching critical mass.

The groundwork has been laid for a new kind of government where it doesn’t matter if you’re innocent or guilty, whether you’re a threat to the nation, or even if you’re a citizen.

What will matter is what the government—or whoever happens to be calling the shots at the time—thinks. And if the powers-that-be think you’re a threat to the nation and should be locked up, then you’ll be locked up with no access to the protections our Constitution provides.

In effect, you will disappear.

Our freedoms are already being made to disappear.

This is how tyranny arrives: not with a constitutional amendment, but with a series of executive orders; not with a military coup, but with a legal memo; not with martial law, but with bureaucratic obedience and public indifference.

A government that rules by fiat, outside of constitutional checks and balances, is not a republic. It is a dictatorship in everything but name.

If freedom is to survive this constitutional crisis, We the People must reclaim our role as the ultimate check on government power.

That means holding every branch of government accountable to the rule of law. It means demanding that Congress do its job—not merely as a rubber stamp or partisan enabler, but as a coequal branch with the courage to rein in executive abuses.

It means insisting that the courts serve justice, not politics.

And it means refusing to normalize rule by decree, no matter who sits in the Oval Office.

There is no freedom without limits on power.

There is no Constitution if it can be ignored by those who swear to uphold it.

The presidency was never meant to be a throne. The Constitution was never meant to be optional. And the people were never meant to be silent.

As I make clear in my book Battlefield America: The War on the American People and in its fictional counterpart The Erik Blair Diaries, the time to speak out is now.

As our revolutionary forefathers learned the hard way, once freedom is lost, it is rarely regained without a fight.

 

John W. Whitehead, constitutional attorney and author, is founder and president of The Rutherford Institute. He wrote the book Battlefield America: The War on the American People (SelectBooks, 2015). He can be contacted at johnw@rutherford.orgNisha Whitehead is the Executive Director of The Rutherford Institute. Read other articles by John W. Whitehead and Nisha Whitehead.

 

A Moral Imperative for the 2025 Canadian Election


Will Canadians Vote for Genocide?



Prime Minister Mark Carney, Conservative Leader Pierre Poilievre and NDP Leader Jagmeet Singh. Photo by Thomas Padilla/AP; Dave Chan/AFP via Getty Images

Back in August 2014, the New Democratic Party (NDP) was led by Tom Mulcair whose Zionism was so extreme that a sitting MP, Sana Hassainia, of the Montreal-area riding of Vercheres-Les Patriotes, could not accept Mulcair’s position and chose to sit as an independent.

The current NDP leader Jagmeet Singh forthrightly denounced the genocide in Gaza and questioned current Canadian prime minister Mark Carney (Liberal Party) about his position on Gaza.

“Mr. Carney, why don’t you call it what it is? It’s a genocide,” said Singh.

Carney replied, “This question is in front of the International Court of Justice. The situation is a horrible situation. I will not, and I will never politicize that word or this situation.”

The Conservative Party leader Pierre Poilievre is a Trump-style politician in Canada. Poilievre promises to deport critics, move Canada’s embassy in Israel, and cut funding to the United Nations Relief and Works Agency (UNRWA) and other international bodies assisting Palestinians.

Poilievre accused UNRWA employees of being involved in the 7 October 2023 attacks on Israel.

Singh demurred, “What you said about UNRWA was disgusting.… Calling it a terrorist organization is unacceptable. It’s hateful and it’s entirely inappropriate.”

There was a choice in the United States election to vote against genocide, but people overwhelmingly voted for one of the two pro-Zionist presidential candidates in the 2024 election, despite there being presidential candidates who were opposed to the Zionist genocide.

The leaders of the two major parties in Canada present as Zionist appeasers, as demonstrated by their own words. The difference from the 2024 US election is that in Canada there is a prominent political party, the NDP, whose leader calls genocide by what it is.

Canadians have a choice to vote No to genocide on Monday, 28 April.

Kim Petersen is an independent writer. He can be emailed at: kimohp at gmail.com. Read other articles by Kim.

