Firearm legislation is a contentious issue in this country. But researchers at Boston Children’s Hospital hope their new study may help shed some light on the topic. The narrative review, published in the November 14 issue of JAMA Internal Medicine found that stronger firearm laws are associated with reductions in firearm homicide rates.
Notes sat down with lead author Lois Lee, MD, MPH, of Boston Children’s Hospital’s Division of Emergency Medicine and Harvard Medical School to discuss the study’s findings and the implications of firearm safety on pediatric practice.
Q: What was the main takeaway of your study?
Lee: Overall, we found evidence that stronger firearm laws are associated with decreased homicides due to firearms. We grouped the laws into five general categories:
- Laws that strengthened background checks
- Laws that curbed firearm trafficking
- Laws that improved child safety, including child access laws, laws requiring trigger mechanisms, and laws that imposed age restrictions for gun purchases and use
- Laws banning military-style assault weapons
- Laws restricting firearms in public places
Specifically, the laws that seemed to have the most effect were those that strengthened background checks and those that required a permit to purchase a firearm.
Q: Your team found that laws specifically aimed to improve child safety had no clear effect on firearm homicide rates. Can you speak more about that?
Lee: We did look at that category of laws but found that, as a category, we couldn’t make any conclusions about their effect. But we only found nine studies in total and these laws — and their penalties — vary widely from state to state. This points to one another important finding in our research, namely that the quality and number of these studies is very limited. There’s a critical need for large studies with more robust study design and statistical analysis. But for that, we need funding.
Q: When is it appropriate to talk about gun safety with patients?
Lee: As a public health pediatrician, I think talking about gun safety is just one part of the conversation we should be having with parents about keeping children safe in general. For example, include gun safety when talking about other types of child safety, like using car seats, wearing helmets and smoking in the home. These discussions help prevent injuries and other negative health outcomes for children.
You want to frame the discussion around the best interest of the child and the family, not as a statement about guns or what that family chooses to do.
There’s a critical need for large data studies with more robust study design and statistical analysis.
You don’t even need to ask if the family has guns; you can just say something like, ‘If you have guns in the home, research shows that if you lock your guns away and keep the ammunition separate from the guns that it’s safer for your child.’ Studies have shown that office counseling visits are effective in improving home safety behavior.
However, before talking about gun safety, be aware of possible pending legislation in your state. Several states are now proposing gag laws for physicians around firearms. This legislation basically proposes that physicians could be penalized for asking families if they have a gun in the home.
Q: At what age do you bring up gun safety?
Lee: This topic is relevant for every family and for children of every age, because so many unintentional shootings occur with 3-year-olds and 4-year-olds who find a gun in the home. We see those unintentional injuries all the time. Young kids may not understand everything you say, but if you start these conversations early, they will pick up on the most important messages.
I think it shows there are laws that will not deny people the right to bear arms but will hopefully protect the public, which is what everybody wants.
Q: What do you say to families who don’t own guns?
Lee: Having conversations about gun safety is important even for families who don’t have guns in the home — maybe even more important, since those families may not have a lot of information about guns. But if their children go into another home and see a gun they need to know to not touch or handle the gun. Accidents happen because children don’t hear this message and pick up and play with guns they find.
Q: What would you like to see as a result of your study?
Lee: Ultimately, we hope our findings will help states draft legislation that is useful and sensible to both sides of the gun issue. I think it shows there are laws that will not deny people the right to bear arms, but will hopefully protect the public, which is what everybody wants.
We’d also like to see funding for more robust research. We looked at 44 years of research, and only came up with 34 studies, so that’s not even one study a year in peer-reviewed literature. That’s really striking when you compare it to, say, the money and research that’s been put into motor vehicle safety, and we’ve successfully decreased motor vehicle death and injury rates over the last four decades. I think if we take that same attitude toward firearm injury, we’ll also see reductions in the numbers of injuries and deaths from firearms.
Lois Lee, MD, MPH, is an associate physician in Medicine at Boston Children’s Hospital and an assistant professor of Pediatrics and Emergency Medicine at Harvard Medical School. Her research has focused on trauma care, injury prevention and health policy.
Learn more about General Pediatrics Research at Boston Children’s Hospital.