The Third Rail of Pediatric Communication: Discussing Firearm Risk and Safety in Well-Child Exams

Hinnant, Amanda; Boman, Courtney D.; Hu, Sisi; Ashley, Rokeshia Renné; Lee, Sungkyoung; Dodd, Sherry; Garbutt, Jane; Cameron, Glen T.

doi:10.1080/10410236.2019.1700883

Cited by 18 publications

(45 citation statements)

References 65 publications

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“…Overall, provider-parent discussion of firearms is challenging at the outset. Parents may view firearm safety as inappropriate in a health context, an intrusion into personal or political matters [19], or may be surprised or annoyed when a provider brings up the topic [27][28][29]. A recent qualitative investigation reported that firearm owners prefer specific messaging and language surrounding firearms [30].…”

Section: Discussionmentioning

confidence: 99%

“…Our work was guided by an Advisory Board of key stakeholders (3 providers and 3 parents, including a mix of parents and providers who did and did not own firearms) who were involved in the gathering and interpretation of data, and firearm message development. The first 2 phases are completed and are reported elsewhere [19,20]. Briefly, contextual messages were developed and winnowed by successive stages of qualitative interviews, advisory board review, survey results, and psychophysiological lab testing.…”

Section: Methodsmentioning

confidence: 99%

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An informed approach to the development of primary care pediatric firearm safety messages

Fuzzell

Dodd

et al. 2022

BMC Pediatr

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Background Firearm ownership is prevalent in the US and many children spend time in areas where firearms are not stored safely. The AAP recommends firearm safety counseling at pediatric well-visits. Methods We developed and tested six contextual messages to promote safe firearm storage based on: absence of harm, collective appeal to understanding child behavior, pediatrician’s authority, evidence-based, fear appeal, and general safety considerations. One hundred four parents who keep firearms at home were recruited from Amazon Mechanical Turk Prime and viewed video messages and reported behavioral intentions and emotional reactions following each message. Results All six contextual messages were perceived as important and believable and increased parents’ intentions to follow safety advice provided, but also elicited negative emotions. The authority message elicited more negative emotions and resulted in lower intentions to follow safe storage advice. Conclusions Including firearm messages with other child safety advice merits further evaluation. Authority messages should be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

An informed approach to the development of primary care pediatric firearm safety messages

Fuzzell

Dodd

et al. 2022

BMC Pediatr

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“…15 Although some parents may be uncomfortable with direct questions about firearm ownership, physicians should counsel patients on safe storage and general firearm safety in the primary care setting and during hospitalizations, as these discussions can prevent domestic violence. [15][16][17] While all states currently contribute data to NVDRS, only four states provide pediatric-specific data in the form of the Child Fatality Review Module. The general NVDRS variables include useful data to help identify the characteristics of violent deaths, but the supplemental Child Fatality Review Module provides a greater level of detail that helps to characterize pediatric violent deaths with increased granularity and specificity.…”

Section: Discussionmentioning

confidence: 99%

Comparing fatal child abuse involving biological and surrogate parents

Presser

Quiroz

Pérez

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Nearly half of pediatric homicides younger than 5 years are attributable to child abuse. Parents are most commonly the perpetrators, but less is known about incidents involving biological versus surrogate parents. We sought to evaluate the characteristics of fatal child abuse involving biological and surrogate parents using the Georgia National Violent Death Reporting System, which we believe may differ in demographics and incident characteristics. METHODS:This database was used to examine all homicides of children younger than 18 years from 2011 to 2017. Demographics and incident characteristics were analyzed using the existing National Violent Death Reporting System variables and incident narratives. Nonparametric and χ 2 tests were used to compare fatal child abuse incidents involving biological and surrogate parents (e.g., adoptive, foster, step-parents, intimate partners of biological parent). RESULTS:There were 452 pediatric homicides and 219 cases of fatal child abuse. Of all cases of fatal child abuse, 60% involved biological and 29% involved surrogate parents. Compared with children killed by biological parents, children killed by surrogate parents were older (4 vs. 3 years), more often male (71% vs. 51%), more likely to survive the initial injury and present to the emergency department before death (96% vs. 69%), and less likely to have a medical comorbidity (2% vs. 11%; all p < 0.05). Surrogate parents were more likely to be male (90% vs. 48%) and use a firearm (20% vs. 13%) to inflict the injury, both p < 0.05. The race/ethnicity of the child was not associated with the parent's relationship. CONCLUSION:Child abuse accounts for half of all pediatric homicides. Parents are the most common perpetrators of fatal child abuse, but surrogate parent perpetrators are almost exclusively male and more likely to use firearms. Most children have a history of abuse, leaving an opportunity to intervene on potentially preventable deaths if abuse is identified in a timely fashion. (

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“…HCPs caring for children are particularly poised to have these conversations, given their role in safety conversations with parents on other topics. Caregivers generally accept firearm safety discussions in pediatric settings [5][6][7] ; however, many pediatricians do not counsel about firearm injury prevention. 6,8 Although they believe that counseling may reduce firearm-related injury and death, 8 they cite their lack of knowledge, self-efficacy, and ability to have productive conversations as limitations.…”

mentioning

confidence: 99%

“…6,8 Although they believe that counseling may reduce firearm-related injury and death, 8 they cite their lack of knowledge, self-efficacy, and ability to have productive conversations as limitations. 7 The political climate around firearms, lack of HCP training, and absence of a shared language between firearm owners and nonfirearm owners are other barriers that HCPs face. 7 The challenge to discussing safe firearm storage lies in finding a common language and navigating a productive discussion.…”

mentioning

confidence: 99%