 

Blood proteins can predict liver disease up to 16 years before symptoms



Ability to predict far in advance could enable early intervention and prevention




Digestive Disease Week





BETHESDA, MD (April 25, 2025) — Scientists have identified five specific blood proteins that can accurately predict a person’s risk for developing a serious form of liver disease as early as 16 years before they experience symptoms, enabling early intervention and possible prevention and treatment, according to a study to be presented at Digestive Disease Week® (DDW) 2025.

The findings address metabolic dysfunction-associated steatotic liver disease (MASLD), which has become the most common form of liver disease worldwide and is continuing to increase. People with MASLD face up to twice the mortality rate of those without the disease.

“Imagine if we could predict risk of MASLD years before it starts,” said Shiyi Yu, MD, resident physician in the department of gastroenterology, Guangdong Provincial People's Hospital in China. “Too often, people do not find out they are at risk for liver disease before they are diagnosed and coping with symptoms. The field urgently needs effective biomarkers and predictive models, and our research shows that plasma proteins offer novel potential strategies for early prediction and intervention.”

Researchers analyzed blood samples from more than 50,000 participants in the UK Biobank. They followed their health records for more than 16 years, identifying levels and combinations of proteins in the blood associated with developing liver disease later in life. Screening more than 2,700 proteins, they found five — CDHR2, FUOM, KRT18, ACY1, and GGT1 — that appear to be early warning signals for MASLD. The combined levels of these five proteins achieved 83.8% accuracy at predicting disease five years from onset and 75.6% accuracy at predicting 16 years ahead of diagnosis. Adding clinical biomarkers such as body mass index and daily exercise amount to the protein levels achieved even greater accuracy of 90.4% at five years and 82.2% at 16 years.

“We achieved similar results when we tested this predictive model in a separate cohort of people in China, further supporting the robustness of the model and showing it can be effective across diverse populations,” Dr. Yu said.

As an observational study, the research does not demonstrate a causal connection between the plasma proteins and the development of liver disease. Further research is underway to explore possible pathways.

 

DDW Presentation Details

Dr. Yu will present data from the study, “Plasma proteomic profiles predict metabolic dysfunction-associated steatotic liver disease up to 16 years before onset,” abstract 323, at 8

a.m. PDT, Sunday, May 4. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit www.ddw.org/press.

 

###

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers, and academics in the fields of gastroenterology, hepatology, endoscopy, and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW is an in-person and online meeting from May 3-6, 2025. The meeting showcases nearly 6,000 abstracts and more than 1,000 lectures on the latest advances in GI research, medicine, and technology. More information can be found at www.ddw.org

 

Study: Artificial intelligence more accurately identifies child abuse



Findings revealed at the 2025 Pediatric Academic Societies Meeting


Pediatric Academic Societies





Artificial intelligence (AI) can help better identify prevalence of physical abuse of children seen in the emergency room, a new study found. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu. 

Researchers used a machine-learning model to estimate instances of child abuse seen in emergency departments based on diagnostic codes for high-risk injury and physical abuse. The researchers’ approach better predicted abuse rates than those that rely solely on diagnostic codes entered by a provider or administrative staff. Relying on abuse codes alone misdiagnosed on average 8.5% of cases.

“Our AI approach offers a clearer look at trends in child abuse, which helps providers more appropriately treat abuse and improve child safety,” said Farah Brink, MD, child abuse pediatrician at Nationwide Children's Hospital, and assistant professor at The Ohio State University. “AI-powered tools hold tremendous potential to revolutionize how researchers understand and work with data on sensitive issues, including child abuse.”

Researchers studied data from 3,317 injury and abuse-related emergency department visits at seven children’s hospitals between February 2021 and December 2022. All children were under the age of 10 and nearly three quarters were under the age of two.

