Latest stats are just a start in preventing gun injuries in kids

On June 18, 4-year-old Bentley Thomas Koch fatally shot himself in the face. A few weeks earlier, Harmony Warfield, age 7, was shot and killed by her 2-year-old cousin. And teens Shadi Najjar and Artem Ziberov, both on the eve of graduating from high school, died in a hail of gunfire. Stories like these of kids dying from gunshot wounds are devastating, but, sadly, they aren’t an anomaly.

The most comprehensive look at fatal and nonfatal firearm injuries among children in the United States makes that abundantly clear. Every day, roughly 19 children die or are medically treated in an emergency department for gun-inflicted wounds, a study published June 19 in Pediatrics finds.

The statistics, based on data from 2002 to 2014, are stark:

• Nearly 1,300 children, from birth to age 17, die from gunshot wounds each year on average and another 5,790 kids are wounded;
• Of the deaths, 53 percent are homicides, 38 percent are suicides and 6 percent are accidents;
• Boys ages 13 to 17 make up the bulk of gunshot victims;
• Cause of death varies by race — African-Americans are overwhelmingly more likely to die from homicide than suicide; white kids are nearly three times as likely to die from suicide as from homicide; and for American Indian and Asian-American kids, it’s 50-50.

But this study doesn’t just lay out the numbers. It starts to dig deeper into the whys. And those whys can have important implications, laying the framework for policies that could ultimately lead to a drop in the numbers.

For the numbers, Katherine Fowler, a behavioral scientist at the U.S. Centers for Disease Control and Prevention, and colleagues started with data from the National Vital Statistics System and the National Electronic Injury Surveillance System.   

For the whys, her team looked at cases described in the National Violent Death Reporting System, or NVDRS. That let the researchers fill in details like where an incident took place and whether it involved multiple victims — for instance, a homicide followed by suicide or a multiple victim homicide. The database also includes demographic information about the shooter, evidence of alcohol or drugs at the time of death, and whether the incident was gang-related or involved a boyfriend or girlfriend or parents. Clues to whether relationship, financial or school issues were part of the problem also come to light, as does evidence of depression, anxiety, any previous suicide attempt, treatment for mental health problems and physical health problems. Notes about playing with a gun or thinking the gun was a toy, as well as hunting accidents are also included.

This tally of circumstances led Fowler and colleagues to conclude that firearm homicides of younger children, up through age 12, often involve conflict between parents, intimate partners or among family. “This highlights how children can be caught in the cross fire in cases of domestic violence and points to the importance of addressing the intersection of these forms of violence,” she says.

The results also reveal something important about child suicides involving guns. “While mental health factors are important, the findings also show that firearm suicides were also frequently related to situational life stressors and relationship problems with an intimate partner, friend or family member,” Fowler notes.

It’s these kinds of details that can help researchers and lawmakers create more effective policies to prevent such tragic deaths and injuries. It’s worked in other cases. Statistics have shown that tweaks to laws regulating the times of day teens can drive lead to injury prevention. Ditto for access to free swimming lessons when it comes to stopping accidental drownings. But similar data on gun deaths and injuries and the effectiveness of policy to prevent them are harder to come by thanks to lack of funding and political support (SN: 5/14/16, p. 16).  

Even so, “we know kids are killing themselves and others with guns,” says David Hemenway, a Harvard University economist and an expert in gun research. When it comes to combatting the problem, “the circumstances help narrow down the policy.”

Fowler says the findings “highlight the need for evidence-based solutions to address this public health problem.” She’s armed with a laundry list of potential policies that could have an impact on the whys of gun violence and make a dent in the stats. School counseling programs could help kids manage their emotions and develop skills to resolve problems in relationships and with peers, she says. Along with therapy, those programs could help to reduce suicidal behavior and youth violence. Street outreach programs may also reduce gang-related violence. Parents and pediatricians talking about storing guns safely — a policy touted by the American Academy of Pediatrics, but one that has met resistance in some states — is another option.

There’s another big need, too: more data.

Despite a better picture of what’s happening when kids get a hold of guns, the data are fragmentary and incomplete, says pediatrician Eliot Nelson of the University of Vermont Children’s Hospital in Burlington. For instance, information from the NVDRS was limited to 17 states, so the numbers aren’t nationally representative. Last year, the database was expanded to 42 states and could eventually be expanded to all 50, but that will take additional funding from Congress.

The way gun injury and death data are coded in databases is another issue. Many unintentional deaths, such as when a child accidentally shoots and kills a sibling or friend, are labeled homicides, Hemenway says. Such misclassifications make it more difficult to create a policy, he says. Take, for instance, encouraging parents to lock up guns in the house. Without correctly coded data to say that younger kids are more likely to be killed by a gun at home while older kids are more likely to be killed by guns at a friend’s house, it’s harder to know how to talk to parents. For parents of young kids, the message might be to lock up their own guns; for parents of older kids, it might be to inquire about guns at the homes of their children’s friends. “We don’t always know who best to target our message to,” Nelson says.

Studies such as Fowler’s are slowly filling in the gaps. But not fast enough for kids like Bentley, Harmony, Shadi and Artem. “We want to keep growing our knowledge to prevent problems,” Nelson says. But, he says, it’s hard to do when money and politics hamper research into the problem. Gun-related deaths ranks third as the leading cause of death in 1- to 17-year-olds in the United States. “Gun death in kids is such a common problem,” Nelson says. “We can’t continue to ignore it.”