From the Journals

Family handgun ownership linked to young children’s gun deaths

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Improved gun safety features vital to preventing child deaths

The “unique and important approach” used by Prickett et al. to investigate an association between gun ownership and children’s gun deaths is “novel” because of their focus on firearm types and the youngest children, wrote Shilpa J. Patel, MD; Monika K. Goyal, MD; and Kavita Parikh, MD, all with the Children’s National Health System in Washington, DC, in an editorial published with the study (Pediatrics. 2018 Jan 28. doi: 10.1542/peds.2018-3611).

The findings are particularly relevant to pediatricians’ conversations with families about safe firearm storage practices. The American Academy of Pediatrics recommends all firearms are stored locked and unloaded with ammunition stored separately.

For families who find these guidelines difficult because they keep handguns at the ready for protection, “it is important to note that the risk of unintentional or intentional injury from a household firearm is much greater than the likelihood of providing protection for self-defense,” the editorial’s authors wrote. But they advocate for personalized safe storage strategies and shared decision making based on families’ needs and values.

“This study is a loud and compelling call to action for all pediatricians to start open discussions around firearm ownership with all families and to share data on the significant risks associated with unsafe storage,” they wrote. “It is an even louder call to firearm manufacturers to step up and innovate, test, and design smart handguns that are inoperable by young children to prevent unintentional injury.”

Although having no firearms in the home is the most effective way to reduce children’s risk of gun-related injuries and deaths, developing effective safety controls on guns could also substantially curtail young children’s gun deaths. “We as a society should be advocating for continued research to childproof firearms so that if families choose to have firearms in the home, the safety of their children is not compromised,” they wrote.

Dr. Parikh is a hospitalist, Dr. Goyal is assistant division chief or emergency medicine, and Dr. Patel is an emergency medicine specialist, all with Children’s National Health System in Washington, DC. They reported no funding and no disclosures.


 

FROM PEDIATRICS

A recent increase in U.S. handgun ownership among white families tracks with a similar trend of recently rising gun deaths among young white children, a new study found. This association held even after adjustments for multiple sociodemographic variables that research previously had linked to higher gun ownership and higher firearm mortality.

A handgun and bullets Kateywhat/ThinkStock

“Indeed, firearm ownership, generally, was positively associated with firearm-related mortality among 1- to 5-year-old white children, but this correlation was primarily driven by changes in the proportion of families who owned handguns: firearms more often stored unsecured and loaded,” wrote Kate C. Prickett, PhD, of the Victoria University of Wellington (New Zealand) and her associates in Pediatrics.

“These findings suggest that ease of access and use may be an important consideration when examining firearm-related fatality risk among young children,” they continued. Given the lack of attenuation in the relationship from controlling for sociodemographic variables, they add, “this finding is in line with research documenting that the presence of a firearm in the home matters above and beyond other risk factors associated with child injury.”

Even though U.S. gun ownership and pediatric firearm mortality overall have been dropping over the past several decades, the latter has stagnated recently, and gun deaths among children aged 1-4 years nearly doubled between 2006-2016, the researchers noted.

Given the counterintuitive increase in young children’s gun deaths while overall gun ownership kept dropping, the researchers took a closer look at the relationship between gun deaths among children aged 1-5 years and specific types of firearm ownership among families with children under age 5 years in the home. They relied on household data from the nationally representative General Social Survey and on fatality statistics from the National Vital Statistics System from 1976-2016.

Over those 4 decades, gun ownership in white families with small children decreased from 50% to 45% and in black families with small children from 38% to 6%.

Simultaneously, however, handgun ownership increased from 25% to 32% among white families with young children. In fact, most firearm-owning white families (72%) owned a handgun in 2016 while rifle ownership had declined substantially.

Meanwhile, “firearm-related mortality rate among young white children declined from historic highs in the late 1970s to early 1980s until 2001,” the authors reported. “After 2004, however, the mortality rate began to rise, reaching mid-1980s levels.” Further, gun deaths constituted 2% of young children’s injury deaths in 1976 but nearly 5% in 2016.

When the researchers compared these findings, they found a positive, significant association between white child firearm mortality and the proportion of white families who owned a handgun but not a rifle or shotgun.

The association remained after the researchers adjusted for several covariates already established in the evidence base to have associations with firearm ownership, child injury risk and/or firearm mortality: living in a rural area, living in the South, neither parent having a college degree, and a household income in the bottom quartile nationally. In addition, “the annual national unemployment rate by race was included as an indicator of the broader economic context,” the authors wrote.

Although young black children die from guns nearly three times more frequently than white children, the authors were unable to present detailed findings on associations with gun ownership because of small sample sizes. They noted, however, that handgun ownership actually declined during the study period from 15% to 6% in black families with young children.

The researchers concluded that the recent increase in young children’s gun deaths may be partly driven by an increase in handgun ownership, even as overall gun ownership (primarily rifles and shotguns) has continued dropping.

“For young children, shootings are more likely to be unintentional, making the ease at which firearms can be accessed and used a more important determinant of mortality than perhaps for older children,” the authors wrote. “Moreover, relative to other firearms like hunting rifles, handguns, because they are more likely to be purchased for personal protection, are more likely to be stored loaded with ammunition, unlocked, and in a more easily accessible place, such as a bedroom drawer.”

The research was funded by the National Institute of Child Health and Human Development. The authors reported having no conflicts of interest.

SOURCE: Prickett KC et al. Pediatrics. 2019;143(2):e20181171.

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