# # #

EDITOR:
Dr. Farah Brink will present “A Machine Learning Approach to Improve Estimation of Physical Abuse” on Mon., April 28 from 5:00-6:30 PM ET. 
Reporters interested in an interview with Dr. Brink should contact Amber Fraley at  amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting
Pediatric Academic Societies (PAS) Meeting 
connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: A Machine Leaming Approach to Improve Estimation of Physical Abuse

Presenting Author: 
Farah Brink, MD

Organization
Nationwide Children's Hospital

Topic
Child Abuse & Neglect

Background
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are inaccurate for determining child physical abuse (PA) prevalence, particularly in emergency department (ED) settings. Consideration of injury codes along with abuse-specific codes may enable more accurate PA prevalence estimates.

Objective
To develop a coding schema to better estimate PA using machine learning.

Design/Methods
We performed a secondary data analysis of children < 10 years evaluated by a child abuse pediatrician (CAP) due to concerns for PA during Feb 2021-Dec 2022 at 7 children's hospitals contributing data to both CAPNET, a multicenter child abuse research network, and Pediatric Health Information System (PHIS). We excluded encounters not linked with PHIS and those not evaluated in the ED during the CAPNET encounter. True PA was defined by CAP assigned rating 5- 7 on a 7-point scale of PA likelihood within the CAPNET database. Abuse-specific codes, including suspected codes, were defined as ICD-10-CM codes for PA modified from the Centers for Disease Control and Prevention child abuse and neglect syndromic surveillance definition. All 4-digit injury ICD-10-CM codes were used. We developed LASSO logistic regression models to predict CAP¬ determined PA for encounters with and without abuse-specific codes and used the models to calculate site-specific estimates of PA prevalence. We calculated the estimation error for site estimates based on 1) abuse-specific codes alone and 2) our LASSO predictive models. Estimation error was defined as estimated PA prevalence minus CAP-determined PA prevalence (true value).

Results
3317 of 6178 CAPNET encounters were successfully linked with PHIS and seen in the ED. Median age was 8.4 months with 74% < 2 years and 59% < 1 year. CAP diagnosed PA in 35% (n=l145) of all encounters, 12.7% (n=240) of encounters without abuse-specific codes, and 63.4% (n=905) of encounters with abuse-specific codes. At least one abuse-specific code was assigned for 43% of encounters. Site-specific estimates of PA prevalence based only on assignment of abuse-specific codes overestimated prevalence with estimation errors ranging from 2.0% to 14.3% (average absolute error 8.5%). Estimates of site-specific PA prevalence based on our predictive models had reduced errors from -3.0% to 2.6% (average absolute error 1.8%) (Fig. 1). Absolute error decreased for 6 of 7 sites and increased by 0.6% for the remaining site (Fig. 2).

Conclusion(s)
Our predictive models more accurately estimated the prevalence of PA compared to abuse-specific codes alone.

Tables and Images
PAS Figure 1.ROC curves 20241101.png
PAS Figure 2.estimate plot.png

 

Study: Opioid use disorder treatment improves pregnancy outcomes



Findings revealed at the 2025 Pediatric Academic Societies Meeting


Pediatric Academic Societies





Pregnant women living with opioid use disorder (OUD) and their infants had significantly better health outcomes when treated with buprenorphine, according to a new study at Vanderbilt University Medical Center and Emory University’s Rollins School of Public Health. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu. 

Pregnant women who received buprenorphine, a medication used to treat OUD, were less likely to have a preterm birth, face serious health complications, or have their infants hospitalized in the NICU compared to those who did not receive the treatment, the study found.

“We know that treatment with medications like buprenorphine substantially reduces the risk of overdose death for pregnant women with opioid use disorder, but its benefits to newborns have not been well understood,” said Stephen Patrick, MD, MPH, senior author and chair of the Department of Health Policy and Management at Emory University’s Rollins School of Public Health. “We found a profound reduction in preterm birth among infants whose mothers were treated with buprenorphine, which can have a lifelong impact.”

