Use pediatric research to solve the threat of gun violence

The recent Philadelphia-, El Paso- and Dayton-area shootings brought all my memories back. As a pediatric pulmonary and critical care physician, I have been here so many times before.

At 11:12 a.m. on a Wednesday last September, as I sat in my office enjoying a sunny day in the Midwest, I received a two-word text from my 15-year old high school junior: “I’m OK.”

“What happened?” I asked. “Active shooter at Greenway Station,” was the response, less than 1/4 mile from his high school.

That is how the threat of gun violence — an issue which has affected so many — yet again, touched my life. In 1999, the year of the Columbine shooting, I was a pediatric critical care physician in Denver. In 2012, when the Aurora Theater shooting occurred, I was a physician at Children’s Hospital Colorado. Now, as a parent, three stressful, dark hours passed until an “all clear” alert was sent, and I knew my son had survived.

I picked up my son and was at first proud he was unfazed by the day’s events, but then as a parent (one who spent a decade training to address children’s health issues) I was overwhelmed by the realization that this is the “new normal.” Our children live under a dark cloud of the ever-present risk of gun violence and “active shooter” drills.

Though 83 children are injured or die each day from guns, there is no federal commitment to fund research on gun violence prevention. As a pediatric scientist, I know firsthand this would be unacceptable for absolutely any other condition which claims too many children’s lives.

The Society for Pediatric Research, a group of the nation’s foremost pediatric scientists and researchers has joined with the American Academy of Pediatrics and over 160 other national organizations in requesting $50 million in federal funding for the Centers for Disease Control to investigate gun violence prevention strategies that may help keep children safe from firearm injuries.

Research to understand the short and long term multifaceted impact of gun violence, and policies that are demonstrated to reduce both accidents and acts of violence are desperately needed. Evidence currently suggest that firearm fatalities are lower in states with higher numbers of firearm laws. We even know what we need to be answered. Key emergency-medicine relevant research questions have been identified by the American College of Emergency Physicians.

In 2015, the number of gun-related fatalities exceeded the number of traffic deaths. In 2016, the number of deaths of children, ages 10-19 from firearms was over 1,700. Though guns kill more than half as many children as traffic accidents, there is currently no federal investment in this issue. Annually, the National Highway and Transportation Safety Administration invests $500 million to understand the factors contributing to motor vehicle deaths. Their work has resulted in a steady decline of traffic-related deaths (which were as high as 41,000 in 1997).

Progress in reducing those deaths occurred because the federal government recognized the potential harm of motor vehicles and invested in public health research to better understand how to protect children riding in cars. Research funding has given us child car seats, seal belt laws, and innovations like airbags. Public officials used scientific research to craft policies like mandatory seat belt laws and minimum car safety requirements that have saved countless lives.

In the absence of strong federal support, non-profit organizations have been leaders in piecing together the evidence that is available to help guide gun safety policy. The modest amount of evidence has yielded actionable results. The RAND Corporation, for example, has noted evidence supports state regulations which penalize gun owners if they do not safely store their firearm in a locked container with the ammunition stored separately. Such “safe storage” laws could reduce accidental childhood deaths from guns by 33%. But private organizations, even those for which gun violence research is a priority such as the American Academy of Pediatrics and the Robert Wood Johnson Foundation, cannot match the sustained financial investment required to address the research aims to generate evidence-based guidelines, policies, and laws. These dollars are also needed to jumpstart a group of researchers who have been starved from access to federal research dollars for over two decades. During that time, thousands of bright, rising early-career investigators abandoned research into gun injuries because they could not sustain careers or obtain academic promotion without federal grants.

Passage of this $50 million appropriation (the amount the federal government spends in 7 minutes and 12 seconds) must be paired with funding from states and non-profit groups, which are often more nimble in re-allocating dollars to address novel issues and less prone to political partisanship. New York, California, Connecticut, Delaware Massachusetts, New Jersey, New York, Rhode Island, and Puerto Rico have made state-based investments in funding gun violence prevention.

The Pediatric Policy Council, a group representing five major academic pediatric organizations, noted the urgent need for research on gun violence and compiled a list of the most basic questions which need to be answered about protecting children from accidental and intentional firearm injuries. These questions could easily be used to guide the allocation of these initial federal funds:

1. What are the most effective methods to prevent young children from unintentionally discharging a firearm?

2. What kinds of public health campaigns best influence safe storage practices by parents?

3. Since two-thirds of successful firearm-related deaths are successful suicides, what characteristics distinguish firearm from non-firearm suicides which are amendable to prevention by parents, teachers, and pediatricians?

4. How are different local and state-based policies around mental health access, public health education, gun regulations, and background checks impacting firearm safety in communities?

5. What individual, family, and community factors are associated with firearm safety in children — specifically unintentional injury, suicide, and homicide?

6. What product safety measures, alone or in combination, are most effective in reducing unintentional injury, suicide, and homicide from firearms in children?

7. What is the impact of consuming violent media content, including over social media on firearm misuse?

8. How can state and federal databases be efficiently developed and linked to create a de-identified, comprehensive, open-access research tool that allows the use of analytics to better predict and prevent inappropriate gun use by or against children?

9. What as the long-term societal costs of gun misuse against children caused by deaths, suicides, serious injury, traumatic stress, and family disruption?

10. What effective gun strategies have been utilized in other countries/culture to promote appropriate gun use?

11. How are school shootings best prevented and when they occur, most effectively mitigated?

Gun violence is both a national issue and a local one. It is an epidemiological and cultural issue. Preventing gun violence against children in all forms should be a universal cause and a universal priority. In the wake of another school shooting, and the daily loss of 83 children, now is the time to understand the science around gun violence better, develop newer evidenced-based policies and dissipate the cloud that is hanging over our children each day they head to school.

Vivek Balasubramaniam, Joyce Javier, Shetal Shah, and Debra L. Weiner are pediatricians and members, Society for Pediatric Research Advocacy Committee.

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