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Addressing Gun Violence

The Federal Level

For over twenty years, the AAP has been a leading public health voice in federal advocacy efforts to address the public health threat unintentional firearm injuries pose to children. Pediatricians understand that the safest home for a child is one without a firearm. However, research clearly demonstrates that homes that do have firearms are safer when they are stored safely, with firearms locked and ammunition also locked and stored separately. Additionally, pediatrician counseling about firearm safe storage when accompanied with gun lock distribution has been found to increase safe storage rates. Unintentional injury prevention is a part of standard anticipatory guidance that pediatricians provide, including firearm safety. The AAP supports federal policies that support physicians’ anticipatory guidance about firearm safety and reduce child access to firearms.
 
Federal policies must protect children and their communities from gun violence. Research has demonstrated that access to firearms results in a direct increase in conflict-related deaths and injuries, and also increases the risk of serious unintentional injury and death. Adolescents are at particular developmental risk, as this period is marked by a search for identity and independence, accompanied with emotional characteristics including curiosity, strong peer influences, immaturity, and mood swings. Each of these ordinary developmental stages and experiences put young people at a greater risk for impulsive and sometimes violent action, particularly for adolescents with a history of aggressive and violent behaviors, suicide attempts, or depression.
Limiting access to and the prevalence of firearms can help protect young people from harming each other or themselves. For these reasons, AAP has strongly supported strengthening background checks and opposed concealed firearm carry reciprocity. Placing more firearms in our communities with fewer restrictions on who can possess them will serve only to catalyze and expand the scope of gun violence. Additionally, the AAP supports a federal ban on assault weapons, measures to address gun trafficking, and encourage safe firearm storage.
 
Public Health Research
Gun violence prevention research is essential to developing effective public health interventions to address gun violence. Other successful public health initiatives have successfully employed this model. Since the 1950s, a research-based public health approach aimed at promoting motor vehicle safety has contributed to an 80 percent reduction in fatalities per mile driven. This approach has been so effective because it translated extensive research into prevention and systems change. While public health research has generated safety gains for motor vehicles, a dearth of such research on firearms has contributed to the stagnation of progress in addressing this public health issue. The gun-related death rate is down from a high of 15 per 100,000 in the mid-1990s, but it has since plateaued at 10 per 100,000 in 2000 and has remained steady.  It is estimated that in 2015, the rate of gun deaths will surpass the rate of motor vehicle accident deaths.
 
Clearly, research can contribute to fewer lives lost, reductions in injuries and changes in social norms. Federal infrastructures already exist to establish prevention and harm reduction strategies. Significant research investments could address these issues by helping provide a more accurate understanding of the problems associated with gun violence and to determine how best to reduce the high rate of firearm-related deaths and injuries. Unfortunately, in 1996 Congress eliminated all funding for CDC research on gun violence and accompanied the cut with language barring any research that would “advocate or promote gun control.” Renewed annually and subsequently expanded to include all of HHS, this language had a chilling effect and resulted in a dearth of research on this critical topic. The AAP is committed to advocating for federal policies that invest in public health research on gun violence without restrictions.
 
Community Violence
Exposure to violence has a profoundly negative effect on children’s health and development. The AAP policy statement on toxic stress notes that adverse childhood experiences, including exposure to violence, can have a negative impact on physical and mental health outcomes across the life span. Our society benefits from protecting children’s safety and well-being and ensuring they have the support they need to thrive.
Community violence contributes to negative child health outcomes and puts children at risk for victimization and perpetration of violence. The AAP advocates for federal support of programs that address the needs of at-risk children and those exposed to violence and trauma, including at the Centers for Disease Control and Prevention (CDC) and Department of Justice (DOJ).

Domestic Violence and Intimage Partner Violence
Over 60 percent of children and adolescents are exposed to violence each year. Children exposed to violence are at increased risk for future victimization and perpetration of violence, among other negative health and social outcomes. Children whose mothers are being assaulted are themselves likely to be victims of violence, so the abuse of women is also a pediatric issue. In 2010, 25 percent of women and one in seven men experienced severe physical violence by an intimate partner. That same year, 1.3 million women were raped. This violence has long-term effects, with 81 percent of women and 35 of percent men who experienced rape, stalking, or physical violence by an intimate partner experiencing short or long term impacts such as PTSD.
Firearms are the most common weapon used in intimate partner homicides. Access to firearms exacerbates the devastating effects of domestic and intimate partner violence. The AAP supports federal policy efforts to strengthen background checks to ensure criminals cannot access firearms and to ensure that children exposed to violence have access to needed health services.

Mental Health

Suicide Prevention
A gun stored in the home is associated with a fivefold increase in the risk of suicide. Adolescents are at particular developmental risk, as this period is marked by a search for identity and independence, accompanied with emotional characteristics including curiosity, strong peer influences, immaturity, and mood swings. Each of these ordinary developmental stages and experiences put young people at a greater risk for impulsive and sometimes violent action, particularly for adolescents with a history of aggressive and violent behaviors, suicide attempts, or depression. Additionally, adolescent suicide risk is strongly associated with firearm availability. Suicides among youth are typically impulsive, and easy access to lethal weapons largely determines outcomes. The AAP supports federal policies that support physicians’ anticipatory guidance about firearm safety and reduce child access to firearms.
 
Exposure to Violence
More than 60% of children and adolescents are exposed to violence each year, contributing to toxic stress and increasing the risk for developing depression and other mental health ailments throughout their lives. Individuals with mental illnesses are also more likely to be victims of violence than perpetrators. While more than 20% of children have mental health disorders, only 21% of those affected actually receive needed services. It is critical that children have access to needed mental health services.
The AAP supports federal policy efforts to improve child access to needed mental health services to address the effects of exposure to violence. This includes investments in research and treatment, as well as federal support to expand that field of child mental health providers.
Click here to learn more about AAP advocacy efforts and to learn how pediatricians can get involved. 
Find additional information on addressing gun violence in the Practice, Community, and State.

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