Despite rates of OUD in pregnant women increasing more than fivefold from 1999 to 2017, more than half still do not receive treatment, researchers said. Previous research estimates that up to 20% of pregnant women with OUD may have a preterm birth, nearly double those without OUD. Preterm birth, a growing public health issue, increases the risk of health problems in children, including respiratory issues, infections, cerebral palsy, developmental delays, and vision and hearing problems.

Researchers also noted stark disparities in equitable care. Those receiving buprenorphine were significantly less likely to be Black.

“Disparities in access to buprenorphine significantly affect vulnerable populations, including pregnant women,” said Sunaya Krishnapura, graduating medical student at Vanderbilt University School of Medicine and presenting author. “Our findings underscore the urgent need for policies that expand treatment access in the United States to ensure a healthy pregnancy and future for mothers and infants.”

The study examined more than 14,000 pregnant women with OUD who were enrolled in Tennessee Medicaid between 2010 and 2021.

# # #

EDITOR:
Sunaya Krishnapura will present “Association Between Buprenorphine Treatment for Maternal Opioid Use Disorder and Maternal-Infant Outcomes” on Sun., April 27 from 5:30-5:45 PM ET.

Reporters interested in an interview with Sunaya should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting
Pediatric Academic Societies (PAS) Meeting 
connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: Association Between Buprenorphine Treatment for Maternal Opioid Use Disorder and Maternal-Infant Outcomes

Presenting Author: Sunaya Krishnapura

Organization
Vanderbilt University School of Medicine; Rollins School of Public Health, Emory University

Topic
Public Health & Prevention

Background
Opioid use disorder (OUD) in pregnancy is associated with adverse perinatal outcomes. Treatment with methadone or buprenorphine, both opioid agonists, is recommended to improve pregnancy outcomes. Much of the existing research has evaluated the effectiveness and efficacy of methadone compared to buprenorphine, but limited evidence remains comparing buprenorphine to no treatment. As most pregnant individuals still do not receive treatment for OUD, there is a public health imperative to examine how buprenorphine treatment compared to no treatment influences maternal-infant outcomes.

Objective
To determine if treatment with buprenorphine improves maternal outcomes (severe maternal morbidity (SMM), ICU admission, maternal mortality) and infant outcomes (preterm birth, NICU admission, infant mortality) compared to no treatment.

Design/Methods
This retrospective cohort study between 2010-2021 included maternal-infant dyads with a diagnosis of OUD and enrolled in Tennessee Medicaid from 20 weeks estimated gestational age (EGA) to 6 weeks postpartum using Medicaid claims linked to vital statistics. The exposure of interest was buprenorphine treatment, defined by filled prescriptions between 20 weeks EGA to birth. We calculated descriptive statistics and created propensity scores with overlapped weighting to account for treatment bias between groups.

Results
Among 14,463 who met our inclusion criteria, 7,469 dyads received buprenorphine treatment. Compared to those who were treated, pregnant individuals who did not receive treatment were more likely to be non-Hispanic Black (10% vs. 2.1%; p< 0.001; Table 1). The crude percentage of adverse perinatal outcomes was significantly lower in dyads treated with buprenorphine compared to the untreated group (25% vs. 31%; p< 0.001); the treatment group had a lower percentage of SMM events, preterm births, and NICU admissions (Table 2). In adjusted propensity score analyses, dyads treated prenatally with buprenorphine had 5.1% (95% CI, 3.5%-6.7%) lower probability of adverse pregnancy outcomes, including a 1.2% (95% CI, 0.4%-2.1%) lower probability of SMM, 1.7% (95% CI, 0.4%-2.9%) lower probability of NICU admission, and 5.3% (95% CI, 4.0%-6.6%) lower probability of preterm birth (Figure 1).

Conclusion(s)
In a large population-based cohort, we found that receipt of buprenorphine during pregnancy improved outcomes for both mother and infant, underscoring the need to improve access to treatment nationwide.

Tables and Images
Table 1.png
Table 2.png
Figure 1.png

 

Study: Education improves in-home gun safety






Findings revealed at the 2025 Pediatric Academic Societies Meeting


Pediatric Academic Societies






More information about gun safety has increasingly led parents to ask about firearms in the homes their kids visit, according to a new national study. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu.  

