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Youth
Violence Preventation and the Role of the Physician
Fact Sheet
Improving the Physicians Response to
Youth Violence Prevention
Quick
Facts about Youth Violence, and Firearm Injuries
- Homicide is the second leading cause of death among young
people ages 15-19, and in 1998, 82% of the youth homicide
victims (ages 15 to 19) were killed with guns.
- On average, 16 children and youth in the United States
under the age of 20 years are killed each day, and many
more are injured, making American youth under age 15 nearly
12 times as likely to die from gunshot wounds than are youth
in 25 other industrialized nations combined.
- In LA County, firearm homicides are the number one cause
of death for children aged 10 to 19 years, with firearm
suicides ranking second.
- Children who have been exposed to firearm violence have
a greater predisposition to commit violence, and to experience
poor academic performance, sleep disturbances, anger, withdrawal,
posttraumatic stress disorder, delinquency, risky sexual
behavior, and substance abuse.
- Annual firearm violence costs to society have been estimated
to equal $15 billion, which include substantial costs of
medical expenses and lost productivity; the costs of public
and private efforts to reduce the risk of gun violence;
and the financial consequences of behavior changes caused
by the fear of victimization.
- Federal law makes it illegal for anyone under 18 to have
a handgun, yet children and adolescents have little difficulty
getting them. Many children and youth can borrow or steal
them from friends and/or family, but many more simply have
access to guns right in their own homes. An estimated 35%
of homes with children under age 18 have at least one firearm.
- In one national study of male high school sophomores and
juniors conducted in 1998, 50% of respondents reported that
obtaining a gun would be "little" or "no"
trouble. Six percent of respondents said they had carried
a handgun outside of the home in the previous 12 months.
- A recent study found that 43% of households in the U.S.
with children and teens had at least one gun. In the same
study, more than 1 in 5 gun owners with children under 18
said that they stored their weapons loaded, and about 1
in 11 said that their weapons were stored loaded and unlocked.
- In about 1.4 million households, with 2.6 million children,
guns are stored unlocked and loaded, and therefore easily
accessible to children.
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The
Role of the Physician, and Health Professional in Youth Violence
Prevention and Firearm Safety
- For some victims, their first and only attempt to get
help is from their physicians and health professional, rather
than the police, courts or violence victim services, i.e.,
victims of certain ethic communities who don't view police
as a resource or victims who can't contact anyone else to
help them other than their physician.
- Evidence is available to demonstrate that counseling by
primary care clinicians to families with children aged 5
years and younger can influence the prevention of burns
and motor vehicle crashes; so, the same might also apply
to the prevention of youth violence. Studies have found
that parents would be receptive to this counseling, and
would be willing to consider, or to follow, their pediatrician's
advice about safe storage practices of firearms.
- Raise firearm and violence issues during well-child and
adolescent preventive care visits as part of standard injury
prevention screening and counseling. Screen for guns in
the home, and to provide counseling to parents and youth
on firearm removal and safe storage with use of the GUNS
mnemonic (see back).
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Resources
on Youth Violence Prevention and Firearm Safety
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G.U.N.S. Screening
Mnemonic*
Is there a Gun in
your home?
If yes, then the most important educational element for physicians
to convey is that keeping a gun in the home dramatically increases
the risk of firearm-related injury to his or her family and/or
friends.
- A gun kept in the home is 4 times more likely to be involved
in an unintentional shooting, 7 times more likely to be
used in a criminal assault or homicide and 11 times more
likely to be used to commit or attempt a suicide than to
be used in self-defense.
If your patient, and/ or family member, chooses to keep a
gun at home, then suggest keeping guns stored, locked and
unloaded with access limited to one or two household members.
This reduces the risk that others will intentionally or unintentionally
shoot themselves. The lack of immediate availability may,
under some circumstances, allow the potential shooter to clam
down or the potential victim to escape. Some suggestions for
safe storage include:
- Lockable gun boxes.
- Trigger locks; some are nonspecific, requiring only a
key, while others require a specific unlocking mechanism
that may be part of a gun-owner's ring. Yet, remember with
trigger locks, there are as yet no standards for trigger
lock manufacture, and there has been no study of their effectiveness.
- Firearm safety education and training courses are readily
available thought the country and in theory should increase
safety by improved forearm handling. However, some evidence
suggests that gun owners with such training may be less
careful than those without it, perhaps as a result of over-confidence.
There is no evidence that such training reduces the risk
of injury or death from firearms.
Are you around Users
of alcohol or other drugs, or is there a history of mental
illness or violence in your family?
If yes, then explain to your patient and/or family that a
gun can make any situation deadly, and especially if alcohol
or other drugs are involved. Also, when there is a history
of violence, intimate partner abuse or mental illness, combined
with easy access to a gun, the risk of a family member being
injured in a firearm-related incident is greatly increased.
- Guns are the number one way that teens take their own
lives. Almost 60% of teen suicide deaths in recent years
have involved guns, and they most often do so in their own
homes.
Do you feel the Need to protect
yourself?
If yes, then the physician needs to explain to the
patient and/or family that keeping a gun in the home and/or
carrying a gun will not make them safer. The risks of gun
ownership greatly outweigh the possible protective benefits.
Yet, some youth are tempted to carry guns because they are
surrounded by gun violence, and they are afraid or because
they want to intimidate others, but the bottom line is that
guns can only escalate conflicts and increase the chances
that someone will be seriously harmed.
- If someone carries a gun, they are twice as likely to
become the victim of gun violence. They also run the risk
that the gun may be turned on them or on an innocent person,
resulting in injury or death.
Do any of these Situations
apply to you?
- Have you seen or been involved in acts of violence?
- Have you experienced sadness, depressions or mental illness?
- Do you have School-age children or adolescents in your
home?
If yes, then explain that one cannot eliminate younger children's
curiosity about guns, but one can reduce the likelihood that
children will encounter them. Children are by nature curious
and inquisitive. A parent should never assume that his or
her child does not know where the household gun is stored.
If your patient keeps a gun in the home, advise that it be
stored properly.
- Young children are strong enough to fire many handguns
now in circulation: in one study, 25% of 3- to 4-year-olds,
70% of 5- to 6-year-olds, and 90% of 7- to 8-year-olds had
the ability to pull a trigger of at least ten pounds. Fifty-nine
of 64 commercially available handguns require a trigger-pull
strength of 10 pounds or less.
* HELP Network, and May JP, Christoffel KK,
Sprang ML. Counseling patients about guns. Chicago Medicine,
1994; 97:13.
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