My comment to JAMA Pediatrics
Home Gun Safety Queries in Well-Child Visits published today.
Abstract:
Firearms are a leading cause of death in US children, and the rate of suicide by firearms in people aged 10 to 19 years has increased since 2008.1 In the United States, 4.6 million children (approximately 7%) live in households with at least 1 gun that is stored loaded and unlocked.
My comment:
Gun and Bibles - Targeting Tailored Solutions
[myname] | Crime Prevention Research Center
CDC reports unintentional non-fatal injuries by firearms 2010-2017 has dropped off the Top 20 list of causes for 0-19 year olds in the US (WISQUARS) This good news is not paralleled for 1-19 year olds in the rates of fatal injury/deaths for by firearms, where suicide (18,570) ranks 2nd behind unintentional causes (55,203) followed by homicide (18,352).
A recent study suggests that "...gun homicide and gun suicide are behaviors, and behaviors are functions of culture", finding that regions with high suicide rates more often do not overlap regions with high homicide rates.
To that end, effective solution should address regional and cultural considerations, which are less amenable to national regulation than state and local regulation. Homicide has sociodemographic attributes that are quite different than suicide. Hence, addressing those ~18,000 homicides and suicides may have very different approaches.
In some regions, questions on guns by health care practitioners are considered highly invasive and may discourage well-child visits, much as stigmatizing mental illness appears to discourage many from seeking needed help. The question "Do you have guns in your home" can be startling and offensive to some, if not presented among questions on other hazards (seat-belt use, household chemical/drug storage, fall protection, pool safety, etc.
To health care practitioners, tobacco-use, drug-use, alcohol-use, sexual practices and other behaviors are items on a checklist, but to patients, especially those that display risky behaviors, such questions can discourage seeking medical care. While self-assessed health appears to be correlated to religiosity, most health care practitioners would hesitate to cross into that territory. In areas of the US where inhabitants value their bibles and guns, the message needs to be tailored for acceptance. "Gun Safety" is a very one-sided perspective in medicine, with the safe use of guns outside the scope of practice. With 40%+ of homes having guns, and 25% of the US population being children living in 50 million+ households, the exposure to guns is enormous - most seem to be doing it right. The challenge is not to dilute efforts directed toward those that do it wrong by broad-brush policies, laws and guidelines.