Every new source of information increased parents’ likelihood of asking by 40%. Researchers found that 16% of caregivers who had never received firearm safety information asked about firearms where their child was visiting, compared to 79% of those who had heard about firearm safety from eight different sources.

While education from other parents had the biggest impact, the study found that any additional source of information—such as a family member, a school official, or social media—made them more likely to ask about guns when their kids visited other homes. Hearing firearm safety information from a health care provider also increased the likelihood of asking, yet less than 9% of parents report discussing firearm safety with their providers.  

“Robust firearm education for parents builds a safer future for children where conversations about gun safety among parents and in communities are the norm rather than the exception,” said Maya Haasz, MD, associate professor at Children’s Hospital Colorado and presenting author. “As the research shows, the more education about gun safety, the safer families can be, especially when children as young as two years old can accidentally pull a trigger.”  

The findings underscore the need for ongoing, multifaceted education about gun safety, study authors say. Guns are the leading cause of death among children in the United States, research shows. 

The survey consisted of nearly 1,600 caregivers of children under the age of 18.  

# # #

EDITOR:
Dr. Maya Haasz will present “Caregivers’ Asking About Firearms in Homes That Youth Visit: A Nationally Representative Cross-Sectional Survey” on Mon., April 28 from 3:30-3:45 PM ET. 

Reporters interested in an interview with Dr. Haasz should contact Amber Fraley at Amber Fraley amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting
Pediatric Academic Societies (PAS) Meeting 
connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit 
www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: Caregivers’ Asking About Firearms in Homes That Youth Visit: A Nationally Representative Cross-Sectional Survey

Presenting Author: Maya Haasz, MD

Organization
Children's Hospital Colorado 

Topic
Injury Prevention 

Background
Reducing unsupervised youth firearm access is associated with lower morbidity and mortality. In addition to considering firearm safety within households with youth, efforts have been extended to consider household firearms in homes that youth visit. Little is known about whether caregivers ask others about firearm access within households their youth visit (i.e. asking behaviors).

Objective
1) Estimate the prevalence of asking behaviors; 2) Evaluate the relationship between the number of distinct firearm safety information sources (e.g., class, healthcare provider, social media) and asking behaviors.
 
Design/Methods

Data is from a nationally representative cross-sectional survey of US adults conducted by Gallup May-June 2023. Participants included adults living with a child < 18 years old (unweighted n=1591). We examined distinct sources where caregivers received firearm safety information. The primary exposure was the number of distinct sources of firearm safety information. The primary outcome was whether caregivers had asked other parents about the presence of household firearms. Bivariate statistics, logistic regression, and Chi-squared statistics were used to describe independent relationships between: 1) Sociodemographics 2) Sources of firearm information and the behavioral outcome of asking about firearm safety. We performed multivariable logistic regressions and predictive marginal methods to estimate the relationship between the number of information sources and asking behaviors. Analyses were weighted and account for the complex survey design. Approved by the University of Michigan IRB.

Results
 Among this nationally representative sample of caregivers, 29.6% have asked other parents about the presence of household firearms. Each distinct source of firearm safety information received increased the likelihood of asking by 40% (Figure 1). Sources of firearm safety information most highly associated with increased asking behavior were other parents/guardians(OR 3.3; 95% CI 2.2, 5.0) and the child's school or childcare provider (OR 3.0; 95% CI 1.6, 5.7) (Table 1); all sources of firearm safety information were associated with increased asking behavior.

Conclusion(s)
Enhancing household firearm safety behaviors is important to pediatric firearm injury prevention. Unlike previous studies exploring the credibility of different messenger types (i.e., veterans, providers), our findings underscore the value of safety messaging from multiple distinct sources. This has important implications to increase asking about firearms at other homes, and may be useful for other forms of firearm safety education.

Tables and Images
Table 1.jpg
Figure 1.jpg